A tubal ligation is a form of female sterilization that is among the most effective methods of permanent birth control. During the procedure, a woman’s fallopian tubes are blocked so that a man’s sperm cannot fertilize the eggs. Every year, less than 1 percent of women who have had a tubal ligation become pregnant, according to the Food and Drug Administration (FDA).
Tubal ligations are generally performed:
After childbirth or an abortion. Some pregnant women decide before delivery or before having an abortion to have their tubes tied during the same hospital procedure.
As a separate procedure. Usually performed with a thin instrument called a laparoscope, which is introduced to the body through a small incision. A new procedure called Essure is performed through the vagina.
Tubal ligations are generally safe, and recovery time is relatively brief. Although the procedure can be reversed, this is not always successful. For this reason, a woman should be sure she no longer wants to have children before she has a tubal ligation.
About tubal ligation
A tubal ligation is a surgical procedure that blocks a woman’s fallopian tubes to prevent unwanted pregnancy. The fallopian tubes, or oviducts, are a pair of structures attached to the uterus. Each tube sits adjacent to one ovary. In women of childbearing age, the fallopian tubes normally carry one of the eggs (ova) from the ovary to the uterus each month. If sperm joins with the egg inside of the fallopian tube, the egg may become fertilized. After fertilization, the egg travels down into the uterus and lodges into the uterine wall, where it gradually develops into a fetus. The purpose of a tubal ligation is to prevent the sperm from ever reaching and fertilizing the egg.
Tubal ligation is considered to be one of the most effective forms of available birth control. Every year, less than 1 percent of women who have had this procedure become pregnant, according to the Food and Drug Administration (FDA). A tubal ligation is usually performed:
Following childbirth or an abortion. Some pregnant women decide before delivery or before having an abortion to have their “tubes tied” as part of the same hospital procedure. This can be a great convenience that avoids a separate second surgery.
Advantages of having the tubal ligation after childbirth or abortion include:
The patient is already in the hospital and has been prepped for the procedure.
If performed under anesthesia after a vaginal delivery, the patient’s abdominal wall is relaxed, and her uterus is near her navel, which is where the incision is normally made for the operation. This makes it easier for the physician to access the fallopian tubes.
If the patient has a Caesarean section, her abdomen is already open. In such instances, the tubal ligation can be performed in just a few minutes.
Having a tubal ligation will not lengthen the patient’s postpartum hospital stay.
However, it should be noted that surveys have indicated that women tend to regret tubal ligation more often when it is performed right after childbirth than under other circumstances. In addition, some physicians will not perform this surgery until three to six months after a woman has given birth.
Separate procedure. When a tubal ligation is not performed in conjunction with childbirth, the physician usually uses a laparoscope. This thin instrument is inserted through a small incision and used to view and operate inside the woman’s abdomen. A new procedure called Essure is performed through the vagina. This method does not involve an incision.
A woman should not rush into having a tubal ligation. Although the procedure can be reversed, this is not always successful. In addition, the risk of having an ectopic pregnancy (pregnancy that develops outside the uterus) rises after the reversal of a tubal ligation. As a result, a woman should be certain she no longer wants to have children before she has a tubal ligation. If a woman does become pregnant after reversal of a tubal ligation, she should see her doctor immediately to confirm that the pregnancy is inside the uterine cavity, and is not an ectopic pregnancy.
In addition, couples seeking a form of permanent birth control may instead opt for the man to have a vasectomy. Compared to tubal ligations, vasectomies carry less risk, are less complicated and involve a shorter recovery time. Like tubal ligations, vasectomies sometimes can be reversed.
Before and during the tubal ligation
Prior to a tubal ligation, patients should follow all of the preparatory steps recommended by their physician. These may include dietary restrictions or changes to a medication regimen.
A tubal ligation can be performed in either a hospital or an outpatient surgical center. In most cases, general anesthesia will be used and the patient will be asleep during the procedure. In other cases, a local anesthetic will be used. If outpatient surgery is scheduled, the woman should have someone else drive her home following the procedure.
What happens during the procedure depends upon the method used:
After childbirth or abortion. If a woman has had a vaginal delivery, the physician is likely to perform a minilaparotomy. A small incision (1 to 3 inches [2.5 to 7.6 cm] long) is made below the navel, and the physician raises a portion of each fallopian tube. The pathway through the fallopian tubes will then be blocked in some fashion. This is usually done by cutting the tube and sealing each end. After a first-trimester or early second-trimester abortion, the tubal ligation is usually performed via laparoscopy (see laparoscopic sterilization below).
Separate procedure. In laparoscopic sterilization, the patient’s abdomen is inflated with gas (carbon dioxide), which helps the surgeon locate the fallopian tubes. A small incision is made below the navel, and a laparoscope is inserted into the abdomen. Instruments are inserted into the same incision or a separate incision and the tubes are either cut and tied, cauterized (use of heat to form an electric current to fuse the tubes) or closed with plastic clips or rings. In some cases, a small piece of each tube is removed. The procedure is often performed on an outpatient basis.
The Essure procedure is the most recent sterilization technique to receive approval from the Food and Drug Administration (FDA). In this procedure, a catheter is used to introduce a soft, flexible metallic micro-insert through thevagina and into each fallopian tube. Within three months, scar tissue forms around the micro-insert and blocks off the fallopian tube. The entire procedure can be completed within 35 minutes and does not require any incisions.
However, the procedure is considered to be irreversible, and not all women achieve successful results with it. In addition, the procedure is relatively new, so long-term results are unknown as of yet. Three months after this procedure, the patient is required to have a procedure called a hysterosalpingogram, a dye test to assure that the tubes are blocked. This procedure is not considered effective, and should not be used as contraception, until the hysterosalpingogram has proved that the tubes are blocked.
After the tubal ligation
Following surgery, patients are likely to experience soreness in their abdomen. This can usually be treated with a mild pain reliever. Other side effects of the procedure include dizziness, fatigue, bloating and nausea.
Women who have a laparoscopic tubal ligation may experience discomfort in the shoulder or side of the neck as a result of the gas that is used to inflate the abdomen. Within eight hours, most women feel strong enough to walk around and eat food, as well as to care for their infant if they have just had a baby.
Most side effects that accompany tubal ligation should disappear within one to three days. A physician may advise the patient to refrain from heavy lifting for about a week. Patients should alert a physician if they experience any of the following symptoms:
Fever
Bleeding from an incision
Severe stomach pain
Fainting spells (syncope)
Women who have the Essure method will have to return to their physician three months after the procedure for a test called a hysterosalpingogram. This is an x-ray that takes pictures of the uterus and fallopian tubes to ensure that the tubes are blocked. Dye is injected into the uterus to provide a clearer image of the tubes.
In some cases, women change their minds about having children in the future and regret their tubal ligation. The most commonly cited reasons for regret include:
Change in marital status.
Age at the time of the procedure. Women who have the procedure at a younger age are more likely to eventually regret their choice.
Outside factors that influenced the decision to undergo the procedure. These may include circumstances such as pressure from a partner to consider tubal ligation or stress following pregnancy complications.
Tubal ligation can be reversed (tubal reversal), but this is not always successful. Even when it does succeed, the woman will be at increased risk for ectopic pregnancy. In some cases, women who can no longer become pregnant in a traditional way may consider in vitro fertilization. This involves taking mature eggs from the woman’s ovary, fertilizing them with sperm from a partner or donor and then surgically implanting the eggs into the woman’s uterus. However, this procedure is expensive and is not guaranteed to be successful.
Potential benefits of tubal ligation
The most obvious benefit of tubal ligation is that it is among the most effective methods of permanent birth control. However, other benefits have also been associated with the procedure, including:
Less intense menstrual periods. Women who undergo sterilization will still get their period, but they are likely to have fewer days of bleeding, less blood loss and reduced pain. However, their cycles may become more irregular.
Reduced risk of ovarian cancer.
In addition, tubal ligation does not affect any glands or hormones. Women who undergo tubal ligation do not experience premature menopause nor do they gain weight or experience increased facial hair. Finally, tubal ligations have no effect on a woman’s sexual desire or sexual performance.
Potential risks with tubal ligations
As with any surgical procedure, tubal ligations pose certain risks. These include:
Pelvic infection
Reaction to the anesthetic
Injury to blood vessels in the abdomen
Injury to the bowel or bladder
Burns resulting from cauterization
There are disadvantages to both minilaparotomy and laparoscopic sterilization that must be weighed by the patient. Disadvantages of minilaparotomy include:
Greater need for pain medication
Slightly longer recovery time
Larger surgical incision than used in laparoscopic procedure
Disadvantages of laparoscopic sterilization chiefly revolve around certain medical conditions that may prohibit use of the procedure. Women who have heart or lung disease or a history of bleeding may not be candidates for tubal ligation. In addition, women who are obese or have intra-abdominal scarring may be prohibited from the procedure.
According to the Food and Drug Administration (FDA), less than 1 percent of women who have had a tubal ligation become pregnant each year. However, failure rates increase over time, as the fallopian tubes can fuse back together. This is especially true of women who had the procedure early in their reproductive years. Some medical centers have reported a failure rate in young women of 5 percent during the first decade after the surgery.
Women who get pregnant after a tubal ligation are at higher risk for an ectopic pregnancy. Recently published results from a 14-year study that was supported by the National Institutes of Health (NIH) found that the likelihood of ectopic pregnancy varied according to the method of sterilization used and the age at which the patient underwent the tubal ligation. Generally, women who are younger than age 30 at the time of sterilization are at greater risk of experiencing a subsequent ectopic pregnancy than older women. The researchers also found that ectopic pregnancy may occur as many as 10 years after tubal ligation.
Patients who experience symptoms of an ectopic pregnancy should seek immediate medical care. These symptoms include:
Severe pain in one or both sides of the lower abdomen
Abdominal pain and spotting, particularly after a missed or light period
Feelings of faintness or dizziness
Questions for your doctor on tubal ligation
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about tubal ligation:
Am I a candidate for tubal ligation?
Which procedure is best for me?
What are the risks and benefits associated with this procedure?
When should I schedule the tubal ligation?
Where will the procedure be performed?
How long will I need for recovery?
Will I need any additional tests or treatment following a tubal ligation?
What are my birth control options if I’m not able to have a tubal ligation?
If I want to have it reversed in the future, what are the chances it will be successful?
Am I at risk for other gynecological problems if I have a tubal ligation?
