IVF following impossible or failed surgical reversal of tubal sterilization

Effectiveness of in vitro fertilization in women with previous tubal sterilization

OBJECTIVE

The objective was to determine the effectiveness of in vitro fertilization (IVF) on live-delivery rates in women who had previously undergone tubal sterilization.

STUDY DESIGN

We examined first IVF live deliveries for women aged 20-44 years at their first embryo transfer (ET) with history of hospital admission for tubal sterilization in Western Australia (WA). The ET cycles (n=178) were ascertained over the period of 1996 to 2010 using WA hospital records. A control group of subfertile women matched by age was randomly selected (n=178). We used Kaplan-Meier curves and life-table analysis to evaluate the cumulative live-delivery rates.

RESULTS

An overall cumulative live-delivery rate in women who had undergone previous tubal sterilization (31%) was comparable to that of subfertile controls (34%) within the first 24 months. Younger women (aged 20-34 years) with previous sterilization (34%) were slightly more likely to deliver an IVF live baby than older women (aged 35-39 and 40-44 years) (33% and 22%, respectively), although this difference was not statistically significant (p=.449).

CONCLUSION

Women who desire fertility after a tubal sterilization procedure and undergo IVF have rates of pregnancy similar to age-matched subfertile IVF control patients.

IMPLICATIONS

In vitro fertilization success in women who had undergone previous tubal sterilization is similar to that of the subfertile controls and thus does not depend on past fertility. Age is the most important predictive factor in achieving pregnancy.

Infertility surgery is dead: only the obituary remains?

Despite the multiple advantages of assisted reproductive technology compared with surgery, there remain several diagnoses for which surgery is still widely performed: distal tubal occlusion, regret of permanent sterilization, and endometriosis. Assisted reproductive technology is superior to surgery and should be offered as first-line treatment.

Canadian Contraception Consensus

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

[What medical intervention in the late desire for a child?]

Therapeutical decisions in case of unsuccessful late child wish in a woman aged more than 35, must take into account several issues. In a context where time cannot be considered as "therapeutical" in the sense that the probability of onset of a pregnancy per cycle can not increase with time, the moment of check-up for infertility can be fixed at 6 months of sexual intercourse, assumed to be possibly fecundant. The assessment of ovarian age allows to formulate a double prognosis, that of therapeutical efficacy for obtaining onset of pregnancy and that of the quality of possible conceptus. The choice of treatment from the etiological check-up will not go from the simplest to the more sophisticated as is done for younger women. This is an important issue since the remaining time of possible fertility is short.