What is Tubal Ligation (Tubal Sterilization)?
- Tubal ligation is surgery to block a woman's Fallopian tubes. A tubal ligation is a permanent form of birth control. After this procedure has been performed, an egg cannot move from the ovary through the tubes (a woman has two Fallopian tubes), and eventually to the uterus. Also, sperm cannot reach the egg in the Fallopian tube after ovulation (release of an egg from the ovary). Thus, pregnancy is prevented.
- Tubal ligation is often referred to as having one's "tubes tied." More formally, it is known as a bilateral tubal ligation (BTL).
- Some tubal ligations are performed immediately following childbirth. The remainder is elective procedures performed as a same-day operation in an outpatient surgical facility or the hospital. Many US women aged 15 to 44 years rely on sterilization as a means of contraception (birth control) to prevent pregnancy. As of the year 2000, an estimated 190 million couples worldwide used surgical sterilization as a safe and reliable method of permanent birth control.
- Prior to the 1960s, female sterilization in the United States was generally performed only for medical problems or when a woman was considered "too old" to have children or at risk to her health. The changing cultural climate in the 1960s resulted in safe, minimally invasive female sterilization procedures virtually on demand.
What Happens in the Tubal Ligation Procedure?
While the patient is under anesthesia, one or two small incisions (cuts) are made in the abdomen (one usually near the navel), and a device similar to a small telescope on a flexible tube (called a laparoscope) is inserted through the incision.
Using instruments that are inserted through the laparoscope or the second incision, the tubes (Fallopian tubes) are coagulated (electrocoagulation), cauterized (burned), or obstructed using a small clip. The skin is then closed with a few stitches. Most patients feel well enough to go home within a few hours after the procedure.
The health care professional may prescribe analgesic medications to manage post-operative pain.
Most women return to normal activities, including work, in a few days, although some women may be advised not to exercise for a short time. Sexual intercourse may resume when the patient is comfortable.
A tubal ligation can also be performed immediately after childbirth through a small incision near the navel or at the time of a Cesarean section.
Currently, laparoscopic tubal ligation is the most popular method of female sterilization in non-pregnant women. Periumbilical mini-laparotomy in which a segment of each tube is removed through a small incision in the umbilicus (Pomeroy, Parkland) is the most commonly used procedure immediately following childbirth.
What Is Non-Surgical Tubal Ligation?
There is a device that acts as a form of tubal ligation by blocking the interior of the Fallopian tubes. The US Food and Drug Administration has approved a small metallic implant (called the Essure System) that is placed into the Fallopian tubes of women who wish to be permanently sterilized. Unlike other currently available tubal sterilization procedures for women, placement of the device does not require an incision or general anesthesia.
During the Essure procedure, the healthcare professional inserts an obstructive device into each of the two Fallopian tubes at the time of hysteroscopy. This is done with a special catheter that is inserted through the vagina into the uterus and then into the Fallopian tube. The device works by inducing scar tissue to form over the implant, blocking the Fallopian tube and preventing fertilization of the egg by the sperm.
A system similar to the Essure, known as the Asiana System, is also available. With this technology silicone implants are introduced into the Fallopian tubes via hysteroscopy. These implants also induce scar tissue formation in the tubes, thus preventing the sperm from reaching the egg.
What Are the Risks of Tubal Ligation?
As with any surgery, there is always a risk when a person is given general anesthesia. The surgery itself may present problems with bleeding, infection, or damage to surrounding organs. However, tubal ligation is considered to be a very safe procedure and complications are rare.
There is still a chance a woman may become pregnant after tubal ligation. About 1 in 200 women become pregnant who have their tubes tied. This may be caused by an incomplete obstruction of the tubes. If a woman conceives after the procedure, she is at increased risk for an ectopic pregnancy (the pregnancy develops outside of the uterus, most commonly in the Fallopian tube). An ectopic pregnancy may be dangerous and requires emergent medical care.
Because the procedure is performed by tiny instruments inserted into the abdomen through small incisions, the patient may have the injury to other organs in the body.
Tubal Ligation Recovery and Results
Most women recover from the laparoscopic procedure with no problems. There are no tests required to confirm that the woman is now sterile (that is, unable to become pregnant) after a laparoscopic procedure.
During the first 3 months after the Essure or Adiana procedure, the patient must use another form of birth control. At the 3-month interval, the patient must then undergo a final X-ray procedure (hysterosalpingogram) in which dye is injected into the uterus and an X-ray is taken to confirm that the Fallopian tubes are completely blocked.
What Are Alternatives to Tubal Ligation?
If a woman feels she wants a permanent solution to birth control, she should discuss the options with a healthcare professional. Sometimes younger women who choose permanent sterilizations come to regret their decision later. The younger the woman, the more likely she will regret choosing a permanent form of contraception.
The doctor will discuss your personal circumstances and your desire for future childbearing if your life should change. This is an important decision. Women with certain medical conditions may not be suited for this procedure.
Tubal ligation is surgery. Couples, when considering their options for sterilization, should weigh the benefits and risks as to whether the woman would undergo tubal sterilization or the man should have a vasectomy.
Tubal ligation is not intended to be temporary. Although tubal ligations can, in some cases, be surgically reversed, such a procedure represents a major surgical undertaking. A tubal reversal is only successful (i.e. the patient conceives after the procedure) about 40% to 80% of the time.