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Q&A Sessions: |
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Q & A Sessions: Tubal/Vasectomy Reversal
Our experienced Penn Fertility Care physicians answered
your questions about tubal or vasectomy reversal.
Maly asks:
My husband and I have three children.
He had a vasectomy in 1992 and a
reversal in 1999. Subsequent semen
analysis have shown no return of
sperm. No form of birth control has
been used since then and I have been
unable to conceive. We are both 40
years old, and in good health. Is
there any chance of us being able
to have another child? And if so,
what are our options?
Penn Fertility Care responds:
We suggested that in part based on
your age and your husband's history
that you be evaluated by a fertility
specialist. They can run a check
on your ovarian reserve and can
determine any other underlying
issues. Best wishes to you. If
you would like to see a Penn Fertility
Care specialist at either our Radnor
or Philadelphia office call, 1-800-789-PENN
(7366). |
Lyn asks:
My husband had vasectomy. Is it possible
to make me pregnant through injection
without reversing his vasectomy?
Samantha
Butts, MD MSCE responds:
When a man has a vasectomy, the vas
deferens, which is the structure
that allows sperm to travel from
the testicle to the penis, is cut
or sealed. To get past this blockage,
there are two options: reversing
the vasectomy or harvesting sperm
near the testicle before the blockage.
The second option, however, would
require that you undergo in vitro fertilization
because the amount of sperm that can
be acquired this way is usually much
less than normal. I would recommend
that you seek out a consultation with
an infertility specialist who can counsel
you about the various options and help
you make a decision. |
Dee asks:
About 16 years ago I had my tubes tied.
My first husband and I had problems
and our children had health problems.
Now I am remarried and my new husband
and I would like to have children.
What would I have to go through to
have a baby?
Pasquale Patrizio, MD responds:
Depending on your age and hormonal
conditions, you can be evaluated
for tubal reversal or in vitro
fertilization. We will be more
than happy to discuss a plan at
a consultation. |
MLA asks:
My husband and I are in our mid to late
20's and want another child but he
had a vasectomy three years
ago. What is the better option: a
reversal or IVF (covered by insurance)
and ICSI? We want one child for sure
and maybe more but reversal seems
so expensive and it may not work.
However, with IVF/ICSI, I think we
have a good chance but I am not a
doctor.
Samantha
Butts, MD MSCE responds:
In your case, you have several things
going for you that make either option
reasonable. First, you are young
and this lends itself to the best
odds of pregnancy no matter which
option you choose. Second is that
your husband had his vasectomy three
years ago. It has been shown that
the odds of pregnancy are best if
a vasectomy reversal is performed
within three years of the vasectomy.
The cost of a vasectomy reversal may
be as much as $12,000 and this may
be a consideration especially if IVF
is covered by insurance. I would start
by scheduling a consultation with a
urologist, if you are seriously considering
the vasectomy reversal to see what
options they offer as well as risks
and benefits. If you proceed with IVF
without a vasectomy reversal, a urologist
would have to be involved anyway to
perform a sperm aspiration. |
Shantae
asks:
I had my tubes untied over a year ago.
Why have I not been able to get pregnant?
My husband does have kids already but we
want one child together. My tubes are open.
Penn Fertility Care responds:
The ability to acheive a pregnancy is determined
by many factors (ie age, condition of ovaries).
If you have not seen a fertility specialist
to date, we suggest you go for a consultation/evaluation.
There could be other reasons for your fertility
issues. Unfortunately, without reviewing
your medical records we cannot provide an
answer as to why you have not conceived
since your surgery. We would be happy to
meet with you to discuss your medical history
and determine a course of action. |
Sepp asks:
Do you check the condition of the ovaries
before doing a tubal
reversal? Is there a detour to get sperm
to the ovary/egg without
reversal.
Christos
Coutifaris, MD, PhD responds:
Yes, the ovarian reserve needs to be checked
prior to tubal reversal.
The results, in combination with the age
of the patient and the proximal
and distal tubal lengths determine whether
a tubal reanastomosis is
appropriate.
No, there is no other way to
anatomically bipass the
blocked tubes. However, in vitro fertilization
is a good alternative to tubal reversal,
does not require major surgery and is increasingly
being used with high success (depending
of the woman's age and ovarian reserve). |
Millie asks:
I am a 25 year-old female with two wonderful children, I made a huge mistake last year and had my tubes tied. Sometimes I wish I didn't. When I first decided to get my tubes tied me and my fiancé thought it was the best because we have our pair: our son is six and our daughter is two and a half. But we were wrong; I would like to have more kids. I would like to know what can I do to have a tubal reversal. Will my insurance pay for it or will I and how much will it cost?
Sharon Byun, MD responds:
You will need to see an infertility specialist to discuss options for pregnancy after tubal ligation. Typical options include having surgery to try to reverse the tubal ligation procedure (i.e. put the tubes back together) or use in vitro fertilization. Cost and insurance coverage will depend on the kind of insurance you have and the state in which you live. |
Resse asks:
I have two children, both born prematurely due to an incompetent uterus. I had my tubes tied six weeks after the birth of my second child (2006), because of fear of delivering early and the threat of complete bed rest during any further pregnancies. I and my significant other desire more children (his first). I want to have a reversal done. What are my risks, the cost, and chances of conception?
Kurt Barnhart, MD, MSCE responds:
It is possible to have your tubes re-anastomosed. It requires a major operation. The success depends on how much tube is undamaged and how old you are. The cost depends on your insurance coverage, but it includes not only the operation, but also the hospital stay after.
Another option is in vitro fertilization (IVF). This has at least the same success (maybe more) and does not require an operation. You should have a full consultation to discuss this with a reproductive endocrinologist like the ones at Penn Fertility Care. |
Melanie asks:
I had a tubal ligation in 2002 when I had my son. I am now going to marry a wonderful
man. We have talked about having another child. I have been reading a lot
that your tubes can become untied. Is there a test to see if they can come
untied? I am not regular with my cycle. I can be anywhere from one week late
to two weeks late at times. They haven't been regular since I had my son.
Kurt
Barnhart, MD, MSCE responds:
Yes, your tubes can be put back together. It reguires a major surgery and success
depends on how much tube you have left (and your age). Another option is in vitro
fertilization.
You should speak to a fertility
specialist to help you decide which
option is best for you. That specialist
can also help you with your irregular
cycles. |
SJ asks:
I had my tubes reversed and now they are blocked. What kind if surgery is there
to get them unblocked?
Clarisa
Gracia, MD responds:
Unfortunately, repeat surgery is not very successful. In general after tubal
ligation, in vitro fertilization is a very successful procedure to obtain a pregnancy. |
Rick asks:
My wife and I have two kids. After the last one she had her tubes tied. We now
want to have another baby within the next year. Is there any chance of this,
and what are our best options? Thank you for any help you can give.
Steven
J. Sondheimer, MD responds:
Many couples inquire about fertility potential after a sterilization procedure
such as a female fallopian tube ligation (a.k.a. tubes tied) or male vasectomy.
These procedures are meant to be permanent but occasionally they can be surgically
reversed. However, the surgical reversal is not always successful.
Many factors determine the likelihood
of surgical repair, including the
type of ligation performed, the amount
of tube destroyed, the time interval
since the initial ligation and the
age of the women. You and your wife
should obtain the old surgical records
and consult with an infertility specialist.
Often the best approach to pregnancy
after tubal ligation is through in
vitro fertilization. Even though
your wife has had a tubal ligation
it is likely her ovaries are still
functioning normally (depending upon
her age) and her uterus is still
capable of carrying a pregnancy.
She could be stimulated to produce
multiple follicles, each follicle
could be retrieved in an attempt
to obtain an egg, each egg could
be fertilized with your sperm and
an embryo formed. Two of these embryos
could be transferred into her womb
via the vagina and cervix, bypassing
the ligated fallopian tube. If you
would like to consult with a Penn
fertility specialist, please call
800-789-PENN or request
an appointment online. |
cgina30 asks:
Is it possible to become pregnant after having your tubes tied for five years?
Richard
Tureck, MD responds:
Yes, we do perform this type of reversal surgery at Penn Fertility Care. However,
it depends on how much of the fallopian tubes were removed and the type of tubal
ligation procedure that was performed.
I would suggest you obtain records
of the tubal ligation and set up
a consultation with one of our fertility
specialists. Bring your records with
you to your consultation so that
you and the specialist can discuss
the issue at hand. To make an appointment
for a consultation call 1-800-789-PENN. |
Question:
I have four wonderful children and had my last a year ago. At the time he was
preterm and we decided to have a tubal ligation done. Now we regret our decision
and we are wondering if there is anything we can do to up our chances of
getting pregnant. We have looked into IVF and tubal reversal but all are
costly. Is there any other way?
Kurt
Barnhart, MD, MSCE responds:
Both surgery (to reverse your tubes) or IVF are the only ways for you to have
another baby. All things being equal, IVF gives you the better chance (50-60
percent depending on your age). Tubal reversal is a major surgery (reguing an
incison in your abdomen, a two to four day hosptial stay, and a six week recovery).
Depending upon the policy of your
insurance carrier, sometimes the
tubal surgery is covered by insurance.
The advantage of surgery is, that
if it works (20- 50 percent of the
time, depending on how much of your
tube is left) it can allow you to
have more than one child. It does
require further family planning if
you only want one child.
We can best compare these options
with you during a consultation and
we would be happy to discuss thses
issues with you further. |
JR asks:
I had my tubes tied when I was 21 because I was in a bad marriage and I already
had two children. I now have a good husband and want to have a baby with
him. Is it possible to have the procedure reversed? If so how would I go
about it?
Richard
Tureck, MD responds:
Yes, we do perform this type of reversal surgery at Penn Fertility Care. However,
it depends on how much of the fallopian tubes were removed and the type of tubal
ligation procedure that was performed.
I would suggest you obtain records
of the tubal ligation and set up
a consultation with one of our fertility
specialists. Bring your records with
you to your consultation so that
you and the specialist can discuss
the issue at hand. To make an appointment
for a consultation call
1-800-789-PENN (7366). |
Pamela asks:
I had my sterilization reversed a few years ago. I have been trying to conceive
since then but getting nowhere. How long should I be trying before I go to
my general practitioner for help? I'm 35 years old and I have three kids
from a previous marriage.
Christos
Coutifaris, MD, PhD responds:
You need to have an x-ray study (a hysterosalpingogram) to evaluate whether the
tubes are open or closed following the surgery. Also, did your partner have a
semen analysis? These are the two studies I would recommend at the present time
and then follow-up depending on the results.
If you have further questions or
would like to schedule an appointment
with a Penn Fertility Care specialist,
please contact 1-800-789-PENN (7366)
or request
an appointment online. |
Joyce asks:
Is it possible to conceive after a 15 year old tubal ligation? What are my options
at age 46 since both my new husband and I desperately want our own child.
Christos
Coutifaris, MD, PhD responds:
The first step is to determine your ovarian reserve. This is done with some specific
endocrine blood tests. If the tests show that you have good ovarian reserve,
then you need to meet with a reproductive endocrinology and infertility specialist,
who will review the options of tubal anastomosis vs. IVF with you. Then you and
your husband can make an educated decision.
Unfortunately, even if your ovarian
reserve is good, the odds of success
at age 46 with your own eggs are
very low (probably 4 to 6 percent
at best). You need to also remember
that if your ovarian reserve is poor,
there is the option of using donated
eggs and your husband's sperm with
the resulting embryos transferred
to your uterus.
Success with donated
eggs from a younger donor (ideally
below 30) is more than 10 times higher
(greater than 50 percent). Decisions
of how to proceed are VERY personal
and this is why consultation with
a specialist is the best way to proceed. |
Notsure asks:
I am a 37 year-old diabetic, diagnosed 30 years ago. I had one child ten years
ago at the Hospital of the University of Pennsylvania and had my tubes tied.
I have regretted it for years and am wondering if I would be a candidate
for reversal of tubal ligation? IVF concerns me due to the possibility of
multiple births. Financial considerations would also be a consideration but
insurance may consider.
Richard
Tureck, MD responds:
We would need more information regarding your fertility (such as health records,
age, FSH level or results from a fertility evaluation) to determine if you are
a candidate for in vitro fertilization. If you are interested in a tubal reversal,
we do have experienced physicians within this treatment option.
We can also perform
a comprehensive fertility evaluation
to determine your best course of
treatment. Please feel free to contact
our office by calling 800-789-PENN
(7366) to set up an appointment.
You can also request
an appointment online. |
Lesley asks:
I had my sterilization reversed two and a half years ago and have had courses
of clomid, and I am still not pregnant. Why?
Steven
J. Sondheimer, MD responds:
When a woman undergoes a sterilization procedure, part of her fallopian tubes
are destroyed. Even after a surgical reversal, the fallopian tubes may not function
properly. I assume you have had a test, such as an HSG (hysterosalpingogram),
to now show your tubes are open.
If so, and if all the other fertility
tests are not markedly abnormal (such
as semen analysis and hormonal tests
on you, such as FSH — follicle stimulating hormone
— level on day three of your menstrual
cycle), then the two of you should consider
in vitro fertilization (IVF). IVF is
fertilization of your eggs by your partner's
sperm and transfer of one or two embryos
directly into your womb, bypassing the
fallopian tubes. |
Susan asks:
I had my tubes tied six years ago, and I want to get pregnant again. What are
the chances? Thanks a lot.
Clarisa
Gracia, MD, MSCE responds:
Depending on your age and how many children you wish to have, you may be a candidate
for a tubal reversal. However, this usually requires major surgery and has only
a 60 percent chance of success over one to two years.
In vitro fertilization
is a very good option that does not
involve major surgery and has a success
rate of up to 50 percent per cycle
for women less than 35 years of age.
You should check to see if your insurance
covers either of these options. |
Tracy asks:
I'm 37 years old. I would like to have a reversal done. I was young when I had
my tubes cut and tied. Can this procedure be done? We really want to have
a baby.
Samantha
Butts, MD MSCE responds:
A tubal anastamosis (tubal reversal) to put your tubes back together can be a
successful treatment. However, it has risks that you need to consider, and there
are treatment alternatives. In some cases, the tubes cannot be put back together
because the tubal ligation has made them too short.
Also, in many cases, the
surgery to put the tubes back together
is a major operation requiring that
you stay in the hospital for several
days afterward, and recover for six
weeks at home after that. There is
also a risk that the procedure will
not work because one or both of the
tubes did not remain open, or a risk
of getting a pregnancy trapped in
one of the tubes (ectopic pregnancy)
after the procedure.
An alternative to tubal anastamosis
that you should at least consider
is in vitro fertilization, which
involves taking fertility medications
and harvesting eggs from your ovaries
to bypass the block in the tubes.
The best way to help you sort out
these issues is to schedule an appointment
for a consultation with an infertility
specialist. |
Wendy asks:
I would like some information on getting a reverse tubal or getting artificaly
insimamated. I am going on 33 years of age.
Response:
Penn Fertility Care performs both tubal reversal (tubal reanastomosis) and in
vitro fertilization procedures. To find out more information on both procedures
click on the following links:
If you would like to find out detailed
information on how a fertility specialist
can assist your specific needs call
1-800-789-PENN to schedule a consultation
with a Penn Fertility Care physician. |
Ms. Polk asks:
I had a child there two years ago. She died from trysomy 18 and, before I found
out, I got my tubes tied. I would like to give birth again. Will I be able
to and where can I get finanical help?
Luis
Blasco, MD responds:
Penn Fertility Care does perform tubal reversals. We would be happy to meet with
you to discuss your care. Our financial counselor can also meet with you to discuss
any financial concerns that you have.
|
Lissa asks:
What is the success rate of your tubal
reanastomsis? Do most insurances
cover this procedure? If not, what
is the cost of it?
Scott
Edwards, MD responds:
The success rate of tubal reanastamosis
(tubal ligation reversal) will depend
on many factors such as patient age
and how much of the fallopian tube
was undamaged by the tubal ligation.
Pregnancy rates can be as high as
70 percent after reversal.
Some insurance plans cover this procedure
but you would have to check with your
own carrier to determine whether or
not it would be covered. At the time
of consultation, a financial counselor
would be able to give an estimate of
the cost. |
HB asks:
What is the success rate of a tubal ligation reversal and who performs the procedure?
Steven
Sondheimer, MD responds:
The success of tubal reversal is related to the amount of remaining fallopian
tube and the type of ligation performed. For example, if the end of the tube
has been removed a repair is not possible. When the fallopian tubes are occluded
(blocked) by cautery, the amount of tube destroyed can vary. The more tube destroyed,
the less likely for the reversal to succeed.
For many sterilizations, a reversal
has a 50 percent chance of success
and a 10 percent chance that a pregnancy
will implant in the surgically repaired
tube. In vitro fertilization of your
eggs and the transfer of the embryo
back to your uterus for many patients
is often the best, easiest and safest
approach to having a child versus
tubal ligation reversal.
If you have any further questions
or would like to schedule an appointment
with a Penn Fertility Care specialist,
please contact 1-800-789-PENN (7366)
or request
an appointment online. |
Baby Girl
asks:
I want to know about a tubal reversal. My question to you is, how would I go
about getting help for a tubal reversal? I would like to have another baby. My
tubes have been tied for five years. If you can be any assistance to me please
respond. Do you guys have any financial places for your patients.
Answer provided by Penn Fertility
Care:
Yes, Penn Fertility Care can assist you with tubal reversal. We would first want
to meet with you for a consultation/evaluation to discuss your previous health
history. We also offer financial counselors within our practice. Feel free to
call us for more information or to set up an appointment at 800-789-PENN (7366). You
can also request
an appointment online.
|
Cheermom asks:
I had a tubal ligation 11 years ago thinking that I didn't want to have any more
children. I know they were cauterized. I am now 36 and remarried to a wonderful
man. We would love to have a baby together. I feel this may be impossible
since he had a vasectomy over 10 years ago. What options, if any, do we have
available to us?
Steven
Sondheimer, MD responds:
You may regret your decision to have had a sterilization procedure now, but it
may have been the best choice at that time in your lives, giving you the self-confidence
to move on to find this new relationship. I do think others might learn from
your experience and consider contraceptive methods such as the intrauterine devise
or the soon to be released hormonal implant which gives very effective long term,
forgettable contraception with easy reversibility.
There are two possible ways for
pregnancy to occur in your situation.
Your partner can have a vasectomy
reversal and you a tubal reversal.
Both of these are surgical procedures
and success is based on the type
of sterilization performed, the time
since sterilization and the experience
of the surgeon. Another approach
which I would prefer, would be to
use ovarian stimulation, egg retrieval
and in vitro fertilization. Individual
sperm are injected into individual
eggs, this is called intra-cytoplasmic
sperm injection (ICSI).
Your partner would need to have
the sperm retrieved from his vas,
this is a simpler procedure than
a vasectomy reversal. With both options,
you need to see a reproductive infertility
specialist to review each of these
choices and your individual situations.
Good luck. |
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