Reversal of sterilisation vs. IVF: a cost-benefit analysis

A consecutive series of 132 cases of reversal of sterilisation carried out in a teaching hospital in England between 1982 and 1995 was analysed. Follow-up data was obtained on 112 patients. The overall cumulative conception rate was 47% at 12 months and 55% at 24 months. Among the 71 pregnancies there were seven miscarriages (9%) and 11 ectopic pregnancies (15%). Factors affecting the outcome of surgery were examined. The pregnancy rate achieved with microsurgical techniques was significantly higher than the conventional (macrosurgical) techniques (61% v. 40%, P = 0.05). The method of sterilisation also has a significant impact on the outcome; Filshie clips 69%; Fallope ring 46%; Pomeroy technique 31% (P < 0.05). Age, associated infertility factors and the interval between sterilisation and reversal operation did not appear to have a significant impact on the outcome. When compared with IVF, reversal of sterilisation is associated with a higher ectopic rate, lower multiple pregnancy rate and a lower miscarriage rate. We conclude that reversal of sterilisation carries a higher overall success rate than IVF and is more cost effective when the method of sterilisation is by the clip or ring and when the reversal operation is carried out with microsurgical techniques.