Tubal Ligation Health Article

Risks

While major complications are uncommon after tubal ligation, there are risks with any surgical procedure. Possible side effects include infection and bleeding. After laparoscopy, the patient may experience pain in the shoulder area from the carbon dioxide used during surgery, but the technique is associated with less pain than mini-laparotomy, as well as a faster recovery period. Mini-laparotomy results in a higher incidence of pain, bleeding, bladder injury, and infection compared with laparoscopy. Patients normally feel better after three to four days of rest, and are able to resume sexual activity at that time.

The possibility for treatment failure is very low—fewer than one in 200 women (0.4%) will become pregnant during the first year after sterilization. Failure can happen if the cut ends of the tubes grow back together; if the tube was not completely cut or blocked off; if a plastic clip or rubber band has loosened or come off; or if the woman was already pregnant at the time of surgery.

Normal results

After having her tubes tied, a woman does not need to use any form of birth control to avoid pregnancy. Tubal ligation is almost 100% effective for the prevention of conception.

Morbidity and mortality rates

About 1–4% of patients experience complications following tubal ligation. There is a low risk (less than 1%, or seven per 1,000 procedures) of a later ectopic pregnancy. Ectopic pregnancy is a condition in which the fertilized egg implants in a place other than the uterus, usually in one of the fallopian tubes. Ectopic pregnancies are more likely to happen in younger women, and in women whose tubes were closed off by electrocoagulation.

Rarely, death may occur as a complication of general anesthesia if a major blood vessel is cut. The mortality rate of tubal ligation is about four in 100,000 sterilizations.

Alternatives

There are numerous options available to women who wish to prevent pregnancy. Oral contraceptives are the second most common form of contraception—the first being female sterilization—and have a success rate of 95–99.5%. Other methods of preventing pregnancy include vasectomy (99.9% effective) for the male partner; the male condom (86–97% effective); the diaphragm or cervical cap (80–94% effective); the female condom (80–95% effective); and abstinence.

See also Vasectomy.

BOOKS

"Family Planning: Sterilization." Section 18, Chapter 246 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.

PERIODICALS

Baill, I. C., V. E. Cullins, and S. Pati. "Counseling Issues in Tubal Sterilization." American Family Physician 67 (March 15, 2003): 1287-1294.

Kariminia, A., D. M. Saunders, and M. Chamberlain. "Risk Factors for Strong Regret and Subsequent IVF Request After Having Tubal Ligation." Australian and New Zealand Journal of Obstetrics and Gynaecology 42 (November 2002): 526-529.

ORGANIZATIONS

American College of Obstetricians and Gynecologists. 409 12th St., SW, P. O. Box 96920, Washington, DC 20090-6920. <www.acog.org>.

Planned Parenthood Federation of America, Inc. 810 Seventh Ave., New York, NY, 10019. (800) 669-0156. <www.plannedparenthood.org>

OTHER

Centers for Disease Control and Prevention. Fact Sheet: Risk of Ectopic Pregnancy after Tubal Sterilization, August 6, 2002 [cited March 1, 2003]. <www.cdc.gov/nccdphp/drh/mh_ectopic.htm>.

Planned Parenthood Federation of America. All About Tubal Sterilization. [cited March 1, 2003]. <www.plannedparenthood.org/bc/allabouttubal.htm>.

Planned Parenthood Federation of America. Facts About Birth Control, January 2001 [cited March 1, 2003]. <www.plannedparenthood.org/bc/bcfacts1.html>.

Mercedes McLaughlin Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Tubal ligation is generally performed by an obstetrician/gynecologist, a medical doctor who has completed specialized training in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics. The procedure is performed in a hospital or family planning clinic, and usually as an outpatient procedure.

QUESTIONS TO ASK THE DOCTOR

• How many tubal ligations do you perform each year?
• What method of ligation will you use?
• What form of anesthesia will be used?
• How long will the procedure take?
• What side effects or complications might I expect?
• What is your failure rate?