Laparoscopic Tubal Re-Anastomosis or IVF in Previously Ligated Patients: A Comparison of Fertility Outcomes and Survey of Patient Attitudes.

STUDY OBJECTIVE: To compare live birth rates, cost analysis and a survey of patient attitudes between laparoscopic tubal re-anastomosis and IVF in patients with previous tubal ligation Design: Retrospective cohort review and survey. SETTING: Single Reproductive Medicine and IVF unit in Singapore. PATIENTS: Retrospective study: Patients who underwent previous tubal ligation and currently seeking fertility. Survey: Patients attending the subfertility clinic. INTERVENTIONS: Retrospective study: Laparoscopic tubal re-anastomosis or IVF, from January 2011 to December 2016. Survey: Questionnaire and information sheet on both IVF and tubal re-anastomosis. MEASUREMENTS: Retrospective study: First live birth after treatment. Interval to first pregnancy, miscarriages and ectopic pregnancies were also reported. Survey: Choice of treatment before and after reading the information on laparoscopic tubal re-anastomosis and IVF. RESULTS: Retrospective study: Twelve patients underwent tubal re-anastomosis while 31 patients underwent IVF treatment. Pregnancy (75.0% vs 35.5%) and live birth (58.3% vs 25.8%) were significantly higher in the tubal surgery group (P<0.05%) after transferring all available embryos in one stimulated IVF cycle. Cost per live birth was also lower in the tubal surgery group ($27,109 vs $52,438). Survey: One hundred patients participated in the survey. A majority of patients preferred tubal surgery to IVF (68.2% vs 31.8%) before given information on the procedures, but indicated a preference for IVF (54.6%) to surgery (45.4%) after receiving information on the procedures. CONCLUSIONS: For women less than 40 years of age, desiring fertility after tubal ligation, laparoscopic tubal re-anastomosis offers better live birth rates and cost-effectiveness. Patients in Singapore are equivocal as to their preference after education regarding the choices. Thus laparoscopic tubal re-anastomosis remains a viable alternative to IVF treatment.