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Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?
Get the facts
- Have surgery on your fallopian tubes.
- Have in vitro fertilization.
Key points to remember
- Fallopian tube surgery can reverse infertility if a tubal problem is the cause. If you get pregnant after tubal surgery, you shouldn't need more fertility treatment.
- In vitro fertilization (IVF) doesn't reverse infertility. You need to have IVF each time you try to get pregnant.
- You may be able to get pregnant sooner after IVF than after surgery.
- You'll need surgery if the tubal problem causes a buildup of fluid called a hydrosalpinx. Fluid that drains from a hydrosalpinx into the uterus greatly reduces your chances of getting pregnant, with or without IVF.
- It's hard to know if treatment for a tubal problem will work. Your chances of getting pregnant and having a healthy pregnancy depend on how bad the tubal problem is, your age, and whether you or your partner has any other fertility problems.
- If you are age 35 or older, your doctor may recommend that you skip the surgery and have IVF. After age 35, the chances of IVF working drop a lot as each year passes. You may not want to spend time having surgery and then waiting to see if you get pregnant.
There are several types of surgery to fix blocked fallopian tubes. The type of surgery you have will depend on the type of blockage, where it is, and how bad it is. Surgery may be done to:
- Remove the blocked part of the tube, clear out scar tissue, or put in a plastic tube to open the blocked area.
- Rejoin a fallopian tube that was cut in a tubal ligation.
- Remove the diseased part of the tube. This may be done to treat a hydrosalpinx, which is a fluid-blocked fallopian tube that may drain into the uterus. A doctor also may remove fluid, create a drainage hole in the tube, or block the tube's opening to the uterus.
These surgeries are usually done through a small incision (laparoscopically).
The success of fallopian tube surgery depends in part on the location and extent of the blockage. It may also depend on whether you have other fertility problems or pelvic conditions. Talk to your doctor about his or her success rates with any procedure you are considering.
Fallopian tube surgery may or may not lead to a healthy pregnancy. About 7 to 9 out of 100 women who get pregnant after fallopian tube surgery have an ectopic (tubal) pregnancy, which can be dangerous. This means that 91 to 93 out of 100 women who have the surgery don't have an ectopic pregnancy. These pregnancies usually happen because of tubal damage the women already had before surgery, rather than because of the surgery itself.1
For women age 35 or older, perhaps the greatest risk is the time it takes to recover from surgery and then try to get pregnant. If you want to try only tubal surgery, the sooner you begin, the better. If you are thinking about having IVF with your own eggs, you may want to start IVF as soon as possible, rather than having surgery.
During in vitro fertilization (IVF), a woman's eggs are mixed with a man's sperm in a lab. The resulting embryo or embryos are then transferred into the uterus. Your doctor can use your eggs and sperm for IVF, or you can try donor eggs or sperm if needed.
Most women begin the IVF process by having daily hormone shots to grow multiple eggs. This is called superovulation. The eggs are then collected, either through a needle guided by ultrasound or laparoscope. The best-quality eggs are fertilized with sperm, and the best embryos are implanted in the uterus. Then you have a series of hormone shots to support the first days of pregnancy.
Some women choose to use their own eggs naturally and not use superovulation.
In vitro fertilization (IVF) was first used for women with no fallopian tubes. Now this procedure is also used to treat couples whose infertility is caused by:
- Blocked or diseased fallopian tubes.
- Severe endometriosis.
- A tubal ligation, or surgery that wasn't able to reverse tubal ligation.
- Low sperm counts.
- Unexplained infertility that has gone on for a long time.
The success of IVF depends on many different things, including age, the cause of infertility, whether the woman has given birth before, and whether the woman's own eggs or donor eggs are used. Talk to your doctor about what to expect based on these and other factors.
In vitro fertilization (IVF) is emotionally and physically demanding. You need to have several procedures to produce and collect eggs and then to implant embryos. IVF increases the risks of:
- Multiple pregnancy. About 31 out of 100 births in the United States that result from methods like IVF produce two or more children.2 Multiple pregnancies are high-risk for both the mother and the fetuses.
- Severe ovarian hyperstimulation syndrome, which can be deadly. This happens in up to 2 out of 100 IVF cycles.1 Your doctor can reduce this risk by closely checking your ovaries and hormone levels.
If you choose IVF, talk to your doctor about how to reduce your risk of multiple pregnancy.
Your doctor might recommend surgery on your fallopian tubes if:
- You have a problem that causes fluid to build up in your fallopian tubes.
- A problem with your fallopian tubes is your only fertility problem.
- You are age 34 or younger and are willing to take the time to have surgery, recover, and then see if you can get pregnant.
Your doctor might recommend IVF if:
- You have severe tubal damage or disease.
- You are 35 or older. You may want to try to get pregnant as soon as you can, rather than wait to recover from surgery and see if you get pregnant. The chances that IVF with your own eggs will work drop a lot the older you get.
- You want to get pregnant fairly soon, whatever your age. You may be able to get pregnant sooner after IVF than after surgery.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You stay in the hospital for 2 or 3 days, depending on the surgery.
- It takes from a few days to up to 6 weeks to recover, depending on the surgery.
- It can help you get pregnant if a problem with your fallopian tubes is your only fertility problem. Up to 60 out of 100 women who have a blockage close to the uterus are able to get pregnant after the procedure.1 The chance of pregnancy is lower if the blockage is near the end of the fallopian tube.
- If the surgery works, you won't need to have more treatment each time you want to get pregnant.
- You may not get pregnant after surgery. Your chances of pregnancy after surgery depend on the type of tubal damage you have.
- There is a chance of having an ectopic (tubal) pregnancy after surgery. About 7 to 9 out of 100 women who get pregnant after the surgery have an ectopic pregnancy.1
- Surgery involves risks of general anesthesia.
- It may take longer to get pregnant than it would with IVF because of the time it takes to recover from surgery.
- Your health insurance may not cover fallopian tube surgery for infertility.
- You have a series of hormone shots to make multiple eggs.
- You have a procedure to take the eggs out of your body and another one to implant the fertilized eggs.
- It can help you get pregnant. Your chance of getting pregnant depends in part on your age and whether you use your own eggs. Between 30 and 40 women out of 100 who use their own eggs and are younger than age 35 get pregnant with IVF.3 The odds of getting pregnant with your own eggs are much less after age 35. But for women in their late 20s through mid-40s who use donor eggs, the chances of getting pregnant are about 55 out of 100.3
- You can avoid having surgery and then waiting to see if you get pregnant.
- You might be able to get pregnant sooner with IVF than you can after surgery.
- You may not get pregnant. Your chances of pregnancy with IVF depend on how good your eggs are. (Donor eggs may improve your chances).
- IVF can lead to having twins or more. Pregnancy with more than one baby is higher-risk.
- The process can be hard emotionally and physically.
- The hormone shots can sometimes lead to a serious problem (ovarian hyperstimulation syndrome) that means you have to stop the IVF cycle.
- IVF doesn't fix a fertility problem. So you need to do IVF each time you try to get pregnant.
- The average cost of one IVF cycle is $10,000 to $15,000 in the United States. Health insurance often doesn't cover IVF.
Personal stories about tubal infertility treatment
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
Since we learned that I have blocked fallopian tubes, we've been going back and forth about what to do. Time is ticking away, so we need to act soon. I've decided that I'm willing to have surgery and keep trying to conceive for a year. My hormone tests tell me that I'm still fertile, and who knows—maybe we could actually have more than one child after fixing the problem. If not, we're considering adopting.
Karen, age 36
I was shocked to learn that my fallopian tubes were so badly damaged by the chlamydia infection I had a few years ago. My doctor says that we can try surgery to repair the tubes, but that my best bet is trying in vitro fertilization. We can't possibly afford in vitro fertilization, and we're lucky that my provincial health plan will cover the surgery, so I'm going to have the surgery and see if it helps.
Marianna, age 26
Now that we're ready to have a child, we're really ready! We don't care what it takes. Our doctor tells us that in vitro fertilization is really our only choice, considering my age. By the time I have my tubes repaired and start trying to get pregnant, I'll be too old to have any other options if that doesn't work. So, we're going to go for it and do the in vitro fertilization. We figure we'll try it three times and hope one of them takes.
Teri, age 39
I'm told that I have a small blockage in one of my fallopian tubes that can be treated without surgery. The doc says she can put a little plastic catheter in my fallopian tube to open up the blockage, and I have a good chance of getting pregnant after that.
Anne, age 30
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery
Reasons to have IVF
I want to have surgery and then wait and see if I can get pregnant.
I don't want to take the time to see if surgery will work.
I don't want to go through a fertility treatment each time I want to get pregnant.
I want to get pregnant as soon as possible, even if I have to do IVF each time I want to get pregnant.
I'm scared of having a bad problem from the hormones in IVF.
I'm not worried about side effects from taking hormones.
I don't mind paying for the one-time cost of surgery.
I'm worried about the cost of IVF. I can't afford to have IVF each time I want to get pregnant.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
What else do you need to make your decision?
Check the facts
Which treatment can fix a problem with your fallopian tubes?
- SurgeryYou're right. Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.
- IVFSorry, that's not right. Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.
- BothNo. Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.
- I'm not sureIt may help to go back and read "Key points to remember." Surgery can fix the fallopian tubes. IVF only bypasses a problem with the tubes. If you choose IVF, you must use it each time you want to get pregnant.
Which treatment might your doctor recommend if you are 35 or older?
- SurgeryNo, that's not right. If you are 35 or older, your doctor may recommend that you save time by going right to IVF.
- IVFThat's right. If you are 35 or older, your doctor may recommend that you save time by going right to IVF.
- I'm not sureIt may help to go back and read "Get the Facts." If you are 35 or older, your doctor may recommend that you save time by going right to IVF.
Which treatment guarantees that you can get pregnant?
- IVFSorry, that's not right. There's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on your age and other things for both tubal surgery and IVF.
- Surgery to fix the fallopian tubesNo. Actually, there's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on your age and other things for both tubal surgery and IVF.
- NeitherThat's right. There's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on your age and other things for both tubal surgery and IVF.
- I'm not sureIt may help to go back and read "Key points to remember." There's no guarantee that you can get pregnant with either treatment. Your chance of getting pregnant also depends on age and other things.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||Sarah Marshall, MD - Family Medicine|
|Specialist Medical Reviewer||Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology|
- Bhattacharya S, et al. (2010). Female infertility, search date October 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Fritz MA, Speroff L (2011). Assisted reproductive technologies. In Clinical Gynecologic Endocrinology and Infertility, 8th ed., pp. 1331–1382. Philadelphia: Lippincott Williams and Wilkins.
- Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology (2008). 2008 Assisted Reproductive Technology Success Rates: National Summary and Fertility Clinic Reports. Available online: http://www.cdc.gov/art/ART2008/PDF/ART_2008_Full.pdf.
Last Updated:December 7, 2011