What is tubal ligation. How is the procedure performed. What are the benefits and risks of tubal ligation. Can tubal ligation be reversed. Who should consider tubal ligation. How effective is tubal ligation as a contraceptive method. What are the alternatives to tubal ligation.

Understanding Tubal Ligation: The Basics of Female Sterilization

Tubal ligation, commonly known as “tying the tubes,” is a surgical procedure designed to permanently prevent pregnancy in women. This form of female sterilization involves closing or blocking the fallopian tubes, which connect the ovaries to the uterus. By interrupting this pathway, the procedure prevents sperm from reaching and fertilizing an egg, effectively eliminating the possibility of pregnancy.

The fallopian tubes play a crucial role in the reproductive process. Each month, an egg is released from one of the ovaries and travels through the fallopian tube towards the uterus. If fertilization occurs, it typically happens within the fallopian tube. By blocking these tubes, tubal ligation ensures that sperm cannot reach the egg, thus preventing conception.

How effective is tubal ligation as a contraceptive method?

Tubal ligation is considered one of the most effective forms of contraception available. When performed correctly, it has a success rate of over 99%. This means that fewer than 1 in 100 women will become pregnant in the first year after the procedure. However, it’s important to note that while highly effective, no contraceptive method is 100% foolproof.

The Tubal Ligation Procedure: What to Expect

Tubal ligation is typically performed as an outpatient procedure in a hospital or clinic setting. The surgery usually takes about 30 minutes to complete and can be done under general anesthesia or spinal anesthesia with sedation. Here’s a step-by-step overview of the procedure:

1. Anesthesia administration: The patient is given either general anesthesia, rendering them unconscious, or spinal anesthesia, which numbs the lower body while allowing the patient to remain awake.
2. Incision: The surgeon makes one or two small incisions in the abdomen, typically near the navel.
3. Abdominal inflation: In some cases, the abdomen is inflated with gas to create more space for the surgeon to work.
4. Laparoscope insertion: A narrow tube with a tiny camera (laparoscope) is inserted through one of the incisions, allowing the surgeon to view the fallopian tubes on a monitor.
5. Tube occlusion: The fallopian tubes are then blocked using one of several methods:
   • Cauterization: The tubes are burned shut using an electrical current.
   • Clips or rings: Small clips or rings are placed on the tubes to block them.
   • Complete removal: In some cases, the tubes may be surgically removed entirely.
6. Closure: The incisions are closed with stitches or surgical glue.

It’s worth noting that tubal ligation can also be performed immediately after childbirth, either through a small incision near the navel or during a cesarean section.

Benefits and Advantages of Choosing Tubal Ligation

Tubal ligation offers several benefits that make it an attractive option for women seeking permanent contraception:

• Highly effective: With a success rate of over 99%, tubal ligation provides reliable, long-term protection against unintended pregnancy.
• Permanent solution: For women who are certain they don’t want future pregnancies, tubal ligation offers a one-time procedure with lifelong results.
• Hormone-free: Unlike some forms of contraception, tubal ligation doesn’t involve hormones, making it suitable for women who can’t or prefer not to use hormonal birth control methods.
• Reduced cancer risk: Studies have shown that tubal ligation may lower the risk of ovarian cancer, particularly when the entire fallopian tube is removed.
• Convenience: Once the procedure is complete, there’s no need for ongoing contraceptive management or regular doctor visits for birth control.
• Cost-effective: While the initial cost of the procedure may be high, it can be more economical in the long run compared to years of other contraceptive methods.

Who should consider tubal ligation?

Tubal ligation is typically recommended for adult women who are certain they don’t want to become pregnant in the future. It may be particularly suitable for:

• Women who have completed their families and don’t want more children
• Women who are at high risk for pregnancy-related complications
• Women in their 40s who are approaching menopause
• Women with a family history of ovarian cancer, who may benefit from complete tube removal

However, it’s crucial to note that tubal ligation is a significant decision that should be made after careful consideration and consultation with a healthcare provider. The procedure is intended to be permanent, and while reversal is possible in some cases, it’s not guaranteed to restore fertility.

Potential Risks and Considerations of Tubal Ligation

While tubal ligation is generally safe, like any surgical procedure, it does carry some risks. It’s important for women considering this option to be aware of potential complications:

• Incomplete closure: In rare cases, the tubes may not be completely blocked, which could result in an unintended pregnancy. The risk is approximately 1 in 200.
• Ectopic pregnancy: If pregnancy does occur after tubal ligation, there’s an increased risk of it being ectopic (occurring outside the uterus), which can be dangerous.
• Surgical risks: As with any surgery, there’s a risk of infection, bleeding, or injury to nearby organs or tissues.
• Regret: Some women, particularly those who undergo the procedure at a younger age, may later regret their decision if their circumstances or desires change.
• Menstrual changes: While tubal ligation doesn’t affect hormone levels, some women report changes in their menstrual cycles after the procedure, though this may be due to stopping hormonal birth control.

Can tubal ligation be reversed?

While tubal ligation is considered a permanent form of contraception, reversal is possible in some cases. The procedure to restore fertility after tubal ligation is called tubal reversal or tubal reanastomosis. However, it’s important to understand that:

• Reversal is a complex, major surgery that’s not always successful
• Success rates vary depending on factors such as the woman’s age, the type of tubal ligation performed, and the amount of fallopian tube remaining
• Even when successful, reversal doesn’t guarantee pregnancy
• The procedure can be expensive and is often not covered by insurance

For women who regret their tubal ligation but want to have children, in vitro fertilization (IVF) may be an alternative to reversal surgery. IVF bypasses the blocked fallopian tubes entirely by fertilizing the egg outside the body and implanting the embryo directly into the uterus.

Alternatives to Tubal Ligation: Exploring Other Contraceptive Options

While tubal ligation is an excellent option for many women, it’s not the right choice for everyone. There are several alternatives available for those seeking long-term or permanent contraception:

• Vasectomy: A surgical procedure for male partners that blocks the tubes carrying sperm. It’s less invasive than tubal ligation and has a quicker recovery time.
• Intrauterine Devices (IUDs): Long-acting reversible contraceptives that can provide protection for 3-10 years, depending on the type.
• Hormonal Implants: Small rods inserted under the skin of the upper arm that release hormones to prevent pregnancy for up to 3 years.
• Hormonal Injections: Shots given every three months to prevent pregnancy.
• Birth Control Pills: Oral contraceptives taken daily to prevent pregnancy.
• Sterilization Implants: Non-surgical devices placed in the fallopian tubes to create scar tissue that blocks the tubes.

Each of these methods has its own set of benefits and potential side effects. The best choice depends on individual circumstances, health factors, and personal preferences.

Recovery and Aftercare Following Tubal Ligation

Recovery from tubal ligation is typically quick, with most women able to return home the same day as the procedure. Here’s what to expect during the recovery period:

• Immediate aftermath: Patients may experience some discomfort, bloating, and shoulder pain (from the gas used to inflate the abdomen) for a day or two.
• Pain management: Over-the-counter pain relievers are usually sufficient to manage any discomfort.
• Activity restrictions: Most women can return to normal activities within a few days, but should avoid heavy lifting and strenuous exercise for about a week.
• Wound care: The incision sites should be kept clean and dry. Any stitches or staples are typically removed within a week.
• Follow-up: A post-operative check-up is usually scheduled for about two weeks after the procedure.

It’s important to note that tubal ligation does not provide immediate contraception. Women should use an alternative form of birth control until their first post-operative period or as advised by their doctor.

When to seek medical attention after tubal ligation?

While complications are rare, it’s important to be aware of potential warning signs. Patients should contact their healthcare provider if they experience:

• Fever or chills
• Severe abdominal pain
• Heavy bleeding from the incision sites
• Fainting or dizziness
• Signs of infection, such as redness, swelling, or discharge at the incision sites

Long-Term Effects and Considerations of Tubal Ligation

While tubal ligation is primarily a contraceptive procedure, it’s important to consider its potential long-term effects:

• Ovarian function: Tubal ligation does not affect hormone production or ovulation. Women will continue to have regular menstrual cycles and go through menopause at the usual time.
• Sexual function: The procedure does not impact sexual desire or enjoyment. Some women report improved sexual satisfaction due to reduced anxiety about unintended pregnancy.
• Cancer risk: As mentioned earlier, tubal ligation, especially when the entire tube is removed, may reduce the risk of ovarian cancer.
• Post-tubal ligation syndrome: Some women report experiencing symptoms such as heavy periods, hormonal imbalances, or pelvic pain after tubal ligation. However, scientific evidence for this syndrome is limited, and many experts believe these symptoms may be related to stopping hormonal birth control rather than the tubal ligation itself.

It’s crucial for women considering tubal ligation to have thorough discussions with their healthcare providers about these long-term considerations and how they might impact their overall health and well-being.

Making the Decision: Is Tubal Ligation Right for You?

Choosing to undergo tubal ligation is a significant decision that requires careful consideration. Here are some factors to consider when contemplating this procedure:

• Certainty about future childbearing: Are you absolutely sure you don’t want to have children in the future?
• Relationship status: How might your decision be affected by potential changes in your relationship status?
• Age: Younger women are more likely to experience regret after tubal ligation. Are you confident your feelings won’t change as you age?
• Health considerations: Are there medical reasons why pregnancy would be risky for you?
• Alternative options: Have you explored and considered other long-term contraceptive methods?
• Partner involvement: Have you discussed this decision with your partner? Would vasectomy be a suitable alternative?
• Religious or cultural beliefs: Are there any personal, religious, or cultural factors that might influence your decision?

It’s essential to have open and honest discussions with your healthcare provider about these factors. They can provide valuable information and guidance to help you make the best decision for your individual circumstances.

How to prepare for a tubal ligation consultation?

If you’re considering tubal ligation, it’s helpful to prepare for your consultation with your healthcare provider. Consider the following steps:

• Write down your reasons for wanting the procedure
• List any questions or concerns you have about the surgery, recovery, or long-term effects
• Bring your medical history, including any previous surgeries or health conditions
• Be prepared to discuss your current contraceptive method and why you’re considering a change
• Think about your future plans and how permanent sterilization fits into them
• Consider bringing your partner to the consultation if they’re involved in the decision-making process

Remember, the goal of this consultation is to ensure you have all the information you need to make an informed decision about your reproductive health.

Tubal ligation Information | Mount Sinai

Sterilization surgery – female; Tubal sterilization; Tube tying; Tying the tubes; Hysteroscopic tubal occlusion procedure; Contraception – tubal ligation; Family planning – tubal ligation

Tubal ligation is surgery to close a woman’s fallopian tubes. (It is sometimes called “tying the tubes.”) The fallopian tubes connect the ovaries to the uterus. A woman who has this surgery can no longer get pregnant. This means she is “sterile.”

Surgical sterilization which permanently prevents the transport of the egg to the uterus by means of sealing the fallopian tubes is called tubal ligation, commonly called having one’s tubes tied. This operation can be performed laparoscopically or in conjunction with a Cesarean section, after the baby is delivered. Tubal ligation is considered permanent but reversals can be done in many cases.

The ovaries are connected to the uterus by the uterine tubes (fallopian tubes). The egg travels through the tube to the uterus.

Description

Tubal ligation is done in a hospital or outpatient clinic.

• You may receive general anesthesia. You will be asleep and unable to feel pain.
• Or, you will be awake and given spinal anesthesia. You may also receive medicine to make you sleepy.

The procedure takes about 30 minutes.

• Your surgeon will make 1 or 2 small surgical cuts in your belly. Most often, they are around the belly button. Gas may be pumped into your belly to expand it. This helps your surgeon see your uterus and fallopian tubes.
• A narrow tube with a tiny camera on the end (laparoscope) is inserted into your belly. Instruments to block off your tubes will be inserted through the laparoscope or through a separate small cut.
• The tubes are either burned shut (cauterized), clamped off with a small clip or ring (band), or completely removed surgically.

Tubal ligation can also be done right after you have a baby through a small cut in the navel. It can also be done during a C-section.

Why the Procedure Is Performed

Tubal ligation may be recommended for adult women who are sure they do not want to get pregnant in the future. The benefits of the method include a sure way to protect against pregnancy and the lowered risk for ovarian cancer.

Women who are in their 40s or who have a family history of ovarian cancer may want to have the whole tube removed in order to further decrease their risk of later developing ovarian cancer.

However, some women who choose tubal ligation regret the decision later. The younger the woman is, the more likely she will regret having her tubes tied as she gets older.

Tubal ligation is considered a permanent form of birth control. It is NOT recommended as a short-term method or one that can be reversed. However, major surgery can sometimes restore your ability to have a baby. This is called a reversal. More than half of women who have their tubal ligation reversed are able to become pregnant. An alternative to tubal reversal surgery is to have IVF (in vitro fertilization).

Risks

Risks of tubal ligation are:

• Incomplete closing of the tubes, which could make pregnancy still possible. About 1 out of 200 women who have had tubal ligation get pregnant later.
• Increased risk of a tubal (ectopic) pregnancy if pregnancy occurs after a tubal ligation.
• Injury to nearby organs or tissues from surgical instruments.

Before the Procedure

Always tell your health care provider:

• If you are or could be pregnant
• What drugs you are taking, even drugs, herbs, or supplements you bought without a prescription

During the days before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• If you smoke, try to stop. Ask your provider for help quitting.

On the day of your surgery:

• You will most often be asked not to drink or eat anything after midnight the night before your surgery, or 8 hours before the time of your surgery.
• Take the drugs your provider told you to take with a small sip of water.
• Your provider will tell you when to arrive at the hospital or clinic.

After the Procedure

You will probably go home the same day you have the procedure. You will need a ride home and will need to have someone with you for the first night if you have general anesthesia.

You will have some tenderness and pain. Your provider will give you a prescription for pain medicine or tell you what over-the-counter pain medicine you can take.

After laparoscopy, many women will have shoulder pain for a few days. This is caused by the gas used in the abdomen to help the surgeon see better during the procedure. You can relieve the gas by lying down.

You can return to most normal activities within a few days, but should avoid heavy lifting for 3 weeks.

If you have the hysteroscopic tubal occlusion procedure, you will need to keep using a birth control method until you have a test called hysterosalpingogram 3 months after the procedure to make sure the tubes are blocked.

Outlook (Prognosis)

Most women will have no problems. Tubal ligation is an effective form of birth control. If the procedure is done with laparoscopy or after delivering a baby, you will NOT need to have any further tests to make sure you cannot get pregnant.

Your periods should return to a normal pattern. If you used hormonal birth control or the Mirena IUD before, then your periods will return to your normal pattern after you stop using these methods.

Women who have a tubal ligation have a decreased risk for developing ovarian cancer.

Isley MM. Postpartum care and long-term health considerations. In: Landon MB, Galan HL, Jauniaux ERM, et al, eds. Gabbe’s Obstetrics: Normal and Problem Pregnancies. 8th ed. Philadelphia, PA: Elsevier; 2021:chap 24.

Rivlin K, Davis AR. Contraception and abortion. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Last reviewed on: 1/10/2022

Reviewed by: John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Tubal Ligation Procedure | Female Sterilization

In This Section

• Sterilization

• How effective is sterilization?

• How safe is sterilization?

• What can I expect if I get a sterilization procedure?

• How do I get a sterilization?

• What are the benefits of sterilization?

• What are the disadvantages of sterilization?

What is sterilization?

Want to make sure pregnancy is not in your future? Sterilization (sometimes called female sterilization, tubal ligation, or “getting your tubes tied”) is a safe and effective surgical procedure that permanently prevents pregnancy.

What are the types of sterilization?

There are a few different types of tubal sterilization procedures: 

• Tubal ligation is a surgical procedure that permanently closes, cuts, or removes pieces of your fallopian tubes.

• Bilateral salpingectomy is a surgical procedure that removes your fallopian tubes entirely.

• Essure sterilization is a tiny coil that a doctor puts in your fallopian tubes to block them — it used to be a common form of sterilization, but Essure is no longer available in the U.S.

How does sterilization work?

Every month, an egg leaves one of your ovaries (called ovulation). The egg moves through one of your fallopian tubes for a few days, waiting for sperm to fertilize it. Pregnancy happens if a sperm cell meets up with one of your eggs, and the fertilized egg implants in your uterus. When your fallopian tubes are blocked or removed after a sterilization procedure, sperm can’t get to an egg and cause pregnancy.

During a sterilization procedure, you’re put to sleep so you won’t feel or remember anything. The doctor pumps gas into your belly so they can see your organs clearly. They make a small cut under your belly button and put a tiny camera inside your belly to find your fallopian tubes. Then they put a tool in through another small cut in your lower belly to close off your fallopian tubes. They’ll use heat, clips, or rings to seal your tubes shut, or remove your tubes altogether.

You still get your period after sterilization — you just can’t get pregnant because sperm can’t get to your eggs.

Is sterilization right for me?

Sterilization is permanent — you should only get sterilized if you’re totally sure you don’t want to be able to get pregnant for the rest of your life.

Sterilization may not be a good choice for you if:

• There’s any chance you’ll want to get pregnant in the future.

• You’re being pressured by your partner, friends, or family.

• You hope sterilization will solve problems that may be temporary — like marriage or sexual issues, short-term mental or physical illnesses, or money problems.

It’s safe for most people to get sterilized. Your doctor will talk with you about your health and life to help you decide if sterilization is right for you.

Does sterilization protect against STDs?

Nope. Sterilization won’t protect you or your partners from sexually transmitted infections. Use condoms to help lower your chances of getting or spreading STDs.

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Sterilization

• 99% effective

• Costs up to $6,000, but can be $0

• Surgical procedure

• Do it once, lasts forever

Sterilization doesn’t protect you from STDs. Use a condom to help stop STDs.

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