
Sterilization Reversal for Men & Women
Normally, sterilization for men (vasectomy) or women (tubal ligation) is considered as permenant methods. Although it is possible to reverse these surgeries with proper operations, there is a very successful alternative to them. IVF can give you a better success rate in selected cases. Infertility is not related to one gender. Both female and male partners must be examined throughtly and couples must decide on the feasibility and eligibility of the treatments. The cost of both (anastomosis and IVF) methods in the selected clinic and the country is an important decision making factor. In some countries, such as USA and UK, IVF can exceed the cost the surgery cumulatively while in Turkey, IVF is more affordable.
The patients must be aware of the possibility of requiring IVF after an unsuccessful surgery.
If you can answer these questions, We can help you more if you benefit from surgery.
- Your age and the year of your sterilization surgery
- The number of your children
- Your current partner’s age and her children and their ages (if applicable)
- If the female partner has any hormone tests or ultrasound examinations (uterus and ovaries), I like to see the reports
- Do you intend to have more than one child in this new partnership (marriage)?
- Do you have any desire to have boys or girls? It is possible to arrange the gender during IVF treatment.
Since the intention for a reversal is to have a child, we have to evaluate your partner’s fertility potential, too. It may be a waste of time and money if you need IVF even after a successful (surgically) reversal operation. The real success is to have a healthy pregnancy. Finding sperm in the ejaculate or having patent tubes after the anastomosis is not the real success of your fertility problem.
Female:
Almost 3% of women who have had surgical tubal sterilization (tubal ligation) request a request a reversal procedure. The tubal ligation at young ages, even after having children, results more likely a regret and seek for a reversal at later ages. Mostly when women desire for children with a new partner.
In general, reversal offers a high cumulative pregnancy rate of upto 80%. However, there are several factors affecting the outcome. The age of the women is the most important one. The methods of the sterilization is also important. The use of clips, or rings are associated with a higher success. Cauterization or removing a part of the fallopian tubes are associated with lower success rate. When the remaining length of the tube after reversal is less than 4 cm, the success rate is lower. The prognosis is also affected by the anastomosis site. The best results are associated when the both sides are equal size. The anastomosis is required very fine suturing. Although it is possible to do it in expert hands via microlaparoscopic and/or robotic laparoscopic techniques, most surgeons prefer an open laparotomy techniques and use an operative microscope. However, a laparoscopic initial examination may be required to choose the best technique as well as the eligibility for the surgery. If the failure risk of the anostomosis is too high, IVF might be a more feasible option.
A recent metaanalysis(many studies are combined in a statistical method) showed that the pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized.
How do I know if I am suitable for tubal anastomosis?
Most of our patients change their minds and do IVF. What is the reason for the tubal obstruction, tubal ligation, infection, adhesion, etc.?
What is the reason for the tubal obstruction? Tubal ligation or infection – adhesion, etc.
Do you have children? How many? What is your age? I will give you a scenario; you should decide what is best for you. A woman had tubal ligation surgery after her second child, and after the divorce of her first husband, she married again, and in her new family, she wants three children. Her age is still young, e.g. 32. This patient is a good candidate for tubal reversal. On the other hand, she wants only one child, and her age is 36. Then, IVF is a better option for cost and overall pregnancy chances.
Again, it would help if you had your husband examined first. You may find out your husband is infertile and you need IVF, and then your surgery will be meaningless.
If you discuss all these factors with an experienced fertility specialist, you are ready for tubal surgery.
This is an expensive surgery. The cost will be about 5000-6000 Euros (including hospital and doctor fees). Depending on the cause of the tubal obstruction, you may have a chance of tubal patency between 20% and 80%.
You must compare the cost of IVF to the cost of surgery. The costs can be very different depending on the country. In Turkey, IVF cost is lower than the surgical expenses. Therefore, most women prefer IVF especially after the age of 35. IVF including ovulation induction drugs can cost around 3500 Euros. However, you must be aware that it is only for one cycle. Patients with tubal factor below 35 years old need to try IVF two cycles in average to get pregnant successfully. You must also consider the possibility of requiring IVF after a tubal anastomosis.
MALE
BEFORE A VASECTOMY REVERSAL SURGERY, THE COUPLE SHOULD BE EVALUATED FOR FERTILITY, NOT JUST THE MALE PARTNER. IF YOU ARE INFERTILE AND NEED IVF, THEN VASECTOMY REVERSAL MAY NOT BE THE SOLUTION TO THE PROBLEM. I HAD SEVERAL PATIENTS WHO NEEDED IVF AFTER A SUCCESSFUL REVERSAL.
Patients with these conditions should expect a better pregnancy rate after a reversal.
- The female partner should be less than 36 years old.
- The female partner should have an examination before the reversal and have a good chance of fertility. The uterus and endometrial cavity should be normal, and the ovarian reserve should be fine.
- Male partners should have proven fertility before vasectomy or good-quality sperm at the time of surgery. It can be done with TESA (Testicular sperm aspiration). TESA can be done before surgery to evaluate the fertility potential with IVF if reversal fails.
- Although some men develop antibodies to their own sperm if a vasectomy is done eight or more years ago, we do not consider this possibility as poor fertility potential for IVF success. So, the duration of obstruction is not a criterion for eligibility for this program.
Although the reversal surgery is considered successful if there are spermazoids in the ejaculate 6-7 months after the surgery, the real success is the pregnancy. The surgical success varies depending on the technique used in vasectomy surgery, between 20-80%. However, anatomical correction does not guarantee the pregnancy. The pregnancy chance after surgery may be very low due to age, sperm quality, and other fertility problems.
The cost of reversal surgery is 3000 Euros. IF THERE IS NO SPERM IN THE EJACULATE IN 6 MONTHS (A FAILED REVERSAL) AND NO PREGNANCY IN THE NEXT YEAR, WE OFFER 20% REDUCTION IN IVF WITH TESTICULAR SPERM RETRACTION. (PLEASE NOTE THAT THE COUPLE SHOULD BE FERTILE OTHER THAN THE VASECTOMY PROBLEM – Drugs for ovulation induction are not included)
The recovery time after surgery is short. Unless there is a complication, you can leave the clinic in a few hours and expect to return to your normal routine in less than a week.