Tubal re-anastomosis or IVF? A difficult choice to make when seeking reversal

Courtesy: Mayo Clinic 

Surgical re-anastomosis is an effective option, especially for younger women, whereas IVF is more cost effective for older women when seeking reversal of tubal ligation says the results of a systematic review published in current issue of Human Reproduction Update.

Female sterilization is one of the most common method of contraception used worldwide, with nearly 19% of women opting for it. The percentage is higher in Asia and Latin American countries (~ 25%) and lowest in European countries (3.8%).

In the United States, it is second most common method of contraception.  

But, circumstances and relationship change or a personal loss may aspire the women to desire future pregnancies. According to a statistic, up to 14.3% of women request reversal of sterilization. The categorical options are either tubal re-anastomosis or IVF.

Choosing between the two options is difficult decision to make and profoundly affected by many factors like age of women, time elapsed since sterilization, cost and desire for multiple children.

This systematic review looked at factors affecting the success of reversal, compared different methods of tubal re-anastomosis and how these methods fared compared to IVF.

The researchers searched the literature for randomized and non- randomized trials comparing fertility outcomes of various surgical methods and also looked at trails comparing re-anastomosis with IVF.

Women who have earlier suffered from tubal factor infertility were excluded from the analysis.

A total of 37 studies, with 10 689 women was included in the final analysis.  The pooled pregnancy rate after reversal was 42–69%, with variation in rate seen across different methods. About 4-8% of women had ectopic pregnancy after the surgery.

Age of the women at reversal of surgery was the only factor affecting the success rate of the procedure. The way the surgery was done i.e. laparoscopically, robotic and laparotomy using microscope did not play any part in achieving pregnancy.

Rates were lower in macroscopic laparotomic technique, which is currently not in much use.

IVF was better choice for women who were older, but no direct comparison data was available nor any cut-off age limit could be established.

The authors stressed the need of larger, randomized trials in future to compare re-anastomosis vs IVF in terms of  pregnancy rates and cost of procedures.