Tubal ligation

Tubal ligation is a surgical procedure that prevents pregnancy by blocking the fallopian tubes. In the United States, millions of women have chosen this form of birth control.


How it works
The fallopian tubes are located on each side of the uterus (the female reproductive organ that houses the embryo and fetus during pregnancy). Each month, an egg from one of the ovaries (the female gland that produces female sex hormones and eggs for reproduction) travels through one of the fallopian tubes to the cavity of the uterus. If the fallopian tubes are blocked, fertilization can't occur.
Tubal ligation is more than 99 percent effective in preventing pregnancy during the first year after the procedure. The effectiveness may change over time, however. Effectiveness may also vary depending on the specific surgical method and your age at the time of the procedure. Be sure to discuss effectiveness rates with your doctor.


Indications
Tubal ligation is an option when you no longer want to become pregnant, either for personal or medical reasons. Tubal ligation is considered a permanent procedure. Reversals of tubal ligations are often unsuccessful, so it's important to be sure of your decision before having the surgery.
If you have concerns about tubal ligation before or after the procedure, talk with a trusted family member, friend or health care professional. Tubal ligation can have an emotional impact on your personal beliefs about what it means to be a woman. You may experience feelings of grief and loss surrounding the inability to bear future children.


Patient preparation
After being counseled about the permanence of this decision, you'll need to sign an informed consent form. Your preparation depends on what surgical method will be used. Ask your doctor for details.

Procedure
A tubal ligation is often done soon after delivering a baby because pregnancy brings the fallopian tubes close to the abdominal wall, which makes them easy for the doctor to reach. But make sure you do not rush into a tubal ligation just because this is a convenient time. Tubal ligation can also be done on an outpatient basis at other times, either at a surgical center or hospital.
You'll receive some type of pain relief for the procedure, such as local anesthesia (which numbs a small area of the body) or general anesthesia (which induces temporary unconsciousness).

Tubal ligation is nearly always done through laparoscopy (in which one or more tiny incisions are made in the abdominal wall) or minilaparotomy (in which a single incision about 1 to 2 inches long is made). After the incision(s) are made, small instruments are passed into the abdomen. Next, the abdominal cavity is inflated with carbon dioxide to separate the organs and tissues and give the doctor a better view of the fallopian tubes. Then, the tubes are closed. They may be clamped shut with plastic clips or rings, cut and then sewn closed or sealed with diathermy or electrical cauterization (using a fine electrically heated wire).


Postprocedure care
Most women go home the same day. There may be pain at the small incision site(s) and mild abdominal aching or cramping. If gas was used, you may have mild pain in your shoulder area due to the migration of any remaining gas to the upper abdomen and diaphragm. You may also have some throat irritation if you had a breathing tube in place during general anesthesia.
You'll receive postoperative instructions when you're discharged from the medical facility. You may be given prescription pain medication to be used for a few days. Report symptoms such as increasing pain, fever or bleeding to your doctor. Strenuous activity and sex are typically restricted for a while, depending on what type of surgical procedure you had. You'll continue to menstruate after the tubal ligation.


Benefits
The contraceptive effects of tubal ligation occur immediately. Backup methods of contraception are unnecessary. Tubal ligation does not interfere with sexual drive or functioning because your hormones are not affected. Each month, an egg will still be released from one of your ovaries. It will simply dissolve and be absorbed by your body. Tubal ligation is considered a very safe method of contraception, with low failure and complication rates. Studies have shown a significantly lower incidence of ovarian cancer in women who've had tubal ligations, although the reasons for this are unclear.

Risks
Statistically, a very small percentage of women who've had a tubal ligation become pregnant. The few women who do become pregnant after a tubal ligation face a higher risk of ectopic pregnancy (when the fertilized egg implants itself outside the uterus). The risk is higher two or more years after the tubal ligation. Discuss your risk factors and any concerns with your doctor.
Tubal ligation does not protect you from sexually transmitted diseases (STDs), including HIV (the virus that causes AIDS). Practice safe sex with male or female condoms to help prevent these infections. If you're exposed to an STD, contact your doctor for testing and treatment.

Complications of a tubal ligation may include:

accidental damage to vital organs near the area being treated, primarily the bowel or bladder
infection
hemorrhage (internal or external bleeding caused by damage to a blood vessel)
rarely, pulmonary embolism (blocking of a blood vessel in the lungs by a blood clot, air bubble, fat deposit or other foreign substance)
rarely, complications from anesthesia

Other options
The U.S. Food and Drug Administration recently approved a new method of female sterilization in which the doctor places metallic implants (such as Essure) into the fallopian tubes. The procedure is done with a special device that's inserted through the vagina and uterus into the fallopian tubes. It requires no incision. Scar tissue develops around the implants, preventing the passage of eggs into the uterus. Another form of contraception is needed for about three months, while the scar tissue is forming. Before stopping the other form of contraception, a special X-ray done with a dye must be used to verify successful placement of the implants. (Occasionally, an implant is unsuccessful on the first try.)
As with tubal sterilization, this procedure is considered permanent. The risk of ectopic pregnancy is higher, and the long-term effectiveness is not yet known. So far, women whoegnant. As with tubal ligation, however, pregnancy may be possible -- even years after the procedure.


Considerations
Before any type of sterilization, carefully consider issues that may be hard to think about, such as divorce or the death of your spouse or children. You're not legally required to have your spouse or partner's consent for the procedure, but thoroughly discussing it with him is strongly recommended. Also, be sure you and your partner discuss other methods of birth control, including vasectomy.
Of the small percentage of women who later regret the decision to have a tubal ligation, most were under age 30 at the time of the procedure or had it done shortly after the birth of a child. Reversal may be possible in some cases, but it depends largely on what type of procedure was done and how much of the fallopian tube was left intact. (Procedures using electrocoagulation destroy the greatest amount of tube and, thus, have the lowest successful reversal rates.) After reversal, the risk of ectopic pregnancy increases. Again, always consider tubal ligation a permanent procedure.