Birth control

Tubal ligation

Is tubal ligation right for me?
Should I get my tubes tied?

Performed in a hospital, a tubal ligation is a surgical procedure in which a woman's fallopian tubes (the tubes that carry the fertilized egg to the uterus) are cut and tied. This sterilization procedure renders a woman infertile: eggs, once released by the ovaries, cannot travel beyond the cut fallopian tubes. As such, male sperm can't make contact with an unfertilized egg. Naturally, if an egg and sperm cannot meet, fertilization—and pregnancy—cannot occur.

While surgical procedures to reverse a tubal ligation do exist, they are not always effective. In addition, reversals are both difficult and expensive. Tubal ligation, therefore, should be considered a permanent procedure. The decision to have your tubes tied should not be made lightly. Tubal ligation may not be the best choice for adolescent girls since in the future, they may decide they want children. In fact, young women with no children may have difficulty finding a surgeon to perform the procedure.

Before surgery: what you should know

Before undergoing surgery, be sure you fully understand the benefits and risks. It's important for your doctor, hospital, or clinic to discuss surgical options with you, to discuss the risks of surgery, and to answer all of your questions prior to surgery. Tubal ligation can be performed at any time, provided you're certain you're not pregnant. If you are pregnant and considering tubal ligation after delivery, be sure to discuss your options with your doctor. Some doctors will perform tubal ligation immediately following childbirth, while others prefer to wait 3 to 6 months. You may decide to delay your tubal ligation until you know your baby is healthy. In addition, women who have a tubal ligation immediately following childbirth run a higher risk of regretting it.

When a woman's reasons for choosing tubal ligation are unrelated to pregnancy or childbirth, a laparosopy is most commonly performed.

Laparoscopy

Lasting approximately a half hour, a laparoscopy is performed while the patient is under local or general anesthetic. It is sometimes performed immediately following pregnancy and childbirth—a good time because the patient is already in the hospital. If you've already undergone a cesarean section, your surgeon can perform a tubal ligation in just a few extra minutes because your abdomen is already open.

In order for the abdominal wall to balloon away from the uterus and fallopian tubes, the abdomen is filled with carbon dioxide gas. The surgeon then makes a small incision just below the belly button—an area corresponding to the top of the uterus and making direct access to the fallopian tubes easier—and inserts a laparoscope, a small telescope equipped with a tiny camera. The camera allows the doctor to view the uterus and fallopian tubes during the surgery. A second incision is made just above the pubic hairline. It is through this incision that the surgeon inserts the instrument that will interrupt the tubal pathway. He or she can use an electrical device (called a cautery) to burn the tubes. Some surgeons may use stitches (sutures) to tie the tubes, and others may attach plastic seals or clips to seal the tubes. Whatever the chosen method, the surgeon may also remove a small portion of each fallopian tube.

Because there may be a delay of several months between your request for a laparoscopy and your actual surgery, you may want to consider an alternative method of birth control in the meantime.

Following a laparoscopy, your doctor will advise you to take 2 to 3 days off and to perform only light activities for about a week or so. You can resume sexual activity as soon as you feel comfortable—usually after about a week.

Minilapartomy: Essure procedure

Although less common, tubal ligation can also be performed through the vagina rather than through the abdomen. This technique, called a minilapartomy, allows the surgeon to approach the fallopian tubes from inside the uterus. This leads to the same results as a laparoscopy, but no incisions are needed. Instead, the doctor uses a small metal coil (called an Essure device) to block each fallopian tube.

Is tubal ligation effective?
Are there any health risks?

Although 99.6% effective in preventing pregnancy, a tubal ligation does not protect against sexually transmitted infections or HIV/AIDS. Similarly, having your tubes tied does not eliminate the need for regular Pap tests. What's more, although pregnancy is unlikely, there is a slightly increased risk of ectopic pregnancy following a tubal ligation. An ectopic pregnancy occurs when a fertilized egg attaches and grows in the fallopian tube or in an area outside the uterus. An ectopic pregnancy can be very dangerous—even life threatening—and requires immediate medical attention.

Other complications following tubal ligation may include:

• reaction to the anesthesia
• injury to blood vessels in the abdomen
• abnormal bleeding
• bladder or bowel injury
• bladder or pelvic infections
• post-tubal sterilization syndrome, a condition characterized by:
  • irregular and painful menstrual periods;
  • mid-cycle bleeding; or
  • no periods at all.

What can I expect after surgery?

Following surgery, you may need mild pain medications to alleviate pain in your abdomen and at the incision site. You may also experience dizziness, fatigue, nausea, and bloating. If you've undergone a laparoscopy, you may also experience pain or discomfort in your shoulder or at the side of your neck. This is a normal response to your diaphragm's (a muscle separating your abdominal cavity from your heart and lungs) being irritated by the gas used to inflate your abdomen. After about 8 hours, though, you should be able to walk around and eat normal, solid foods. Unless you've just had a baby, you should be able to go home the same day as your surgery. If you've just given birth, tubal ligation should not extend your post-partum hospital stay by very much, and you'll be able to go home within a few days.

If you underwent an Essure procedure (your surgery entered through the vagina rather than through an abdominal incision), you should avoid inserting anything in your vagina for 2 weeks in order to prevent infection.

Will tubal ligation affect my sexuality?

You may have some concern about your sexuality following a tubal ligation. This should not be a worry for you: women are fully able to enjoy sex after having their tubes tied. In fact, because they are less worried about becoming pregnant, some women actually experience improved sexual pleasure.

Because the ovaries remain, they continue to release eggs, but these cannot travel beyond the fallopian tubes and are therefore absorbed by the body. In addition, women's hormone levels and menstrual cycles are not noticeably affected by tubal ligation.

Can tubal ligation be reversed?

As mentioned above, techniques do exist should a woman decide to reverse her tubal ligation. Reversal procedures, however, are complicated and costly and they carry a higher risk of failure than the tubal ligation itself. Although between 60 and 80 percent of women who have the reversal are eventually able to conceive, the risk of an ectopic pregnancy increases. For this reason, in-vitro fertilization is more commonly used than tubal reversal surgery by women who have had their tubes tied and who wish to become pregnant. In-vitro fertilization involves taking mature eggs from your ovaries, fertilizing them—in a laboratory—with your partner's sperm, and implanting them in your uterus. An expensive option, in-vitro fertilization carries no guarantee of success.