Tubal Reversal Study Report 2009

Pregnancy And Birth Rates: Tubal Reversal vs. IVF

Women who want to get pregnant after a tubal ligation have two treatment options: tubal ligation reversal or in vitro fertilization (IVF). To compare the success of these two treatments, the tubal reversal pregnancy statistics from Chapel Hill Tubal Reversal Center can be compared with the latest available national IVF statistics (National Summary and Fertility Clinic Reports).

During 2006 in the United States, 99,199 IVF cycles using fresh non-donor eggs or embryos were begun. Of these, 34,719 (35%) resulted in pregnancy and 28,404 (29%) resulted in live birth deliveries. Pregnancy rates after tubal reversal and after IVF were compared based on the age categories reported in the National Summary and Fertility Clinic Reports (Figure 3). The pregnancy rate after tubal reversal was higher than after IVF within every age group.

Figure 3. Pregnancy Rates After Tubal Reversal vs IVF

Tubal Reversal

IVF

Age

Similarly, birth rates were higher after tubal reversal at Chapel Hill Tubal Reversal Center than after IVF for women of all ages and the differences increased with increasing maternal age (Figure 4).

Figure 4. Birth Rates After Tubal Reversal vs IVF

Tubal Reversal

IVF

Age

Comparing Tubal Reversal and IVF

Tubal reversal surgery differs from IVF in significant ways. The chances of getting pregnant after tubal reversal continue each month following the surgery. The pregnancy rate after tubal reversal, therefore, continues to increase over time and more than one pregnancy and birth can result from a sterilization reversal procedure. With treatment by IVF, the outcome is immediate. If pregnancy does not occur, then a couple must decide whether or not to go through the treatment process again. Since the chances of getting pregnant after tubal reversal are cumulative over time, this procedure results in higher pregnancy and birth rates than after an IVF cycle.

Tubal Reversal Pregnancy Study Report 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes
• Comparison Of Tubal Reversal vs. IVF (this page)
• About Pregnancy Statistics

Comments About Tubal Reversal Pregnancy Statistics

Tubal Reversal Pregnancy Report 2009

Pregnancy Outcomes After Tubal Reversal At Chapel Hill Tubal Reversal Center

Pregnancy Outcomes By Age

Table 8 shows the relationship between age and pregnancy outcome following tubal ligation reversal at Chapel Hill Tubal Reversal Center. With increasing age, the percentage of pregnancies resulting in births declined due to an increasing percentage of miscarriages. Among women under age 35, over half of pregnancies resulted in birth or ongoing pregnancy while one third miscarried. The birth rate declined and the miscarriage rate increased significantly for women ages 40 and older. The overall ectopic pregnancy rate for all patients (14%) was higher than that found in the general population of women who have not had a tubal ligation, which is approximately 3%. The ectopic pregnancy rate after tubal reversal surgery may be overestimated, since some early pregnancy losses were reported as ectopic pregnancies when serum HCG levels did not rise normally but without confirmation of the diagnosis by ultrasound or laparoscopy. In the case of very early pregnancy loss, the actual site of the pregnancy (uterine or ectopic) is unknown. Whether there is an increased risk of miscarriage associated with tubal reversal is unclear. The miscarriage rate reported in the general population ranges from approximately 20% to 50% depending on a woman’s age and how early pregnancy testing is performed.

Pregnancy Outcomes By Tubal Ligation Method

Table 9 shows the relationship between the tubal ligation method and pregnancy outcomes. Tubal ligation reversal after tubal clips (Hulka clip, Filshie clip) has the best outcome of all tubal ligation methods, with the highest birth rate (69%) and lowest miscarriage rate (25%) and ectopic pregnancy rate (6%). Reversal of tubal rings (Falope ring, Yoon ring) has the second best outcome, followed in order by ligation/resection and coagulation. These findings are almost certainly related to the minimal damage to the fallopian tube caused by tubal clips and rings.

Pregnancy Outcomes By Fallopian Tube Length

Longer tubes are associated with better pregnancy outcomes than shorter tubes (Table 10). Among women with average fallopian tube lengths measuring 7.5 cm or longer, 61% gave birth or had an ongoing pregnancy. Birth rates declined while miscarriage and ectopic pregnancy rates increased with shorter tubal lengths.

Tubal Reversal Pregnancy Study 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes (this page)
• Tubal Reversal vs. IVF
• About Pregnancy Statistics

Pregnancy and Birth Rates After Tubal Reversal vs. IVF

Tubal Reversal Pregnancy Study Report 2009

About Tubal Reversal Pregnancy Statistics

Gary S. Berger, MD
Medical Director

What To Believe

Claims about the chances of getting pregnant after tubal reversal are often made without supporting documentation such as the number and characteristics of the patient population, study method, and length of follow-up after surgery. These are essential for understanding the basis of pregnancy rates. Statistics must be based on specified numbers of patients for any characteristic, such as age or tubal sterilization method. Most internet sites about tubal reversal do not provide any data at all. Although a doctor can say that his patients have a high success rate, supporting documentation is needed to know whether the claim is valid. The accuracy of any claim of success rates should be questioned in the absence of detailed information.

Evidence Based Medicine

The only way a doctor can truly know what the pregnancy and outcome statistics are for his or her patients is to maintain ongoing patient contact about the outcomes of treatment and record the information systematically in an analytical database. At Chapel Hill Tubal Reversal Center, nurses enter information into an electronic patient database at the patient’s registration, the surgical procedure, and all post-operative communications between patients and staff. Patients are contacted routinely by our nurses during the first year after their tubal reversal procedures.

Chapel Hill Tubal Reversal Center Database

The comprehensive follow-up database at Chapel Hill Tubal Reversal Center is unique. We know of no other doctor or medical facility with a follow-up system and database that can provide such accurate statistics about the chances of getting pregnant after tubal reversal and the outcomes of the pregnancies that occur.

Limitations And Possible Under Reporting

Although we encourage patients to inform us when they have a positive pregnancy test, not all pregnancies are ascertained. Some patients become lost to follow-up after surgery. This occurs when someone moves or changes email address and telephone numbers but does not provide their new contact information to us. In these cases, we may not find out about the long term outcomes of their tubal reversal procedures unless they complete the Pregnancy Report Form each time they conceive. We know that not all patients adhere to this protocol. From the women who do remain in contact with us over the long term, however, it is clear that new pregnancies continue to occur as time passes after surgery. The pregnancy rates reported in this study, therefore, are minimal estimates of the cumulative pregnancy rates for patients at Chapel Hill Tubal Reversal Center.

Tubal Reversal Pregnancy Report 2009
Table Of Contents:

• Overview
• Study Method
• Patient Population – US States
• Patient Population – Age and Tubal Ligation Procedures
• Pregnancy Rates by Age and Method
• Pregnancy Rates by Tubal Length
• Pregnancy Outcomes
• Tubal Reversal vs. IVF
• About Pregnancy Statistics (this page)

Weekly Pregnancy Announcements From Chapel Hill Tubal Reversal Center Patients