Tubal ligation

Tubal ligation

Tubal ligation is a form of permanent birth control. Also called tubal sterilization or getting your tubes tied, it involves having a woman’s fallopian tubes tied, blocked, or cut in order to prevent pregnancy. It’s relatively low-risk and easy to recover from, but it is permanent, with a 99 percent success rate when it comes to preventing pregnancy.

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What is tubal ligation?

Tubal ligation, also known as tubal sterilization or having your tubes tied, involves having a woman’s fallopian tubes tied, blocked, or cut in order to prevent pregnancy. A woman’s fallopian tubes connect the ovaries to the uterus, serving as a passage for the egg(s), and then, possibly, a fertilized egg in the event of a pregnancy. Most eggs are fertilized in the fallopian tubes and then make their way to the uterus for implantation. Blocking the fallopian tube prevents the sperm from meeting the egg and prevents fertilization.

When can I have a tubal ligation procedure?

Tubal ligation can be done whenever you’d like – including right after childbirth or in combination with another type of surgery, including a C-section or at any time that you’ve made the decision to have a sterilization procedure. You’re encouraged to talk to your doctor before surgery to make sure you’re not taking any medications that may interfere with the procedure.

How tubal ligation is performed, however, depends on when and where you get the procedure done.

If you have the procedure done the day or two after a vaginal delivery, you will get regional anesthetic (a spinal typically), and your healthcare provider will make a small incision under your navel and remove some or all of your tubes through it. You may have some soreness at the incision site, but the surgery is not likely to prolong your hospital stay.

You can have a tubal ligation done as an outpatient procedure any time after six weeks postpartum, but you’ll need a general anesthetic if you wait. Your healthcare provider makes a small incision just below the navel and inflates your abdomen with carbon dioxide gas so that the tubes are easier to find. After this, they’ll insert a narrow tube with a light and a tiny magnifying glass on the end (laparoscope), and use it to find your fallopian tubes. Your provider may also make another small incision to insert the instrument used to cut the tubes.

There are several options when it comes to closing or tying your tubes: Your tubes may be completely removed, or they may be sealed with an electric current. Very rarely are devices used to pinch them shut with an elastic band or metal clip, as these two modes have less success in preventing pregnancy. A common option is the salpingectomy, in which the whole tube is removed. This option has an added benefit of decreasing the risk of fallopian tube cancer. When the procedure is finished, your doctor will stitch up the small incisions in your abdomen.

Tubal ligation recovery

The entire tubal ligation procedure generally takes about 30 minutes. Afterward, you’ll probably be up and around in two to four hours, but you may feel some pain for several days. (See your provider if the abdominal pain or swelling gets worse instead of better.) You’ll need time to heal – generally about a week – before exercising or having sex.

Overall, the amount of time it takes you to recover from tubal ligation depends on your general health and tolerance to pain, but generally, women start feeling better within two to three days. You may bathe 48 hours after the procedure, but avoid straining or rubbing the incision. Make sure to carefully dry the incision area after bathing. Your incisions will be dissolvable, and won’t require removal.

The procedures have no effect on your sex drive or your hormone production. You’ll still ovulate each month, but the egg will never reach your uterus. (It’s reabsorbed by your body instead.) You’ll also continue to have menstrual periods.

Tubal ligation side effects

Tubal ligation may have the following side effects that should go away in about a week:

  • Your incision sites may hurt and feel a bit uncomfortable
  • Pain or cramps in your belly
  • Fatigue, dizziness, or nausea
  • Extensive vaginal bleeding

If you experience the below side effects, however, make sure to contact your healthcare provider immediately:

  • High fever that won’t go away
  • Fainting spells
  • Incredibly intense abdominal pain that doesn’t subside after 12 hours
  • Persistent vomiting due to nausea
  • Heavy bleeding with clots that doesn’t decrease over time
  • Difficulty breathing
  • Pain or bleeding at the incision site
  • Unusual discharge or odor from your vagina

How effective is tubal ligation?

Tubal ligation and salpingectomy are more than 99 percent effective in preventing pregnancy.

Note that male sterilization (known as a vasectomy) is slightly more effective than surgical sterilization for women, as well as less risky, has a faster recovery time, and is less expensive.

If you do become pregnant, be sure to see your doctor right away. There’s an increased risk that you’ll have an ectopic pregnancy. In this condition, the egg implants itself outside of the uterus, typically in one of the fallopian tubes, and this is very dangerous and can cause massive bleeding internally.

How common is pregnancy after tubal ligation?

This is incredibly unlikely, but it is possible – 1 in 200 women who have a tubal ligation in their 20s get pregnant after tubal ligation and 1 in 300 women in their 30s get pregnant after the procedure, indicating a 99 percent success rate. In addition, those women who do get pregnant after tubal ligation likely have ectopic pregnancies (less than 7 out of 1,000 of the pregnancies after tubal ligation will be ectopic).

Tubal ligation reversal: Is it possible?

In some cases, yes, but don’t count on it. Reversals are extremely expensive and insurance companies rarely cover them.

They’re also much more complicated than closing or cutting the tubes in the first place, and your chances of being able to conceive after a reversal are uncertain. Between 25 and 87 percent of women who reverse a tubal ligation go on to give birth successfully. And the risk of ectopic pregnancy is higher.

Tubes that are closed off by cauterization are much more difficult to reattach properly because the heat destroys their delicate lining. Reconnecting tubes blocked with nonsurgical implants is even less likely to be successful.

In-vitro fertilization may be an option if sterilization can’t be reversed. IVF is typically less expensive than a reversal procedure and has a higher success rate.

What are the pros and cons of tubal ligation?

Pros

If you’re 100 percent sure you don’t want to have any more children, sterilization may be a good option for you because you don’t have to remember to take a pill every day, and you don’t have to insert or apply anything before having sex, which can be a real bonus for busy new moms. Tubal removal also reduces your risk of fallopian tube and ovarian cancer.

The procedure is also generally low-risk, and the recovery time is fairly simple. It works immediately, and can be performed right after childbirth. It also doesn’t affect your hormones in any way, so your periods come as normal.

Cons

As with all surgical procedures, tubal ligation has some rare, but possible, risks associated with it, including infection and excess bleeding. If you opt for the procedure right after giving birth and experience any of these side effects, it could make your recovery from childbirth that much harder. Two huge, but rare risks of tubal ligation include ectopic pregnancies and post-tubal ligation syndrome (PTLS).

  • Ectopic pregnancy: Women who have had their tubes tied are slightly more likely to have an ectopic, or tubal, pregnancies than other women. Of these, less than seven out of 1,000 of the pregnancies will be ectopic, but that number is still higher than the rate of ectopic pregnancies among non-sterilized women.
  • PTLS: Post-Tubal Ligation Syndrome (PTLS) is a cluster of symptoms reported which include heavy or missed menstrual periods, hormonal problems, or problems that may mimic menopause. Its existence remains controversial among doctors and researchers, but women who have it report symptoms such as dizziness, brain fog, and loss of periods.

Sterilization won’t protect you from sexually transmitted infections such as HIV, herpes, and chlamydia.

But the biggest downside to this procedure is its permanence. If you change your mind, the cost of reversing a tubal ligation is high, with no guarantee of success. An estimated 20 percent of women who undergo sterilization before age 30 regret the procedure. For women who opt for sterilization after 30, only 6 percent regret the decision.

To make sure you don’t want to conceive any more children, ask yourself some tough questions:

  • How would you feel if you lost your partner to death or through divorce or separation?
  • Is there any chance you might want to have a child with another person?
  • Is there any scenario in which you could imagine ever having more biological children?

If you think it’s at all possible, it’s probably best to choose another form of contraception. The good news is that there are non-permanent forms of contraception that are as effective as sterilization, including intrauterine devices (IUDs) and the birth control implant.

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