Tubal Ligation or Tubal Removal: Which Procedure is Right For Me? | University of Utah Health

Are you happy with your family size? Have you had all the kids that you planned or a few more? Are you considering having your tubes tied? Let’s talk about that.

Sterilization Procedures: Then and Now

Prior to the development of effective hormonal contraception, women choosing to end their childbearing through sterilization procedures had major operations to remove their fallopian tubes or had hysterectomies. Although the history of female sterilization is clouded with cases where women may not have given informed consent, since 1960, about the same time that birth control pills came on the market, techniques for female sterilization became less invasive and easier to do with less risk. The term used for these easier techniques is tubal ligation.

Now, there are many techniques and the timing for this procedure, and about 30% of American women have had a tubal ligation. Techniques include taking a suture and tying it around a loop of tube and then cutting the tied-off loop of the tube out. And then there are a number of techniques like this to remove the middle segment of the fallopian tube so sperm cannot get to eggs and fertilize them. Other techniques include putting a clip to close the tube permanently, or cauterize or burning the tube in the middle to close it.

The timing could be shortly after a baby is born, within a day or so, while the woman is still in the hospital, or at the time of Caesarian section when the tube is right there, or anytime between children, when the procedure can be done by laparoscopy. But half of tubal sterilizations occur right after the baby is delivered vaginally or by Caesarian, and that comes to about 350,000 tubal sterilizations a year.

The word “ligation” in the term “tubal ligation” means to tie. This unfortunate term translates into tying your tubes. This has led some women to assume if you had your tubes tied, it would be simple to untie your tubes, like untying your shoelaces. Tubal ligation can be reversed surgically for women who regret having had a tubal sterilization, but it’s expensive and it doesn’t always work.

Decreasing Cancer Risk with Tubal Sterilization

For years, it has been noted that tubal sterilization decreased the risk of some types of ovarian cancer by 30% to 50%. Now, that’s significant. Now, we’re getting to the main topic of this little podcast. The lifetime risk of ovarian cancer in the U.S. is about 1.3 out of 100 women. Ovarian cancer is particularly deadly because it spreads early, and we don’t have any early detection methods the way we do with breast cancer, like a mammogram, or cervical cancer with a Pap smear. Ovarian cancer comes in different types, but one of the most common types, serous ovarian cancer, may often actually arise in the end of the fallopian tube near the ovary. For this reason, women who have genetically-linked risks of ovarian cancer, such as the BRCA1 and 2 mutations with familial breast and ovarian cancer, are recommended to have their ovaries and their fallopian tubes removed when they finished having their families.

Recent studies have suggested that women who are planning a tubal sterilization who have their tubes completely removed have about a 60% reduction in the risk of these serous ovarian cancers compared to women who didn’t have a tubal sterilization or women who just had part of their tubes removed at tubal ligation.

Pros and Cons of Ligation vs. Sterilization

Now, there are other advantages to having the entire tube removed if a woman is planning a tubal sterilization. Tubal ligations have a known failure rate, a pregnancy after the procedure of as much as 3 to 5 pregnancies per 100 women over 10 years who had their tubal sterilization at the time other than when the baby was delivered, with laparoscopy. Women who had their tubes completely removed have a much lower failure rate, almost zero. Women who have a tubal ligation also have an increased risk of ectopic pregnancy or tubal pregnancy if they do become pregnant compared to women who’ve had their tubes removed completely.

Now, we know that putting a little clip on the tube, burning the tube, or cutting a loop of tube is quite simple and takes a very short time. Anybody could do it. Removing the whole tube takes a little longer. Studies recently published looked at women who were randomized to removing the whole tube at the time of tubal sterilization or cutting a loop out at the time of Caesarian section an easy time to do it as the tube is right there to look at and operate on.

One study used an advanced technique to take out the tube completely and found that time was only about five minutes longer compared to the standard procedure of taking out just a part of the tube. Another study using older techniques suggested took about 10 to 15 minutes longer. There was not significantly more blood loss with taking the whole tube out compared to just part of the tube.

The other issue is that if the entire tube is removed, you cannot come back and have your tubes untied or put back together again the way you might if only a part of the tube is removed. Of course, these days, many women who choose to have more children after tubal sterilization will use in vitro fertilization and it doesn’t matter if you have part of a tube or no tube. Although IVF is expensive, so is surgically putting the tube back together again. And in some cases, IVF may be more successful.

What to Consider before Tubal Sterilization

So if you’re planning a tubal sterilization, your tubes, not your husband’s tubes, that would be a vasectomy, consider the following. If you have a BRCA1 or 2 mutation or have a strong family history of ovarian cancer, you should have your entire tubes removed when you have your tubal sterilization, whether it’s right after the baby is delivered or sometime later. And often, women also had their ovaries removed.

If you have concerns about ovarian cancer, and you’re planning a tubal sterilization, talk with your OB-GYN about taking the whole tube out. If you don’t have a family history of ovarian cancer and the concern of the risk of ovarian cancer isn’t high on your worry list, think about the benefits and risks that were just mentioned and discuss your options with your OB-GYN. Many OB-GYNs are discussing tubal removal as an alternative to tubal ligation when women are planning a tubal sterilization. Whatever you choose, we’re glad you are informed about new options and old options in planning your family, and thanks for joining us on The Scope.

updated: September 10, 2020
originally published: August 9, 2018

How Old Do You Have to Be to Get Your Tubes Tied? Laws and Facts

Tubal ligation, or getting your tubes tied, is a form of permanent birth control. It is also referred to as female sterilization.

Tubal ligation is typically done as a laparoscopic surgical procedure. Your surgeon will make small incisions in your abdomen that provide access to the fallopian tubes. The tubes are cut and sealed, or closed with clamps or rings. Tubal ligation stops an egg from traveling into the uterus, where it could have been fertilized by sperm.

Tubal ligation is designed to permanently eliminate the possibility of pregnancy. For this reason, medical professionals sometimes try to dissuade young people with a uterus from having the procedure. However, there is no legal age requirement for tubal ligation.

There is no legal age requirement for getting your tubes tied in the United States. There may, however, be restrictions on who will pay for the procedure, especially if you’re on Medicaid or have health insurance through another federally funded program.

There are also variations about consent in state law. Medicaid requires a consent form to be signed between 30 and 180 days prior to getting the procedure.

In Massachusetts, Medicaid recipients can’t legally sign a consent form for tubal ligation if they’re under 18. In some states, such as Tennessee, California, and others, you must be 21 before you can sign a consent form.

Consent form requirements don’t legally prohibit your ability to get a tubal ligation. Rather, they eliminate the possibility that Medicaid will pay for the procedure.

Most private insurance plans provide coverage for tubal ligation.

Under the Affordable Care Act, any plan that’s purchased through the Health Insurance Marketplace must cover this procedure without charging a copayment or coinsurance, even if you haven’t met your deductible.

Certain organizations and institutions that provide employer-based health insurance may offer plans that don’t include coverage for birth control methods of any kind, including tubal ligation. To be exempt from this requirement, the organization must certify a religious objection to contraceptive coverage. These organizations include:

• churches and other houses of worship
• nonprofit religious hospitals
• nonprofit religious institutions of higher education

No matter your age, there may be many reasons why you might be considering this procedure. They include health and economic concerns, as well as simply not wanting any or more children.

Health issues with pregnancy

Certain health conditions might cause a pregnancy to be dangerous. These include:

• heart disease
• diabetes
• preeclampsia
• stroke

If you have concerns about your health and how pregnancy might affect you, talk with a medical professional. In some instances, it may make sense to have a tubal ligation. In others, treatments might be available that will make pregnancy safer for you.

Genetic concerns

If you or your partner has a genetic condition, or you have a family history of a specific disease, you may be concerned about passing it on to a child. If so, talk with a medical professional. They may recommend carrier screening.

Carrier screening is a genetic test that lets you know if you carry genes for specific genetic disorders. You might also opt to get pregnant and have your embryos tested for the condition instead. This is known as preimplantation genetic testing (PGT). PGT are types of procedures that can be done in conjunction with in vitro fertilization (IVF).

Mental health

Some studies indicate that sterilization regret, which can lead to depression, occurs in around 28 percent of people who get a tubal ligation. The amount of time that has passed since the procedure took place is noted as a potential cause.

Talk with your doctor about your reasons for getting a tubal ligation. In some instances, it may make more sense to opt for long-term birth control, such as an intrauterine device (IUD), instead. Of course, it’s up to you what you wish to do with your body and fertility potential.

Keep in mind that situations fluctuate and change over time. The reasons you have today may be different tomorrow.

After giving birth

Some people opt to have a tubal ligation immediately after giving birth. If you’re on Medicaid and currently pregnant, talk with your doctor about the timing for signing a consent form. You can sign anywhere from 30 to 180 days prior to getting your tubes tied, so it may make sense to fill the consent form out once your first trimester has ended.

If you already have children and are completely confident you won’t want more, even if you have a change of partner, tubal ligation may be a good choice for you.

It may also be a good choice if you’re completely sure you’ll never want any children at all, under any circumstances.

Tubal ligation is designed to be permanent. If you have the slightest doubt about someday wanting children, it is not the right choice for you.

Feeling pressured

Getting a tubal ligation should be solely your decision. If you’re under pressure from your parents, partner, friends, or anyone else, it’s probably not a good choice for you. If you’re in a relationship, you may wish to make this decision along with your partner. However, the final vote about what to do with your body should always be your own.

If you are transgender

If you and your partner both have uteruses, you may assume your partner will be the one who carries a pregnancy. In some circumstances, you may find out it will be challenging for them to do so, for medical reasons. In this instance, you may wish to rethink your decision to tie your tubes.

If you’re transgender and were born with a uterus, you may be considering tubal ligation along with other surgical procedures or hormonal therapies. Keep in mind that trans men do get pregnant by choice, without compromising their transition. You may or may not decide you want the option to get pregnant later on in life.

Try not to let fear of other people’s opinions or concerns about social stigma influence your decision.

If you think a reversal is easy

Don’t let myths about the ease of reversing a tubal ligation influence your decision. Despite what you might have heard, tubal ligation reversal cannot always be done and is not always successful. The extent of damage to your tubes, and the amount of time that has passed since the procedure, are both factors.

In addition, tubal ligation reversal is expensive and not covered by insurance. It may also increase your risk of having a dangerous ectopic pregnancy.

If you’re in your 20s, your doctor may not take your request for a tubal ligation seriously. Keep in mind that in most instances, they’re simply coming from a place of concern that you will regret your decision someday. Even so, you don’t have to accept their refusal to do the procedure as final.

If your doctor refuses to do the tubal ligation, you can remind them that American College of Gynecologists and Obstetricians (ACOG) guidelines state that it is ethically permissible to do this procedure in young people. ACOG guidelines also state that respect for a woman’s reproductive autonomy should be their guiding factor.

You can also opt to find another doctor who respects your decision fully.

Tubal ligation is a form of permanent sterilization. There is no age requirement for this procedure. However, federally funded health insurance plans, including Medicaid, may not pay for it if you’re under 21.

Tubal ligation may or may not be the right choice for you. No matter your age, if you think you may wish to have children someday, you may be better off with long-term birth control rather than sterilization.

Tubal ligation cannot always be successfully reversed.

Hysterosalpingography (HSG), HSG of the fallopian tubes, x-ray of the fallopian tubes in Nizhny Novgorod in the Tonus clinic, checking the patency of the fallopian tubes, obstruction of the fallopian tubes

To successfully assess the patency of the fallopian tubes, hysterosalpingography is performed on days 5-11 of the cycle, although for the diagnosis of certain diseases (uterine fibroids) the phase of the cycle does not matter, the main thing is that there should be no menstruation during the procedure.

Hysterosalpingography technique

For tubal HSG, water-soluble radiopaque agents are used. They are introduced through a catheter. Next, a series of x-rays is taken, with the help of which the patency of the fallopian tubes, the presence of pathological formations in the uterine cavity, etc. are assessed.

If a woman has obstruction of the fallopian tubes , then the contrast cannot fill them completely and go into the pelvic cavity

The interpretation of the results and the issuance of a conclusion is carried out by a radiologist.

X-ray of the fallopian tubes has a number of contraindications.

Absolute contraindications to hysterosalpingography examination of the fallopian tubes:

• History of allergic reactions to radiopaque agents
• Cardiovascular insufficiency
• Renal failure
• Pregnancy

After the procedure for a couple of days, you may experience spotting and mild pain in the lower abdomen. There is no need to worry about this. The use of antispasmodics is recommended to reduce pain.

Benefits of hysterosalpingography:

• Minimally invasive procedure
  This is a minimally invasive procedure that does not cause much discomfort to the woman
• Fast procedure
  The method is quite fast and allows to check the fallopian tubes in a short time. Timely diagnosis is the key to successful and effective treatment
• Under the pressure of a substance introduced into the fallopian tubes, their obstruction can independently recover right during the procedure
• Safe procedure
  X-ray used in diagnostic doses is harmless

Recommendations for hysterosalpingography (HSG)

HSG is carried out from 5 to 11 days of the menstrual cycle

Tests required for HSG:

• CBC (the result is valid for 10 days)
• OAM (result is valid for 10 days)
• Cleanliness swab (valid for 10 days)
• HIV (result valid for 1 month)
• Hepatitis B and C (result valid for 1 month)
• RW (result valid for 1 month)

Bring with you:

• Doctor’s referral
• Passport
• Robe
• Slippers
• Panty liners for critical days

Two days before the examination, it is necessary to refrain from sexual activity, as well as to epilate the intimate area.

Hysterosalpingography in Nizhny Novgorod. Where can you check the fallopian tubes?

Hysterosalpingography in Nizhny Novgorod is performed in the network of clinics “Tonus”. X-ray of the fallopian tubes allows you to diagnose various pathologies using high-tech equipment. After the procedure, you will need a second consultation with an experienced gynecologist to discuss the results of the examination performed and decide on further actions.

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