November 28, 2014

Failed tubal reversal

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!

  • http://fertility shornette allen

    Its sad when a woman gives her all to be able to concieve, and it fails. I can relate to such devastation, i remember for me haveing a tubal done at the age of 27, and then made an attempt to reverse it at age 32, and it failed, can you believe that? the Dr at the time claims he could not reach my tubes because of too much scarring, but if thats the case couldnt they try to remove some of the scarring? well i dont know,if you ask me it was a waste of time and waste of money. I will say this you most definately need a highly qualified trained Dr. in that field to do reversals,i’ve learned my lesson. it was a great disappointment to me, and now that am older well 38 my chances are now even lesser. But you know reversals are still a way to go than IVF, after all a woman still would the chance to conceive natrually, its the best way and normal way. I truly wish any woman out there lots of luck and to hang in there, never give up, i have’nt.

  • sunnyshine812

    I turned 42 in august I too had a failed tr the at the time I had my tr I was 37 the Dr that performed the surgery claims he left me with one tube that was very healthy and long me and hubby wanted to try to conceive naturally for the 1st year however the Dr offer no support no follow up calls not mention my visit were cash insurance did not cover anything! in between these 3-4 year without really knowing if the 1 tube was clear I lost my job so back to not get getting any fertility care. So this year in June got job went to another specialist informed him about the tr he gave me a sono w/menes and put me on Clomid for 2 weeks he also gave me a test to see if my ovary were still working (which I yet to get results on that) next step within these 2 weeks were to take a HSG this was something I’ve had in the past but this time it was very painful the surgeon could not get thru the procedure which tells me that my tubes were blocked again my next appt consisted of him giving me a exam again and sono at that time I got the dreadful news you only made 1 follic and the Dr also told me quote “dont let anyone tell you they can repair that tube”unquote. This was so painful knowing all the money, and time that was spent and within a matter of weeks a dr can tell you this it was just not fair. Please let me know if you have any suggestion? I would consider IVF if I could at least use my own eggs, I feel like I was never given a chance I went into to this without a alot of knowledge and the specialist who performed the procedure didnt offer alot of support either.

  • Rhonda

    I had a TR in 08 at the age of 34. It was successful. I got pregnant right away.(just 6 short weeks later). We lost the pregnancy and were heartbroken. I have not gotten pregnant since. I have charted, temped, tested everything. I ovulate the same time every month. My dr. says my tubes must have become blocked. Should I go for a second TR to unblock my tubes or try IVF? I am so afraid of wasting the money and having no baby to show for it. It’s to much of a roller coaster ride. Any suggestions?

  • IVF-MD

    Typically, under 40 you still have a chance to get pregnant with IUI or IVF. If your tubes are patent and normal, then IUI is usually worth a try. If not, then IVF is vastly superior to a repeat attempt at tubal reconstruction. Good luck!

  • pam

    i am 37 years old and had my tubes “tied” in 2000. my life changed and i desperately desire to have more family. my tr failed in 2008 as well as 3 ivf cycles in 2009 and 2010. my hsg showed both were still blocked. i am now considering another tr. what is ones chances if the tubes are still healthy?

  • Nell

    I had tr in Nov. 2010; I became pregnant about 4 months later, which was ectopic; pregnant again about 6 weeks later, again ectopic; pregnant for last time in Aug 2011 which was (again) ectopic; both tubes are now gone; now looking into atleast one cycle of IVF, wondering if my chances may be better considering I had NO problem getting pregnant, just couldn’t get thru tubes; anyone with similar situation?

  • IVF-MD

    The fact that you got pregnant so readily is a good predictor. The fact that both tubes are now sealed/gone is a good predictor. It depends on the embryo quality and the condition of your uterus now.

  • andrea

    i had a tr last year and it didnt work at all i waisted money and time. realistically the only way to have a baby is to not mess with your insides leave them alone then you dont have to cut them again

  • raj

    suppose it opens the tubes how much time it will take to close