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Getting pregnant after tubal sterilization: surgical reversal or IVF?

BACKGROUND
When women regret having had a tubal sterilization, is the pregnancy rate higher with surgical reversal or IVF?


METHODS
This retrospective cohort study analyses the delivery rates of 163 patients undergoing IVF treatment (n = 79) or surgical reversal (n = 84). Pregnancy outcomes were obtained by reviewing medical records or contacting private physicians and patients. The life table method was used to calculate the chance of becoming pregnant and to construct cumulative pregnancy curves. Cumulative pregnancy curves are compared by log rank tests. A P-value of <0.05 is considered as statistically significant. The cost-effectiveness of the two strategies was also evaluated.


RESULTS
Patient characteristics did not differ between the two groups. The cumulative delivery rate during 72 months was 52.0% in the IVF group and 59.5% in the reversal group (ns). Age was the only factor that influenced delivery rates significantly. The cumulative delivery rate for patients aged < 37 years was 52.4% after IVF and 72.2% after reversal (P = 0.012), while cumulative delivery rates for patients aged 37 years or older were, respectively, 51.4 and 36.6%, a difference that did not reach statistical significance. The average cost per delivery was 11,707 euros for IVF, compared with 6015 euros for surgical reversal. However, in patients aged 37 years or older the difference in cost was smaller.


CONCLUSION
Considering the cumulative delivery rates involved, surgical reversal is recommended for patients younger than 37; older patients are advised to opt for IVF.