Tubal ligation is a permanent voluntary form of birth control (contraception) in which a woman's Fallopian tubes are surgically cut or blocked off to prevent pregnancy.
Description
Tubal ligation, or getting one's "tubes tied," refers to female sterilization, the surgery that ends a woman's ability to conceive. The operation is performed on the patient's Fallopian tubes. These tubes, which are about 10 cm long and 0.5 cm in diameter, are found on the upper outer sides of the uterus, and open into the uterus through small channels. It is within the Fallopian tube that fertilization, the joining of the egg and the sperm, takes place. During tubal ligation, the tubes are cut or blocked in order to close off the sperm's access to the egg.
Normally, tubal ligation takes about 20–30 minutes, and is performed under general anesthesia, spinal anesthesia, or local anesthesia with sedation. The surgery can be performed on either hospitalized patients within 24 hours after childbirth or on outpatients. The woman can usually leave the hospital the same day.
The most common surgical approaches to tubal ligation include laparoscopy and mini-laparotomy. In a laparoscopic tubal ligation, a long, thin telescope-like surgical instrument called a laparoscope is inserted into the pelvis through a small cut about 1 cm long near the navel. Carbon dioxide gas is pumped in to help move the abdominal wall to give the surgeon easier access to the tubes. Often the surgical instruments are inserted through a second incision near the pubic hair line. An instrument may be placed through the vagina to hold the uterus in place.
In a mini-laparotomy, a 3–4 cm incision is made just above the pubic bone or under the navel. A larger incision, or laparotomy, is rarely used today. Tubal ligation can also be performed at the time of a cesarean section.
Tubal ligation costs about $2,000 when performed by a private physician, but is less expensive when performed at a family planning clinic. Most insurance plans cover treatment costs.
Tubal ligation is performed in several ways:
Electrocoagulation. A heated needle connected to an electrical device is used to cauterize or burn the tubes. Electrocoagulation is the most common method of tubal ligation.
Falope ring. In this technique, an applicator is inserted through an incision above the bladder and a plastic ring is placed around a loop of the tube.
Hulka clip. The surgeon places a plastic clip across a tube held in place by a steel spring.
Silicone rubber bands. A band placed over a tube forms a mechanical block to sperm.
Who Performs the Procedure and Where Is It Performed?
Tubal ligation is generally performed by an obstetrician/gynecologist, a medical doctor who has completed specialized training in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics. The procedure is performed in a hospital or family planning clinic, and usually as an outpatient procedure.
Questions to Ask the Doctor
How many tubal ligations do you perform each year?
What method of ligation will you use?
What form of anesthesia will be used?
How long will the procedure take?
What side effects or complications might I expect?
What is your failure rate?
Definition
Tubal ligation is a permanent voluntary form of birth control (contraception) in which a woman's fallopian tubes are surgically cut or blocked off to prevent pregnancy.
Purpose
Tubal ligation is performed in women who want to prevent future pregnancies. It is frequently chosen by women who do not want more children, but who are still sexually active and potentially fertile, and want to be free of the limitations of other types of birth control. Women who should not become pregnant for health concerns or other reasons may also choose this birth control method.
Demographics
Tubal ligation is one of the leading methods of contraception, having been chosen by over 10 million women in the United States—about 15% of women of reproductive age. The typical tubal ligation patient is over age 30, is married, and has had two or three children.
Description
Tubal ligation, or getting one's "tubes tied," refers to female sterilization, the surgery that ends a woman's ability to conceive. The operation is performed on the patient's fallopian tubes. These tubes, which are about 4 in (10 cm) long and 0.2 in (0.5 cm) in diameter, are found on the upper outer sides of the uterus. They open into the uterus through small channels. It is within the fallopian tube that fertilization, the joining of the egg and the sperm, takes place. During tubal ligation, the tubes are cut or blocked in order to close off the sperm's access to the egg.
In a tubal ligation, a woman's reproductive organs are accessed by abdominal incision or laparoscopy (A). The fallopian tubes are cut and tied (B), cauterized (C), blocked with a silicone band (D), or clipped (E) to ensure sperm is not able to fertilize an egg. (Illustration by GGS Inc.)
or local anesthesia with sedation. The surgery can be performed on either hospitalized patients within 24 hours after childbirth or on outpatients. The woman can usually leave the hospital the same day.
Tubal ligation should be postponed if the woman is unsure about her decision. While the procedure is sometimes reversible, it should be considered permanent and irreversible. As many as 10% of sterilized women regret having had the surgery, and about 1% seek treatment to restore their fertility.
The most common surgical approaches to tubal ligation include laparoscopy and mini-laparotomy. In a laparoscopic tubal ligation, a long, thin telescope-like surgical instrument called a laparoscope is inserted into the pelvis through a small cut about 0.5 inches (1 cm) long near the navel. Carbon dioxide gas is pumped in to help move the abdominal wall to give the surgeon easier access to the tubes. Often the surgical instruments are inserted through a second incision near the pubic hair line. An instrument may be placed through the vagina to hold the uterus in place.
In a mini-laparotomy, a 1.2–1.6 in (3–4 cm) incision is made just above the pubic bone or under the navel. A larger incision, or laparotomy, is rarely used today. Tubal ligation can also be performed at the time of a cesarean section.
The tubal ligation itself is performed in several ways:
Electrocoagulation. A heated needle connected to an electrical device is used to cauterize or burn the tubes. Electrocoagulation is the most common method of tubal ligation.
Falope ring. In this technique, an applicator is inserted through an incision above the bladder and a plastic ring is placed around a loop of the tube.
Hulka clip. The surgeon places a plastic clip across a tube held in place by a steel spring.
Silicone rubber bands. A band placed over a tube forms a mechanical block to sperm.
Tubal ligation costs about $2,000 when performed by a private physician, but is less expensive when performed at a family planning clinic. Most insurance plans cover treatment costs.
Diagnosis/Preparation
Preparation for tubal ligation includes patient education and counseling. Before surgery, it is important that the woman understand the permanent nature of tubal ligation as well as the risks of anesthesia and surgery. Her medical history is reviewed, and a physical examination and laboratory testing are performed. The patient is not allowed to eat or drink for several hours before surgery.
Aftercare
After surgery, the patient is monitored for several hours before she is allowed to go home. She is instructed on care of the surgical wound, and what signs to watch for, such as fever, nausea, vomiting, faintness, or pain. These signs could indicate that complications have occurred.
Risks
While major complications are uncommon after tubal ligation, there are risks with any surgical procedure. Possible side effects include infection and bleeding. After laparoscopy, the patient may experience pain in the shoulder area from the carbon dioxide used during surgery, but the technique is associated with less pain than mini-laparotomy, as well as a faster recovery period. Mini-laparotomy results in a higher incidence of pain, bleeding, bladder injury, and infection compared with laparoscopy. Patients normally feel better after three to four days of rest, and are able to resume sexual activity at that time.
The possibility for treatment failure is very low—fewer than one in 200 women (0.4%) will become pregnant during the first year after sterilization. Failure can happen if the cut ends of the tubes grow back together; if the tube was not completely cut or blocked off; if a plastic clip or rubber band has loosened or come off; or if the woman was already pregnant at the time of surgery.
Normal Results
After having her tubes tied, a woman does not need to use any form of birth control to avoid pregnancy. Tubal ligation is almost 100% effective for the prevention of conception.
Morbidity and Mortality Rates
About 1–4% of patients experience complications following tubal ligation. There is a low risk (less than 1%, or seven per 1,000 procedures) of a later ectopic pregnancy. Ectopic pregnancy is a condition in which the fertilized egg implants in a place other than the uterus, usually in one of the fallopian tubes. Ectopic pregnancies are more likely to happen in younger women, and in women whose tubes were closed off by electrocoagulation.
Rarely, death may occur as a complication of general anesthesia if a major blood vessel is cut. The mortality rate of tubal ligation is about four in 100,000 sterilizations.
Alternatives
There are numerous options available to women who wish to prevent pregnancy. Oral contraceptives are the second most common form of contraception—the first being female sterilization—and have a success rate of 95–99.5%. Other methods of preventing pregnancy include vasectomy (99.9% effective) for the male partner; the male condom (86–97% effective); the diaphragm or cervical cap (80–94% effective); the female condom (80–95% effective); and abstinence.
"Family Planning: Sterilization." Section 18, Chapter 246 in The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 1999.
Periodicals
Baill, I. C., V. E. Cullins, and S. Pati. "Counseling Issues in Tubal Sterilization." American Family Physician 67 (March 15, 2003): 1287-1294.
Kariminia, A., D. M. Saunders, and M. Chamberlain. "Risk Factors for Strong Regret and Subsequent IVF Request After Having Tubal Ligation." Australian and New Zealand Journal of Obstetrics and Gynaecology 42 (November 2002): 526-529.
Organizations
American College of Obstetricians and Gynecologists. 409 12th St., SW, P. O. Box 96920, Washington, DC 20090-6920. www.acog.org.
Planned Parenthood Federation of America, Inc. 810 Seventh Ave., New York, NY, 10019. (800) 669-0156. www.plannedparenthood.org
Other
Centers for Disease Control and Prevention. Fact Sheet: Risk ofEctopic Pregnancy after Tubal Sterilization, August 6, 2002 [cited March 1, 2003]. www.cdc.gov/nccdphp/drh/mh_ectopic.htm.
3 negative semen samples required following vasectomy
Clinic review
None
Advantages and Disadvantages
STD protection
None
Benefits
Permanent methods that require no further user actions
Risks
Operative and postoperative complications.
Sterilization (also spelledsterilisation) is a surgical technique leaving a male or female unable to reproduce. It is a method of birth control. For non-surgical causes of sterility, see infertility.
Common sterilization methods include:
Vasectomy in males. The vasa deferentia, the tubes which connect the testicles to the prostate, are cut and closed. This prevents sperm produced in the testicles to enter the ejaculated semen (which is mostly produced in the seminal vesicles and prostate). Although the term vasectomy is established in the general community, the correct medical terminology is deferentectomy, since the structure known as the vas deferens has been renamed the ductus deferens.
Tubal ligation in females, known popularly as "having one's tubes tied". The Fallopian tubes, which allow the sperm to fertilize the ovum and would carry the fertilized ovum to the uterus, are closed. This generally involves a general anesthetic and a laparotomy or laparoscopic approach to cut, clip or cauterize the fallopian tubes. Less commonly used is the Essure office procedure of inducing scarring and occlusion of the tubes by the effects of micro-inserts placed by a catheter passed through the cervix and uterus.
Castration in males. The testicles are surgically removed. This is frequently used for the sterilization of animals, with added effects such as docility, greatly reduced sexual behaviour, and faster weight gain (which is desirable in some cases, for example to accelerate meat production).
Sterilization of animals
In animals, castration (removal of the testes) and salpingo-oophorectomy (removal of the ovaries and fallopian tubes), called "neutering" or "spaying" when applied to pets, are used to reduce or eliminate sexual behaviour, and to prevent conception, heat and possible uterine diseases in females, potentially prolonging a female animal's lifespan. The impact on the long-term health of a neutered male is more negative. Due to the hormonal changes involved with both genders, this will definitely cause minor behavioral changes in the animal. When these changes are undesired, a different method of sterilization can be used, such as vasectomy in males or tubal ligation in females. A typical example of this practise is when male cats are subjected to vasectomy so that they are able to mate with females, thereby "bringing them off heat" (terminating estrus). This keeps the condition of the female from deteriorating due to the extra energy that is expended during estrus. A vasectomized male cat is called a "teaser tom" by cat breeders.
Animal control organizations urge owners who do not keep animals for the specific purpose of breeding to have their pets spayed or neutered in order to prevent an increase in the population of stray animals. Such stray animals are often malnourished, and are frequently euthanized by animal welfare societies. Organizations such as EmanciPET exist in order to prevent animal homelessness and stop animal euthanasia as a means of population control by providing low-cost or free surgical sterilization of dogs and cats.
