Contraception – tubal ligation – Better Health Channel

What is tubal sterilisation?

Tubal sterilisation, also known as tubal ligation or ‘having your tubes tied’, is a permanent method of contraception that you can choose if you are sure that you do not want to have children in the future.

Using keyhole surgery, the surgeon puts clips on the fallopian tubes to block the sperm and egg from meeting. In some instances, the fallopian tubes are removed rather than clipped.

How tubal sterilisation prevents pregnancy

When you ovulate, an ovum (egg) is released from the ovary and moves down the fallopian tube. If the ovum meets a sperm, conception may happen.

Tubal sterilisation blocks the path of the sperm through the fallopian tube. Eggs are still released by the ovaries, but are broken down and safely absorbed by the body.

The ovaries are not affected by sterilisation. They will continue to release the same hormones and your periods will keep happening as usual. Sterilisation does not cause menopause or affect your sex drive or enjoyment of sex.

Even though tubal sterilisation can often be reversed, it is considered to be a permanent method of contraception.

Tubal sterilisation and issues to consider

If you are thinking about sterilisation, issues to talk about with your doctor include:

• your reasons for wanting to be sterilised
• whether tubal sterilisation is the best option for you
• whether removal of the fallopian tubes is a good option
• whether tubal sterilisation is recommended for someone of your age
• whether other methods of contraception might be more suitable
• any side effects, risks and complications of the procedure.

Women with a disability who are incapable of giving their own consent

Under the Guardianship and Administration Act 1986, sterilisation is defined as a ‘special medical procedure’.

A person is considered incapable of consenting to a special medical procedure if they:

• are incapable of understanding the general nature and effect of the procedure
• are incapable of indicating whether or not they consent to the procedure.

Where a person with a disability does not have the capacity to consent to special medical procedures, a guardian cannot provide the consent for sterilisation on their behalf.

However, the Victorian Civil and Administrative TribunalExternal Link can consider an application for sterilisation and provide the consent where agreed.

Tubal sterilisation operation procedure

Tubal sterilisation is an operation that is usually done under general anaesthetic using a procedure called laparoscopy.

Between one and 3 small cuts are made around the navel (belly button). A telescopic device called a laparoscope is put in through one of the cuts.

A small camera at the tip of the laparoscope sends an image to a screen for the surgeon to see the internal organs. The surgeon works through these small holes to:

• put clips on the fallopian tubes, or
• put clips on the fallopian tubes and cut them, or
• cut and seal the fallopian tubes with heat (diathermy), or
• remove the fallopian tubes.

After tubal sterilisation

After having the operation, you can expect to:

• have some pain and nausea in the first 4 to 8 hours (you may need pain medication for a short time)
• have some abdominal pain and cramps for 24 to 36 hours
• go home the same day
• have no changes to your periods
• have the stitches taken out after 7 to 10 days
• see your surgeon for a check-up in 6 weeks.

Risks and complications of tubal sterilisation

Possible risks and complications from the tubal sterilisation operation include:

• an allergic reaction to the anaesthetic
• damage to nearby organs, such as the bowel or ureters
• infection, inflammation and ongoing pain
• haemorrhage (very heavy bleeding)
• infection of the wound or one of the fallopian tubes.

Longer-term possible risks and complications of tubal sterilisation include:

• pregnancy – the method is more than 99% effective, but there is a very small chance of the tubes getting unblocked, which would mean a pregnancy could happen
• ectopic pregnancy – where a pregnancy develops outside the womb (usually in the fallopian tubes) rather than in the uterus (womb).

Caring for yourself after tubal sterilisation

It is important to follow the advice of your doctor or surgeon. Suggestions for caring for yourself after having surgery include:

• Avoid intense exercise for 7 days.
• You can take pain medication to manage the pain, but see your doctor if the pain is very strong.
• You can usually go back to work within a few days.
• You can start having sex again as soon as you feel ready. This is because the procedure starts working straight away.

Reversing tubal sterilisation

A person usually chooses sterilisation if they are sure that they do not want to have children in the future, but circumstances can change.

Tubal sterilisation can sometimes be reversed, but this is not always successful. Success rates depend on the age of the person having the reversal, and the way in which the tubal sterilisation was performed. If the fallopian tubes were removed, this cannot be reversed, although IVF is possible.

To reverse the procedure, the fallopian tubes are reached through a cut in the abdomen and the surgeon re-joins the cut tubes using very small stitches.

Generally, the chance of getting pregnant after reversal of a tubal sterilisation is about 60%, with about 50% having a baby after a reversal procedure. The partner’s age also impacts a woman’s ability to get pregnant.

The risk of ectopic pregnancy after a successful reversal is quite high. This is because scar tissue can stop the fertilised ovum from moving down the fallopian tube.

Tubal occlusion

Tubal occlusion is a sterilisation procedure that, since 2017, is no longer available in Australia.

The procedure involves putting a tiny, flexible device called a micro-insert (EssureTM) into each fallopian tube. After having the procedure, the body grows scar tissue around the micro inserts, which blocks the fallopian tubes.

Other methods of contraception

Other contraceptive methods include:

• hormonal implants
• hormonal and copper intrauterine devices (IUDs)
• hormonal injections
• oral contraceptive pills, such as the combined pill and the progestogen only (mini) pill
• vaginal rings
• barrier methods, such as condoms
• vasectomy, which is a relatively simple method of permanent contraception.

Protection from sexually transmissible infections

Sterilisation does not give protection from sexually transmissible infections (STIs). It is important to practise safer sex, as well as to prevent an unintended pregnancy.

The best way to lessen the risk of STIs is to use barrier methods such as condoms with all new sexual partners. Condoms can be used for oral, vaginal and anal sex to help stop infections from spreading.

Where to get help

• Your GP (doctor)
• 1800 My OptionsExternal Link Tel. 1800 696 784 – for information about contraception, pregnancy options and sexual health in Victoria
• Pharmacist
• Many community health services and public hospitals will have a family planning clinic, a sexual health clinic or women’s health clinic
• Sexual Health Victoria (SHV)External Link – book an appointment online, call Melbourne CBD Clinic: Tel. (03) 9660 4700, Box Hill Clinic: Tel. (03) 9257 0100 or (free call): Tel. 1800 013 952. These services are youth friendly
• Some private clinics which offer abortion also offer contraceptive services.

What Is Laparoscopic Tubal Sterilization?

Laparoscopic tubal sterilization is
surgery to block the fallopian tubes. It may be called having your tubes tied. It’s done
to
prevent pregnancy. During surgery, a thin, lighted tube called a laparoscope is used.
This
allows surgery to be done through small incisions. Tubal sterilization is considered
permanent birth control. Having it means you won’t be able to get pregnant again.
In some
cases, a reversal can be tried, but it’s not often successful. Never plan to have
this
procedure if you think you may want a reversal later.

Discuss all of your choices with your
partner and your healthcare provider.

How effective is surgery?

This surgery is one of the most
effective birth control methods. But in very rare cases, pregnancy can still occur.
In
some cases, the pregnancy is normal. In other cases, a fertilized egg may start to
grow
in a fallopian tube. This is called a tubal (ectopic) pregnancy. It needs emergency
care. Talk with your healthcare provider if you have questions about this risk.

The female reproductive system

During each menstrual cycle, one of
the ovaries releases an egg. This egg travels into a fallopian tube. After vaginal
sex,
sperm can enter the tube and fertilize the egg. The fertilized egg then implants in
the
wall of the uterus. If the egg isn’t fertilized, it’s absorbed by the body. Or it’s
discharged during your monthly period. 

After tubal sterilization

After surgery, each ovary still
releases an egg. But the egg’s passage through the fallopian tube is now blocked.
Sperm
also can’t pass through the tube to the egg. When egg and sperm can’t meet, pregnancy
can’t happen. The egg is absorbed by your body. You’ll keep having menstrual periods
until menopause.

Problems with tubal sterilization

Problems with tubal sterilization
are rare. They can include:

• Infection

• Bleeding

• Damage to blood vessels,
  nerves, or muscles

• Damage to the bladder,
  ureters, or bowel, needing surgical repair

• Blood clots in the legs or
  lungs

• Failure to block the
  fallopian tubes (very rare)

• Formation of scar tissue

• Hernia formation

Is it possible to get pregnant after sterilization.

MAMA clinic

Sterilization is the most radical and extremely effective method of contraception. It is resorted to by women who do not want to become pregnant in the future, and those who are contraindicated to bear a child. But if the situation changes, is it possible to restore reproductive function?

What is the essence of sterilization? Pregnancy occurs if the egg leaves the ovary during ovulation, meets the spermatozoon in the fallopian tube and then, already fertilized, descends into the uterus, where it is fixed and continues to develop. During sterilization, the fallopian tubes are made impassable (cut, stimulate the formation of adhesions, etc.), and the egg cannot enter the uterus, and the sperm cannot get to it. Sterilization is one of the most reliable methods of contraception: the chance of getting pregnant within a year is less than 1 percent.

However, this is often an ectopic pregnancy (in a third of cases, with risks increasing in women who have been sterilized before the age of 30 and those who have chosen bipolar coagulation).

But if a woman changes her mind, if the diagnosis, which was a contraindication to carrying a child, is removed, can she get pregnant? In this case, there are two ways:

1. try to make the tubes passable by surgery

2. turn to assisted reproductive technologies, that is, in this case, IVF.

Age

After the age of 35, the chance of pregnancy decreases: ovulation occurs less frequently, egg quality decreases. Therefore, the world practice is as follows: after sterilization, women at this age are shown in vitro fertilization. In the IVF protocol, the best eggs are selected, embryos are cultured, and then those that could survive to the fifth day are transferred to the uterus. At MAMA, we use proprietary media to increase pregnancy rates for women over 35 that help the embryos grow stronger. And closer to 40 years, androgenic priming will be needed. Androgenic priming is hormone therapy (hormonal levels drop and drug replacement is needed). Testosterone hormone preparations contribute to the production of more eggs during the IVF program and more frequent pregnancies.

Studies have shown that up to 35 years of age, the frequency of pregnancies after IVF and surgical restoration of patency of the fallopian tubes is approximately the same. (According to the available data, obstruction of the tubes does not affect the effectiveness of in vitro fertilization.)

Length of the fallopian tubes

In order for the fallopian tubes to function normally after the operation and ensure the highest possible chances of becoming pregnant, they must be greater than 4 cm. Normally, their length is 10 cm. But when sterilizing and restoring patency, they often need to be cut (how much depends on the chosen sterilization method). If a woman under 35 has tubes less than 4 cm, she is advised to choose IVF.

Cost

Surgical restoration of patency of the fallopian tubes is cheaper than IVF. But you can decide what is best for the family situation only together with an infertility specialist – a reproductive specialist.

Time

The time elapsed between sterilization and the desire to restore reproductive function directly affects the success of a particular method.

If you have any questions about how to get pregnant after sterilization, you can contact our doctor online or make an appointment by phone +7 (495) 921-34-26.

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Tubal ligation in Voronezh – price for surgical sterilization

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Sterilization (tubal ligation) is an irreversible form of female contraception. The essence of the surgical procedure is the artificial violation of the patency of the body, in which the fusion of the sperm with the egg becomes impossible. Anatomical blockade is performed by ligation using electrocoagulation.

The method is very reliable for those who need to avoid unwanted pregnancies. When prescribing an operation, it should be borne in mind that the consequences are irreversible.

One of the indisputable advantages of the technique is that the quality of life remains the same. After bandaging, the menstrual cycle does not change, sexual desire and libido are preserved.

Readings

Tubal ligation is prescribed in the presence of the following conditions:

• repeated caesarean section or scar on the uterus after myomectomy;

• have a history of cancer;

• diseases of the cardiovascular system;

• diseases of the endocrine, digestive, urinary or musculoskeletal systems;

• pathology of blood and hematopoiesis;

• congenital anomalies;

• psychical deviations.

After 35 years, sterilization can be carried out at the request of the woman. To do this, it is necessary that a prerequisite is met – the presence of two or more healthy children. Before the procedure, a preliminary conversation is held. The doctor describes the upcoming stages, explains the pros and cons of the operation. The consequences are described in detail, which may differ in each case.

If there are medical indications, the patient signs an individual voluntary consent to the surgical intervention.

Contraindications

The limitations of the procedure include:

• acute inflammation of the genital organs;

• blood clotting disorders;

• obesity II-IV degree;

• severe pathology of the cardiovascular system;

• some types of neoplasms on the genitals;

• acute kidney and liver diseases;

• pulmonary hypertension.

All contraindications are individual and are discussed with the doctor. The doctor makes a decision after a thorough assessment of the results of the study, anamnesis and the individual characteristics of the patient’s body.

If necessary, the surgeon will prescribe additional research methods, techniques of specialized specialists. Recommendations for proper home preparation are given on the eve of the intervention.

Sterilization at the SOVA Clinic

Surgical contraception is performed by various methods. A specialist should choose the right one.

Preparation

Before the procedure, a comprehensive examination is carried out. It is necessary to pass a number of tests and undergo functional diagnostics:

• general and biochemical analysis of blood, urine;

• tests for HIV, syphilis, hepatitis;

• ECG with interpretation;

• smear from the genital tract and cervical canal;

• examination by a gynecologist;

• anesthesiologist consultation.

The intervention is performed under general anesthesia or epidural anesthesia with laparoscopic access.

Laparoscopy

Through small punctures in the abdominal cavity, endoscopic equipment and instruments are introduced. For better visualization of the surgical field, carbon dioxide is injected. Then the fallopian tubes are sealed using special devices, thereby blocking sperm from accessing the egg. At the end of the insertion site, the trocars are sutured with a cosmetic suture.

Among the advantages of this option, it should be noted:

• short rehabilitation period;

• minimal risk of complications;

• after 2-3 days you can return to the normal rhythm of life.

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Rehabilitation

The following recommendations must be followed:

1. Give up physical activity for 1-2 weeks, until complete recovery.

2. Observe sexual rest in the first 10-14 days after discharge from the hospital.

3. Do not visit saunas, pools, baths. Do not take hot baths for 1 month. Wash in warm water at the optimum temperature.

4. There is no need to use additional methods of contraception.

The risk of complications is minimal. In the first hours after the intervention, pain in the abdomen is possible. To stop the symptom, take painkillers prescribed by a doctor.

If you experience non-specific complaints, you should consult a doctor.

Make an appointment

Result

The success rate for tubal ligation is 99.9%. According to world statistics, conception occurs only in 5 out of 1000 women and only in cases where the procedure was performed incorrectly.

If the patient later decides to have a child, then IVF becomes the most affordable option. However, the effectiveness depends on many factors. In some situations, surgical treatment may be recommended.

Tubal ligation is performed once and is a guarantee to exclude unwanted pregnancy. This keeps the menstrual cycle going. The production of hormones goes at the same pace, so there is no danger of a decrease in sexual desire. The procedure does not affect the nature of the menopause.

Total

Over the past 10 years, anesthetic management and surgical technique have been improved. Surgical sterilization has become the most reliable, safe and economical way to prevent pregnancy.

In the SOVA clinic, all surgical interventions are performed in modern operating rooms equipped with top-end equipment. In one place, you can quickly and comfortably undergo a preoperative examination, consult a doctor.

Recovery after surgical interventions takes place in a round-the-clock hospital under the supervision of specialists. Each room has a bathroom, air conditioning, TV and free Wi-Fi.