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 can be performed by laparoscopic tubal sterilization.
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.
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 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.
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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