Tubal Sterilization

Tubal sterilization is a procedure in which the fallopian tubes are permanently sealed off in order to prevent pregnancy. Once the fallopian tubes are sealed, the sperm and egg cannot meet, and pregnancy does not occur. Tubal sterilization was first reported in 1880, and now used worldwide by more couples than any other method of contraception.

Tubal sterilization has many advantages for the right candidates.

First, it is extremely reliable: Failure rates under 1% are expected with all types of tubal sterilization. Second, tubal sterilization requires no ongoing precautions: There are no prescriptions to fill and no special preparations for intercourse after tubal sterilization. Because the methods are intended to be permanent, women who are quite sure that they have completed their families may be pleased to never have to worry about contraception again. Finally, laparoscopic tubal sterilization—for reasons which remain obscure—is associated with a substantial reduction in the risk of subsequent ovarian cancer.

About half of all tubal sterilization procedures are performed at or immediately after delivery; the remainder are “interval” (i.e., not pregnancy-related) procedures. Interval sterilization is performed either by laparoscopic tubal sterilization, or by the Essure procedure.

Laparoscopic Tubal Sterilization

Laparoscopic tubal sterilization is performed under general anesthesia in a hospital operating room or a surgicenter. In this procedure, a telescope is inserted into your navel through a well-hidden ½ inch incision. A special instrument is then used to seal the tubes, making it impossible for sperm and egg to meet. The procedure typically takes just 15-20 minutes to perform, with women discharged home after a short period of observation in the recovery room. Most patients can return to work after 2-3 days.

Patients typically have mild or moderate pain for a few days, managed with ibuprofen or a mild narcotic. Laparoscopic tubal sterilization is very safe, but rare complications have been reported. Bleeding and infection are not common, but can occur as with any surgical procedure. Other complications, including but not limited to anesthetic complications, injuries to the bowel or to urinary structures, and blood clots have rarely been reported. The risk of failure (i.e., pregnancy) after laparoscopic tubal sterilization is about 1 in 300; this makes laparoscopic steriliazation more reliable than birth control pills, the patch, or the ring, and much more reliable than condoms, diaphragms, and “pulling out.” Importantly, about half of the pregnancies which occur after laparoscopic sterilization are ectopic pregnancies, or pregnancies in the fallopian tubes. Since this is a potentially life-threatening condition, women who think that they may be pregnant after a laparoscopic tubal sterilization should seek medical attention immediately.

Laparoscopic tubal sterilization, for reasons which remain obscure, is associated with a substantial reduction in the risk of subsequent ovarian cancer.

Another important risk to consider is the risk of regret: Laparoscopic tubal sterilization is intended to produce permanent results. If you are not certain whether your family is complete, or you feel that you may change your mind at some point in the future, you definitely should not undergo a sterilization procedure. While it is possible nowadays to achieve pregnancy after being sterilized by tubal ligation, it is not at all easy to do so. Achieving a pregnancy after laparoscopic sterilization requires another operation (to re-connect the tubes) or in vitro fertilization, a highly specialized and expensive reproductive technique. Success in achieving a pregnancy is not guaranteed in either case. Women under 30 and women with unstable marriages are at particularly high risk of subsequent regret.

Overall, most patients are very satisfied with the results of their tubal ligation. They enjoy intimacy without awkward preparations for contraception. They do not have to fill a costly monthly prescription, and worry about the risk of exposure to hormones contained in the pill, patch, and contraceptive injections. The procedure is not expected to change a woman’s mood, her menstrual cycle, or her sexual response—except that some women report more satisfying sexual relations once their fear of pregnancy is removed.

For the right patients, tubal ligation is a sensible, permanent method to prevent pregnancy. If you think that tubal ligation is right for you, we invite you to consult with us at The Woman’s Health Pavilion.

Essure

In 2002 the FDA approved a new method of permanent tubal sterilization, the Essure procedure. The Essure procedure requires no incision at all. Instead, the Essure procedure relies on tiny micro-inserts which are introduced hysteroscopically: A narrow telescope is inserted into the uterus through the vagina, and is used to place the inserts into the tubal openings. Once in place, a filament inside the coils promotes tissue ingrowth, resulting in tubal occlusion.

Sterilation
Sterilation

The Essure procedure takes just 10 minutes to perform. We generally perform Essure procedures in an operating room—either in a hospital or a surgicenter—with anesthesia to ensure that our patients our comfortable. Women are discharged after a short period of observation in the recovery room, and can easily return to work the next day. Unlike traditional laparoscopic sterilization, which requires a few days of recovery, women can easily return to work the day after an Essure procedure. Most women will not even need postoperative pain medication. Essure is a truly ambulatory procedure: Aside from some mild cramping, there is not much “recovery” to speak of.

Importantly, women must use a backup method of contraception for three months after the Essure procedure: This allows tissue ingrowth around the microinsert to completely seal off the tubes. At the end of three months, women must have a hysterosalpingogram (a study performed in a radiologic facility) to confirm that both tubes are completely blocked. Once hysterosalpingogram confirms that both tubes are blocked, the risk of subsequent pregnancy is extremely low: Initial studies demonstrated not a single pregnancy among 664 women with 4 years of follow-up.

It is occasionally technically difficult to navigate the inserts into the tubal openings: In about 5% of procedures, the inserts cannot be acceptably placed in both tubes. We try to discuss this possibility with patients in advance of their planned procedure, since patients may elect to have us perform a laparoscopic sterilization immediately (i.e., while they are asleep) in the event that Essure placement is not successful. Other risks include perforation of the uterus, fluid overload, and risks relating to general anesthesia.

Conclusion

Tubal sterilization is the most popular method of contraception for women over 35 in this country. If you are sure that you have completed your family, call us to schedule a consultation: Laparoscopic tubal sterilization or Essure may be right for you.

If you’re not sure if you want children, or if you might change your mind in the future, you should not undergo a sterilization procedure.

If you are considering a sterilization procedure, think carefully about your life circumstances, your relationship, and your family. Sterilization is sometimes a very sensible and convenient option, but this permanent option requires thoughtful consideration.

Both procedures should ideally be scheduled in the first two weeks of your menstrual cycle (i.e., right after your period) to reduce the possibility that you might be pregnant and not know it when the procedure is performed. If it is not possible to schedule your procedure during this time, make sure you use a reliable form of contraception in the weeks prior to your procedure date.


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