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.

Pros & Cons of Getting Your Tubes Tied

Written by Diana Reese

Medically Reviewed by Neha Pathak, MD on January 03, 2023

• What Is Tubal Ligation?
• The Pros of Tubal Ligation
• The Cons of Tubal Ligation
• What Happens During Tubal Ligation?
• Tubal Ligation Recovery
• How Soon Can I Have Sex After a Tubal Ligation?
• Tubal Ligation Cost
• Other Methods of Birth Control
• More

Tubal ligation — also known as having your tubes tied — is a kind of surgery that will keep you from ever getting pregnant. If you’re thinking about having it done, it’s important to understand the procedure and the advantages and disadvantages before making a decision.

“Tubal” refers to your fallopian tubes, and “ligation” means to tie off. Fallopian tubes are thin tubes that connect each of your ovaries to your uterus — they’re passageways for unfertilized eggs. In a tubal ligation, you’ll have surgery to cut or block your fallopian tubes. That way, the eggs released by your ovary each cycle can’t meet up and be fertilized by sperm.

It’s permanent. This is a big plus if you don’t want to have children or you don’t wish to have any more.

It works. Only about 1 in 200 of those who’ve had a tubal ligation get pregnant. That’s less than 1%.

It doesn’t affect your hormones. It won’t change your periods or bring on menopause. And it doesn’t cause the side effects that birth control pills can, like mood swings, weight gain, or headaches, or the ones sometimes caused by IUDs, like cramps, heavier periods, or spotting.

You don’t need to remember to do anything. You don’t have to put in a diaphragm, take a pill, use a condom, or count days on the calendar to avoid pregnancy. That may make you feel more relaxed about sex.

It may lower your chances of ovarian cancer. Scientists aren’t sure exactly why this happens, but research has shown that tubal ligation can greatly lower the odds of this type of cancer.

If pregnancy would be a health risk for you, or if you or your partner has a genetic disorder that would be risky to pass on to a child, tubal ligation may be right for you.

It’s permanent. While it can sometimes be reversed with surgery, that’s not always possible. Only around half of those who have a reversal are able to get pregnant. Unless you’re certain you’ll never want to get pregnant, tubal ligation isn’t right for you.

It doesn’t protect against STDs. You’ll need to use condoms to prevent sexually transmitted diseases, including HIV.

Pregnancy. It’s rare, but tubal ligation can fail. If your tubes aren’t completely closed, you can get pregnant.

It may lead to an ectopic pregnancy. If you do get pregnant, you’re more likely to have this type of pregnancy, which occurs someplace other than the uterus, usually in one of your fallopian tubes. Ectopic pregnancy may cause the tube to burst. This can lead to severe bleeding. You’ll need surgery right away to fix it.

There are risks to surgery. Problems are very rare, but this type of surgery can cause bleeding or damage your bowel, bladder, or major blood vessels.

After tubal ligation, you might have a rapid decline in the hormones estrogen and progesterone. Whether this may occur is often debated but it is referred to as post-tubal ligation syndrome (PTLS). Symptoms are a lot like menopause: hot flashes, night sweats, a dry vagina, mood swings, trouble sleeping, a lower sex drive, and irregular periods. Or you could have heavy, painful periods.

The cut made from your surgery can get infected, or you might react to the anesthesia. There’s also a small chance of lingering belly pain.

Your risk for these types of issues is higher if you’re overweight, have had surgery in the same area before, or have diabetes, lung disease, or pelvic inflammatory disease.

Burns to your bowel or skin are also possible if your surgeon uses electric current to seal off your fallopian tubes.

You’ll get your tubal ligation in a hospital or at an outpatient surgical clinic. The doctor will give you medicine to make you “sleep” so you won’t feel anything during the surgery.

The surgeon will make one or two small cuts in your belly, then inflate it with gas. They’ll put a long, thin device called a laparoscope into one cut to look into your belly. They’ll put tools into the other to cut, seal, band, clamp, or tie your fallopian tubes shut.

Your surgeon will then stitch up the cuts on your belly. You can go home a few hours later to rest.

Your incision sites (where you got the cuts) may be a little uncomfortable afterward. You might also have pain or cramps in your belly, fatigue, mild vaginal bleeding, dizziness, or a sore throat from the anesthesia.

If the surgeon used gas to inflate your abdomen to do the tubal ligation, you may have some bloating. It could cause belly or shoulder pain. This should go away in a couple of days.

Wait 48 hours after your tubal ligation to bathe or take a shower. Don’t rub or scrub your incision sites for at least a week. Pat your skin dry carefully after your bath or shower.

You should be able to get back to your normal routine a few days after your tubal ligation. But don’t lift anything heavy until your doctor says it’s safe to do so.

You should be able to have sex a week after your tubal ligation.

You don’t need to use a backup form of birth control after the procedure, but it won’t protect you from sexually transmitted diseases (STDs). Using a condom during sex will help prevent STDs.

The cost of your tubal ligation may vary based on where you live, your doctor, and your insurance coverage. Average costs range from $1,500 to $6,000.

Up to 20% of those who have tubal ligation eventually wish they hadn’t, so it’s important to think about all the possibilities. Those younger than 30 are more likely to change their minds later.

If you’re not sure, you might think about these long-term options for birth control:

Vasectomy. If you’re in a committed relationship, your partner might be willing to get this procedure that keeps sperm from getting into semen. It’s a safer procedure than a tubal ligation, and it can be done while the patient is awake.

IUD. Your doctor puts this small T-shaped plastic device into your uterus. It can stay in place from 3 to 10 years. IUDs are more than 99% effective in preventing pregnancy.

Implant. Your doctor puts a plastic rod about the size of a matchstick under the skin of your upper arm. It releases the hormone progestin and can stay in place for up to 3 years.

Next In Blood Clot Risk With Birth Control

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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.

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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, anesthesia and surgical techniques 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.

To make an appointment for tubal ligation, appointment with a specialist, call the call center or fill out the online form on our website. Administrators will help you choose a convenient time for a visit to the clinic, answer all your questions.

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Laparotomic tubal sterilization – Rostov-on-Don, Bushtyreva clinic

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Female sterilization.

Medical and legal aspects.

Family planning allows people to choose how many children they have and when they are born. Planning tools are the use of contraception, diagnosis and treatment of male and female infertility. Modern medicine has given women the opportunity to independently decide whether they will have a pregnancy and what interval between the birth of children is preferable for them. This has a beneficial effect on the health and well-being of couples.

Both female sterilization (tubal ligation) and male sterilization (vasectomy) are both contraceptive and family planning methods. Statistics indicate that the correct use of modern methods of contraception reduces the number of induced abortions, including illegal ones.

Medical sterilization has one of the lowest Pearl Index, which indicates its high efficiency. Recovery takes about two weeks. General anesthesia is usually used, so you should pass all the necessary tests, as well as make sure that you are not currently pregnant. At the same time, this procedure has its pitfalls, which we will discuss below.

Can I use sterilization?

The Ministry of Health of the Russian Federation imposes some restrictions on the use of sterilization.

The operation is allowed to be performed by:

• persons over 35 years of age;
• persons with two or more children;
• people with certain diseases and conditions from the list attached to the Order (these include, for example, uterine rupture, several cesarean operations, serious cardiovascular diseases, severe diabetes, etc.)

If your illness is not on the list, you have the right to undergo a commission consisting of an obstetrician-gynecologist, a doctor in the specialty that deals with your illness, and the head of the department of a medical institution.

The legal sterilization procedure is entirely voluntary, no one has the right to force you to undergo it. Even in the case of persons who have been declared incompetent, a referral for sterilization is issued only on the basis of a court decision.

Is sterilization irreversible?

This method is claimed to be irreversible. In reality, this is not entirely true. Modern advances in microsurgery make it possible to restore the patency of the tubes with their minor traumatization. But success will depend on the method of sterilization, and on the individual characteristics of the patient. The percentage of successful reconstruction of tubal patency varies from 60% to 80%. Therefore, doctors prefer to present this procedure as irreversible, since there is no guarantee of a subsequent possibility of becoming pregnant.

Will I definitely never get pregnant again?

The Pearl Index for surgical ligation of the fallopian tubes in women is 0.1. This means that for every 1000 women during the first year after the operation, there may be one pregnant woman. Unfortunately, there are no 100% effective methods of contraception. But after sterilization, the rate of unplanned pregnancies is extremely low, only abstinence can be more reliable.

Won’t health problems start after that, decrease in libido, sharp aging of the skin?

It is a common misconception that after tubal ligation, female hormones will stop being produced. But they play an important role for the condition of the skin, hair and figure. In fact, the operation does not affect the ovaries in any way – the main supplier of female sex hormones. Your appearance will not change after sterilization.

What if I meet one of the criteria (for example, having 2+ children), but the doctor refuses to sterilize?

If a doctor simply refuses to perform an operation for no reason, you have the right to ask for the reason for the refusal in writing. After that, you can write a statement to the head physician of the institution. Give one copy to him, and the second is certified by a seal in the registry, so that you have confirmation that the application has been accepted. If the application is refused to be accepted, it can be sent to the institution by mail.