Tubal ligation is a form of permanent birth control. It’s also known as female sterilization.
It’s a surgical procedure that involves cutting or blocking the fallopian tubes to prevent eggs and sperm from meeting.
Tubal ligation is sometimes confused with hysterectomy, but they’re very different.
When you have a partial hysterectomy, your uterus is removed. You’ll continue to ovulate, but will be unable to carry a child. A complete hysterectomy involves removing your uterus and ovaries, which prompts immediate menopause.
After a tubal ligation, ovulation and menstruation continue until menopause naturally occurs.
Who’s a good candidate?
You’re a good candidate for tubal ligation if you’re confident that you don’t ever want to conceive, whatever the reason.
If pregnancy would put your health in jeopardy, or if you have a genetic disorder that you don’t want to pass on, tubal ligation may help alleviate your concerns.
Tubal ligation is considered a permanent form of birth control. You’re not a good candidate if you’re uncertain about having more children or you feel pressured to have the procedure.
How do you prepare for this surgery?
Once you’ve made the decision to have a tubal ligation, your doctor will perform a pelvic exam and assess your health.
There are a few ways to approach the procedure, which your doctor will explain.
The surgery requires anesthesia, so be sure to mention any medications and supplements you take. Include over-the-counter and prescription medications. You may have to stop taking them at some point before surgery.
Ask your doctor if you should temporarily use a backup method of birth control after surgery. It’s also important to make your surgeon aware of any health conditions you have.
You’ll be instructed when to stop eating and drinking prior to surgery. Usually, it’s after midnight the night before. Continue to use birth control right up until surgery.
Plan to wear something loose, comfortable, and easy to slip on and off for surgery day. You won’t be able to drive following the procedure, so arrange for someone to drive you.
Because you won’t need birth control anymore, tubal ligation is a one-time expense.
Under the Affordable Care Act (ACA), most marketplace plans must cover contraception, including sterilization. These plans can’t charge a copayment or coinsurance even if you haven’t met your yearly deductible, providing you’re using in-network services.
Check with your insurer before scheduling the procedure so you know what to expect.
What happens during the procedure?
Many women schedule a tubal ligation while expecting a child. If there are no complications with the birth, the procedure can take place shortly thereafter.
Otherwise, your doctor may want to perform a pregnancy test just before surgery.
Tubal ligation with laparoscopic surgery
Tubal ligation can be accomplished with laparoscopic surgery. You’ll have an IV line for administration of general anesthesia and other fluids. It may also involve having a tube in your throat to assist breathing during surgery.
Gas is pumped into your abdomen to make it easier to work. A thin, lighted tube called a laparoscope is inserted through a small incision near your belly button.
Your surgeon makes a second small incision to reach the fallopian tubes. The tubes can be clipped, banded, or cut and sealed. Both incisions are closed with tape or a few stitches and dressings.
Tubal ligation with hysteroscopic sterilization
Another method is hysteroscopic sterilization. An instrument called a hysteroscope is inserted through your vagina and cervix. From inside your uterus, tiny devices are placed in the openings of your fallopian tubes. As you heal, scar tissue forms and blocks sperm from entering.
This procedure can also be performed under general anesthesia. It’s sometimes done in a doctor’s office using only local anesthesia.
Either way, the surgery takes about half an hour. It can take place in a hospital on an outpatient basis. You should be able to go home after a few hours in the recovery room.
What’s the recovery like?
Recovery time following laparoscopic sterilization is short. You’ll probably be able to resume normal activity within a week.
Side effects from laparoscopic surgery may include:
- temporary shoulder pain and bloating from the gas
- abdominal cramping
- sore throat if a breathing tube was used
The risk of complications is low but include injury to blood vessels, the bladder, or bowel. Bleeding, infection, and poor reaction to anesthesia are always possible after surgery.
Recovery time following hysteroscopic sterilization is also short. You won’t have any incisions to heal. If you had local anesthesia, you probably won’t have to deal with dizziness or nausea. You might be able to resume normal activity within 24 hours to one week.
Side effects may include spotting and cramping. Following are some potential risks:
- Your uterus or fallopian tubes can sustain injury during the procedure, which can cause the devices to slip out of place. This would mean you’re not protected from pregnancy, and you might require surgery to remove the devices.
- The devices may not completely block your fallopian tubes, leaving you vulnerable to pregnancy.
- It’s rare, but some women have long-lasting pain. In those cases, the devices can be surgically removed.
If you do get pregnant after a tubal ligation, you’re at increased risk of ectopic pregnancy, a life-threatening medical emergency.
With either procedure, you’ll probably be instructed not to do any heavy lifting for a few weeks. Most women can resume sexual activity after a week, but ask your doctor when it’s safe for you to do so.
Report unusual symptoms such as fever, drainage, or swelling.
Your doctor will schedule a follow-up to check the healing process and remove stitches, if you have them. About three months after hysteroscopic sterilization, you’ll need an imaging test to make sure your fallopian tubes are blocked.
Is it effective in preventing pregnancy?
Laparoscopic sterilization is effective right away. For women who have the procedure, the pregnancy rate is 18 to 37 out of 1,000 women within 10 years.
After hysteroscopic sterilization, it takes about three months for scar tissue to block your fallopian tubes. During that period, you’ll need backup birth control. Following the procedure, less than 1 out of 1,000 women will become pregnant within five years.
Can it be reversed?
You should go into this procedure with the understanding that it’s permanent.
If you do change your mind after having your tubes tied, there is a surgical procedure to reconnect the blocked segments of your fallopian tubes. However, it’s successful only 50 to 80 percent of the time and carries increased risk of ectopic pregnancy.
Because tubal ligation doesn’t involve removal of your ovaries or uterus, in vitro fertilization is still an option.