Fertility Problems: Should I Have a Tubal Procedure or In Vitro Fertilization?

There are several types of surgery to fix blocked fallopian tubes. The type of surgery you have will depend on the type of blockage, where it is, and how bad it is. Surgery may be done to:

• Remove the blocked part of the tube, clear out scar tissue, or put in a plastic tube to open the blocked area.
• Rejoin a fallopian tube that was cut in a tubal ligation.
• Remove the diseased part of the tube. This may be done to treat a hydrosalpinx, which is a fluid-blocked fallopian tube that may drain into the uterus. A doctor also may remove fluid, create a drainage hole in the tube, or block the tube's opening to the uterus.

These surgeries are usually done through a small incision (laparoscopically).

The success of fallopian tube surgery depends in part on the location and extent of the blockage. It may also depend on whether you have other fertility problems or pelvic conditions. Talk to your doctor about his or her success rates with any procedure you are considering.

Fallopian tube surgery may or may not lead to a healthy pregnancy. About 7 to 9 out of 100 women who get pregnant after fallopian tube surgery have an ectopic (tubal) pregnancy, which can be dangerous. This means that 91 to 93 out of 100 women who have the surgery don't have an ectopic pregnancy. These pregnancies usually happen because of tubal damage the women already had before surgery, rather than because of the surgery itself.^{footnote 1}

For women age 35 or older, perhaps the greatest risk is the time it takes to recover from surgery and then try to get pregnant. If you want to try only tubal surgery, the sooner you begin, the better. If you are thinking about having IVF with your own eggs, you may want to start IVF as soon as possible, rather than having surgery.

During in vitro fertilization (IVF), a woman's eggs are mixed with a man's sperm in a lab. The resulting embryo or embryos are then transferred into the uterus. Your doctor can use your eggs and sperm for IVF, or you can try donor eggs or sperm if needed.

Most women begin the IVF process by having daily hormone shots to grow multiple eggs. This is called superovulation. The eggs are then collected, either through a needle guided by ultrasound or laparoscope. The best-quality eggs are fertilized with sperm, and the best embryos are implanted in the uterus. Then you have a series of hormone shots to support the first days of pregnancy.

Some women choose to use their own eggs naturally and not use superovulation.

In vitro fertilization (IVF) was first used for women with no fallopian tubes. Now this procedure is also used to treat couples whose infertility is caused by:

• Blocked or diseased fallopian tubes.
• Severe endometriosis.
• A tubal ligation, or surgery that wasn't able to reverse tubal ligation.
• Low sperm counts.
• Unexplained infertility that has gone on for a long time.

The success of IVF depends on many different things, including age, the cause of infertility, whether the woman has given birth before, and whether the woman's own eggs or donor eggs are used. Talk to your doctor about what to expect based on these and other factors.

In vitro fertilization (IVF) is emotionally and physically demanding. You need to have several procedures to produce and collect eggs and then to implant embryos. IVF increases the risks of:

• Multiple pregnancy. About 31 out of 100 births in the United States that result from methods like IVF produce two or more children.^{footnote 2} Multiple pregnancies are high-risk for both the mother and the fetuses.
• Severe ovarian hyperstimulation syndrome, which can be deadly. This happens in up to 2 out of 100 IVF cycles.^{footnote 1} Your doctor can reduce this risk by closely checking your ovaries and hormone levels.

If you choose IVF, talk to your doctor about how to reduce your risk of multiple pregnancy.

Your doctor might recommend surgery on your fallopian tubes if:

• You have a problem that causes fluid to build up in your fallopian tubes.
• A problem with your fallopian tubes is your only fertility problem.
• You are age 34 or younger and are willing to take the time to have surgery, recover, and then see if you can get pregnant.

Your doctor might recommend IVF if:

• You have severe tubal damage or disease.
• You are 35 or older. You may want to try to get pregnant as soon as you can, rather than wait to recover from surgery and see if you get pregnant. The chances that IVF with your own eggs will work drop a lot the older you get.
• You want to get pregnant fairly soon, whatever your age. You may be able to get pregnant sooner after IVF than after surgery.