Tubal Ligation

Tubal ligation has been a popular form of permanent contraception preferred by many couples. The procedure is meant to be permanent and most women enter into the decision with a sincere intention to prevent additional pregnancies. But life is full of surprises. Circumstances change, relationships change and family-building goals may change accordingly. It is not uncommon for women who have undergone sterilisation by tubal ligation to discover that they desire to have their fertility restored.

The procedure uses a small abdominal incision and micro-surgical techniques to restore the connection between the interrupted tubal segments. Not all types of tubal sterilisations are reversible. If the remaining fallopian tube segments are not healthy due to previous damage or the segments are extremely short, successful reversal is not feasible. A semen analysis for the male partner should always be done prior to surgery; if the findings are significantly abnormal, tubal reversal is extremely unlikely to result in a successful conception. Ruling out a significant male factor avoids unnecessary and costly surgery with its attendant risks.

Even if tubal ligation reversal is successful, it doesn’t guarantee that you can become pregnant. Pregnancy rates following reversal of tubal ligation vary greatly, from 30 to 85 percent, depending on a woman’s age and other factors.

Which is the best choice: IVF or tubal reversal?

Obviously the decision between IVF and tubal reversal is difficult. In addition to costs and success rates, one should also consider long range plans. How many more children are desired? If multiple children are desired and the woman is young, tubal reversal is perhaps a better choice. If only one more child is desired and the woman is older than 35 years of age, perhaps IVF is the best choice. The decision between IVF and tubal reversal is highly complex and profoundly affected by the factors of age, cost and time as well as the presence of other potential infertility problems. Each couple facing this decision must be assessed and counselled individually to ensure selection of the treatment option best suited to them.

Vasectomy

Men decide to have a vasectomy reversal for a number of reasons, including loss of a child, remarriage or improved life situation making it feasible to raise a child. Vasectomy reversal, which repairs a surgically removed section of the vas deferens (sperm duct), is called a vasovasostomy. This is a fairly quick operation, usually lasting around two hours. Postoperative care includes careful monitoring of the healing process and, after six to eight weeks, monthly semen analyses to note improvement in sperm count and motility. The results of a vasectomy reversal depend on how long ago the procedure was done. If 10 years or more have passes since the vasectomy, the chance of having sperm reappearing in the semen after a reversal is greatly reduced. 

Reported pregnancy rates after vasectomy reversal range from 40 to 90 percent. Many factors affect whether a reversal is successful, including the type of vasectomy you had, the time since vasectomy and the experience of the doctor doing the reversal surgery. 

Urologists are the surgical specialists who most frequently perform vasectomy reversals. It is important to see an experienced urologist if you wish to undergo a vasectomy reversal. Your specialist at Medfem Fertility Clinic will be able to advise you on the best professional to see. 

Which is the best choice: Sperm Retrieval or vasectomy reversal?

Sperm can be retrieved from the testicle or epididymis by either a needle aspiration or surgery. The sperm obtained by such methods require in vitro fertilisation (IVF) techniques using intracytoplasmic sperm injection (ICSI). Factors that may affect the decision to proceed with vasectomy reversal or sperm retrieval with ICSI include cost, years since vasectomy, and age of the female partner.

Before a vasectomy reversal is done, your doctor will want to confirm that you were fertile before your vasectomy. You can have tests to see whether you have sperm antibodies in your semen before and after vasectomy reversal. If there are sperm antibodies in your semen after surgery, your partner is unlikely to become pregnant. In such a case, you may wish to try IVF with ICSI.

For further information on sperm retrieval visit the Treatments & Services section of our website. 

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