There are a number of excellent reasons a woman with a previous tubal ligation may desire tubal reversal surgery rather than undergoing IVF. In the case of a patient desiring more than one child, tubal reversal is often more cost-effective. Many patients prefer to conceive “naturally” rather than requiring the increased cost and complexity of IVF. Although IVF is considered quite safe, unresolved issues remain regarding the possibility of increased risks of some birth defects related to babies conceived from IVF. Increased incidence of multiple births (twins, etc.) is easily avoided by choosing tubal reversal. 
A key issue for high-quality patient care is to counsel patients appropriately about who is a good candidate for tubal reversal surgery, as compared to IVF, and be able to give informed recommendations. Keep in mind the saying, “If all you have is a hammer every problem looks like a nail.” If your practitioner only offers tubal reversal then you may not get the most informed and objective perspective. In some cases IVF would be more likely to result in pregnancy.
Most tubal refersal surgeries performed at The East Coast Tubal Reversal Center result in the opening of both fallopian tubes. So why don’t nearly all women with tubal reversal surgery become pregnant? Several things relating to the original tubal ligation procedure affect the chance for pregnancy after reversal of sterilization.
The most important factor predicting success is the remaining length of the fallopian tubes. The fallopian tubes are normally 4-5 inches in length. If the tubal ligation procedure shortens the tubes to less than approximately 2 inches the chance for pregnancy is very low. We can usually predict the length of remaining fallopian tube from the surgical description of the tubal ligation operation-the "operative notes".
There are at least a dozen ways to “tie tubes.” Most do not damage the tubes to an extent that they cannot be repaired. Some methods such as an “interrupted 3-burn technique” do not leave enough tube for repair. Another method call a fimbriectomy is a poor candidate for repair and it would be more cost effective to do IVF. Another factor affecting success is length of time since the tubal ligation was performed. If more than 10 years has passed, the chance for pregnancy is reduced.
Maternal age is also an important influence on fertility. We perform blood tests and an ultrasound to estimate a woman’s fertility potential if she is over 35 years old. Lastly, fertility of the male partner is also obviously very important and a preoperative semen analysis is strongly recommended. If your partner’s sperm count is quite low (and cannot be improved) then IVF is a much better choice.
Tubal reversal also has a higher risk of ectopic pregnancy . So the pregnancy rate is lower than the delivery rate. Keep in mind also that tubal patency after surgery (the tubes being open after surgery) does not mean you can become pregnant. The fallopian tubes are complex organs with a muscular layer and an inner mucosal layer lined with cilia. The muscular contractions and coordinated movements of the cilia are required for a fertilized egg to be pushed down the tube to implant in the uterus. Because a segment of tube was damaged during the tubal ligation the tube may not have completely normal function despite being reopened. We follow our patients post surgery to insure the tubes remain open.
In most cases, intrauterine pregnancy rate after tubal reversal is 50-75%. The fallopian tubes heal quickly following reversal of sterilization and pregnancy may occur within two or three months. If there is a conception there is a 10-15% chance of a tubal pregnancy. As long as an ectopic pregnancy is caught early the risk for serious consequences is low.
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