The choices are In Vitro Fertilization (IVF) or surgical tubal reversal.
IVF involves taking fertility shots for about 8-10 days to make multiple eggs, doing a short ultrasound-guided in office procedure to remove around 10-15 eggs from your ovaries (an egg retrieval). The eggs can then be fertilized by your partner’s sperm, either by mixing the eggs and sperm and letting them fertilize ‘naturally’ in the lab (conventional IVF) or injecting each egg with a single sperm, a procedure called ICSI. The fertilized eggs grow into embryos, and we can put the best 1-3 embryos back inside your uterus (embryo transfer, a simple in-office procedure) and freeze any extra embryos. Success rates can be as high as 60% if you are 35 with good egg supply (ovarian reserve). The frozen embryos can be used to have another child, or if you don’t get pregnant the first time, or if you have a miscarriage. Not everyone has extra embryos to freeze.
Surgical tubal reversal is an outpatient surgery, done either through a surgical telescope (laparoscopy) with small incisions on your lower abdomen, or through a small bikini-line incision (mini-laparotomy). Success rates vary and depend on how much tube was destroyed, with up to 70% of women having at least one open tube after reversal with good surgical technique. There are two ways to burn the tube (unipolar and bipolar electricity) with unipolar cautery doing more damage. Tubal reversal surgery is less successful if the tubes were burned either way. There is a higher chance of tubal pregnancy than with IVF, and this is a much more delicate surgery than tying the tubes in the first place. It needs to be done by a Reproductive Endocrinology specialist, ideally using microsurgery or robotic surgery. If the surgery is successful you will need birth control again.
It is hard to say what’s the best option without knowing more about you – it can be helpful to get the operation report and pathology report from your sterilization to see how much tube was removed and what exactly was done. If the far ends of the tubes were removed (fimbriectomy) IVF is the best choice.
It is worth doing a sperm count for your partner upfront, as if he has low sperm numbers or quality then IVF with ICSI is the best choice. It is also worth testing your fertility including your ovarian reserve (egg supply) – even with 3 kids and six pregnancies, this could be low at age 35.
Hope this helps. I recommend seeing a Reproductive Endocrinologist who does both tubal reversals and IVF, who can look at your individual case.
