Should I have a tubal procedure or in vitro fertilization for tubal infertility?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.
Key points in making your decision
If you have a fallopian tube problem and are unable to become pregnant, you may be considering a fallopian tube procedure, in vitro fertilization (IVF), or both. When making your decision, consider the following:
A fallopian tube procedure can reverse the cause of infertility. If a tubal problem is the only cause of your infertility and surgery is successful (you conceive a healthy pregnancy), you shouldn't need further infertility treatment.
In vitro fertilization (IVF) does not reverse infertility. You need to undergo an IVF cycle for each pregnancy attempt.
If you are around age 35, your doctor may recommend that you skip the surgery and have IVF. As you age beyond 35, the chances of IVF working drop significantly as each year passes. You may not want to spend the time having the surgery and then waiting to see if you get pregnant.
Tubal disease that causes a hydrosalpinx requires a fallopian tubal procedure. Fluid that drains from a hydrosalpinx into the uterus greatly reduces your chances of becoming pregnant, either naturally or with IVF.
IVF is used to bypass a fallopian tube problem (non-hydrosalpinx) and may result in a shorter conception time than would surgery.
Your likelihood of successful tubal infertility treatment is unique to your situation and therefore difficult to predict. Your chances of conceiving and carrying a healthy pregnancy to term are influenced by how severe your tubal problem is, your age, and any other fertility problems you or your partner might have.
Medical Information

What different fallopian tube procedures are available? What are they used to treat?
There are several types of surgery to correct blockages in the fallopian tubes. The specific type of surgery your doctor does will depend on the location, extent, and type of blockage, and may include:
Removal of the affected part of the tube, clearing of scar tissue, or insertion of a plastic tube to open the blocked area (cannulization) to treat a blocked or diseased fallopian tube.
Removal of the diseased part of the tube (salpingectomy), which is one treatment for a hydrosalpinx, a fluid-blocked fallopian tube that may drain into the uterus. This is the only procedure that tries to repair the tube itself. Other procedures include removal of the fluid (needle aspiration), surgically creating a drainage hole in the tube (salpingostomy), or surgically blocking the tube's opening to the uterus.
Tubal reanastomosis, which is used to rejoin a fallopian tube previously cut in a tubal ligation.
Fallopian tube procedures for infertility are usually performed laparoscopically through a small incision.
What are the risks of fallopian tube surgery?
Fallopian tube surgery may or may not result in a successful pregnancy. About 7% to 9% of women who conceive after fallopian tube surgery have an ectopic (tubal) pregnancy, which can become life-threatening. This is caused by preexisting tubal damage rather than the surgery itself.¹
For women 35 or older, perhaps the greatest risk of tubal surgery is the time it takes to perform and heal, and then try to conceive naturally. If you are over age 34 and are interested in trying tubal surgery only, the sooner you begin, the better. If you are considering in vitro fertilization (IVF) with your own eggs, consider skipping tubal repair and starting IVF as soon as possible.
What is in vitro fertilization?
In vitro fertilization (IVF) is the combining of a woman's eggs and a man's sperm in a laboratory. The resulting embryo or embryos are then transferred into the uterus. Your doctor can use your eggs and sperm for IVF or donor eggs or sperm if necessary.
Most women begin the IVF process by having daily hormone injections to stimulate multiple egg growth (superovulation). Multiple eggs are then harvested, either through a needle guided by ultrasound or laparoscopically. The best-quality eggs are fertilized, and the best resulting embryos are implanted in the uterus. Another series of hormone injections is then used to help your newly pregnant body support the first days of implantation and embryo growth.
Some women choose not to use superovulation, instead using their own naturally occurring egg(s).
What is in vitro fertilization used to treat?
In vitro fertilization (IVF) was originally developed to start pregnancy in women with no fallopian tubes. This assisted reproductive technology is now also used to treat couples whose infertility is caused by:
Blocked or diseased fallopian tubes.
Severe endometriosis.
A tubal ligation, or an unsuccessful tubal ligation reversal surgery.
Low sperm counts.
Unexplained infertility that has continued for a long time.
What are the risks of in vitro fertilization?
An in vitro fertilization (IVF) cycle of treatment is emotionally and physically demanding. Multiple procedures are required to stimulate and harvest eggs, and then to implant embryos. IVF increases the risks of:
Multiple pregnancy. Approximately 35% of births in the United States that result from assisted reproductive technologies such as IVF produce 2 or more children.² Multiple pregnancies are high-risk for both mother and fetuses.
Severe ovarian hyperstimulation syndrome, which can be life-threatening. This condition develops in up to 2% of all IVF cycles.¹ Your doctor can minimize this risk by closely monitoring your ovaries and hormone levels during superovulation.
If you choose IVF, talk to your doctor about how to reduce your risk of multiple pregnancy.
If you need more information about infertility treatments, see the topic Fertility Problems.
Your Information

Your choices are:
Have a tubal surgery.
Have in vitro fertilization.
If you have been diagnosed with tubal infertility, your treatment choices will depend on your age and the location and severity of your tubal problem.
Treatment options
To find out more about your treatment options, first click on your age group:

34 or younger

35 or older
The decision about whether to have surgery or try in vitro fertilization for tubal infertility takes into account your personal feelings and the medical facts.
Choosing treatment for a fallopian tube problem
Type of infertility treatment for a fallopian tube problem Reasons to choose Reasons to not choose

Fallopian tube surgery

If a tubal repair is successful, you won't need further infertility treatment to become pregnant.
If you have a hydrosalpinx, tubal surgery improves your chances of pregnancy.
Surgery is usually done through a small incision; recovery is not difficult or prolonged.
Multiple birth risk is minimal when you naturally conceive after tubal surgery.

Are there other reasons you might want to have tubal surgery?

Your chances of pregnancy after surgery may not be good, depending on the type of tubal damage you have.
Tubal (ectopic) pregnancy risk is high (7% to 9%) following tubal surgery.¹ (The average for all pregnancies is about 2%.³)
Surgery involves the usual risks of general anesthesia.
When you are in your late 30s, because of your aging egg supply, conceiving a healthy pregnancy becomes more difficult. Trying tubal surgery and natural conception may use up precious time if you might want to try in vitro fertilization later.
Health insurance often does not cover fallopian tube surgery for infertility.

Are there other reasons you might not want to have tubal surgery?

In vitro fertilization (IVF)

If you have severe tubal damage or disease, experts recommend IVF instead of tubal surgery.⁴
IVF is your only remaining treatment option if you haven't conceived for many months after tubal surgery or if you are not willing to have surgery.
If you are 35 or older, you are more likely to become pregnant using IVF than with tubal surgery.⁴

Are there other reasons you might want to try in vitro fertilization?

Your chances of successful pregnancy with IVF may not be good, depending on how viable your eggs are (donor eggs can improve your chances of success, if necessary).
IVF doesn't repair an infertility problem. You will need to undergo an IVF cycle for each pregnancy attempt.
Daily hormone injections and testing, egg retrieval, and embryo transfer are emotionally and physically demanding.
There is a small risk of ovarian hyperstimulation syndrome during superovulation with hormone injections.
IVF increases the likelihood of becoming pregnant with twins or more. Multiple pregnancies are high-risk.
The average cost of one IVF cycle is $10,000 to $15,000 in the United States. Health insurance often does not cover these expenses.

Are there other reasons you might not want to try in vitro fertilization?

These personal stories may help you make your decision.
Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about tubal surgery and in vitro fertilization. Discuss the worksheet with your doctor.
Circle the answer that best applies to you.
I have the financial resources or health insurance coverage to have tubal surgery or in vitro fertilization. Yes No Unsure
I don't have much fertile time left, so I have to choose a treatment and get started with it soon. Yes No Unsure
I am comfortable with trying to conceive for 6 months to a year or more to see whether tubal surgery works. Yes No Unsure
I plan to have only one child. Yes No Unsure
I am comfortable with the idea of having laparoscopic surgery. Yes No Unsure
I am a good candidate for a successful tubal surgery. Yes No Unsure
I am willing to accept the risks of having a multiple pregnancy after in vitro fertilization. Yes No Unsure
I want to try treatment in a stepwise fashion: first surgery, then in vitro as a last resort. Yes No Unsure
I am willing to use donor eggs. Yes No Unsure
I would rather not try treatment; I prefer adoption. Yes No Unsure
Use the following space to list any other important concerns you have about this decision.

What is your overall impression?
Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have fallopian tube surgery or in vitro fertilization.
Check the box below that represents your overall impression about your decision.

Leaning toward fallopian tube surgery

Leaning toward in vitro fertilization

Return to the topic Fertility Problems.


Author:	Shannon Erstad, MBA/MPH Lila Havens	Last Updated April 7, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Kathleen Romito, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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