I am 41 and my tubes are blocked. I had to go out ofstate to do a Fallopian Tube surgery with a tubal surgery specialist. I was told it had a 70% chance of being successful, but it failed. I am sad the doctor was unable to unblock my tubes. What can I do now?
Minerva from Walterville OR
You’re correct. Yours is a sad story indeed. A woman with blocked tubes is faced with three choices: Try and get the tubes unblocked through surgery, have a baby using IVF or abandon the pursuit of any future children. While each of these first two strategies has its pros and cons, in most cases, IVF is the better way to go. There are several reasons for this.
When making a decision of which method to consider, you might take three main factors into account: PRICE, CHANCE OF SUCCESS and INVASIVENESS. When comparing price, you can research what is available in your area, but in general, you might find tubal reversal procedures running about $5000 to $11000 and IVF procedures running $10000-$15000, so it would appear that tubal reversal holds the edge here. If the prices you find differ from these ranges, then of course you would adjust your strategy accordingly.
Comparing success rates gets tricky because IVF is intended to result in an instant one-time pregnancy from a one-time procedure, while tubal reversal (if successful) is intended to give multiple low-chance attempts over the course of a woman’s remaining reproductive lifetime. I did many tubal-reversal procedures earlier on in my career, but I have not done a single one in over six years. So while you may keep this bias in mind, I still feel there is a very good reason for this bias. It’s because in almost all cases of patients coming to see me to discuss these two options, it turns out that IVF is as good an option or better than tubal surgery. Over the years, the success of IVF has gone up with technological advances in embryo culturing technique in the lab, so much so as to make invasive surgery less practical an approach in comparison.
In a good case scenario (33-year-old with tubal ligation), the chance of a baby can be over 60%, depending on the program and on depending on many factors having to do with the patient herself. In a bad case scenario (40-year-old with endometriosis), the odds could be closer to 15%. Compare this to tubal surgery, which requires two areas of success. First, there is the success or failure of the surgery. If the surgery fails to reconnect the tubes, then the whole project is shot. Even if the tubes DO successfully get reconnected, then comes the monthly attempt of getting pregnant which might be as high as 20% chance PER MONTH chance in the better-case scenarios and lower than 1% chance PER MONTH of getting pregnant in the less favorable scenarios.
With regards to invasiveness, the edge goes to IVF. An egg retrieval is a very easy procedure using just a needle. The patient is comfortably under anesthesia and the procedure is over in less than 20 minutes. A tubal reversal will at the very least involve laparoscopy, which involves three very small surgical incisions, one below the umbilicus and two in the lower abdomen. In comes cases, the procedure involves a large surgical incision. A tubal reversal surgery will take over an hour and sometimes up to three hours. One disadvantage of IVF is the ovarian stimulation which accompanies it, which at best is a little uncomfortable and at worst can result in serious ovarian hyperstimulation.
I’ve had many patients come for IVF after having failed a tubal reversal and get pregnant with the IVF. I try my best to track my patients, but I realize the tracking is not 100% perfect. Still, I have yet to encounter a patient who has failed IVF and then gone on to have a pregnancy with a tubal reversal. I do have one patient who failed IVF at age 38, then went on to have tubal reversal done. It was successful in opening up the blockage, but she never got pregnant. She then came back to see me in her early 40’s and did IVF again, this time successfully.
Minerva, in your specific situation, given your age, I think most RE’s and even most tubal surgeons would agree that IVF is the better way to go for you. Your case was especially sad, because the tubes did not get reconnected. But honestly, even if the surgery had been successful, you would still have a challenge ahead in trying to get pregnant month to month. At this point, I would strongly frown upon any attempts to do another tubal surgery, especially having failed one already. IVF is not a fantastic option, but still is the best one left for you. Your RE can give you a better estimate of your chances of success after evaluating your ovarian age. Good luck!