Publication date: Available online 10 April 2013
Source:American Journal of Obstetrics and Gynecology

Objective Regret after tubal ligation continues to be a problem. After tubal ligation couples have the option of tubal surgery or in vitro fertilization (IVF). Study design Using decision analysis techniques, we compared cost-effectiveness of tubal reanastomosis by tubal type versus IVF for three separate age groups of woman: < 35 years of age, 35 to 40 years of age and > 40 years of age. Tubal techniques was divided into type A, those with more favorable prognosis due to the likelihood of having a more significant length tube at time of reanastomosis and type B, those with a worst prognosis of success. We incorporated delivery costs to address the impact of high order multiples in IVF. Data was extracted by studies available in the literature. All costs were adjusted to 2012 US dollars. One-way and two-way sensitivity analyses were performed. Results The laparoscopic reanastomosis of type A dominated the other groups, since it was more effective and less costly then type B and IVF. However when women were >40 years old with a history of type B, IVF was favored when its costs were at the lower limit. Conclusions The most cost-effective choice for a woman desiring pregnancy after tubal ligation is laparoscopic reanastomosis after a prior clip or ring tubal ligation for women