All About Getting Your Tubes Tied

Surgical Tubal Ligation Options, Risks, and Alternatives

Getting Your Tubes Tied
What should you know about getting your tubes tied?. Steve Debenport/Vetta/Getty Images

If you are considering getting your tubes tied—a tubal ligation—what should you know? What are the different methods for performing the procedure and which option might be best for you? What are the potential risks? And what alternative approaches are available for permanent birth control?

Tubal Ligation: Having Your Tubes Tied

Tubal ligation is a permanent form of contraception or birth control. Getting your tubes tied is another way of saying that you have had a tubal ligation.

This procedure may also be referred to as female sterilization or permanent infertility.

No matter the terminology used, a surgical tubal ligation is a procedure that closes off your fallopian tubes. Once your tubes are sealed, sperm will be unable to pass through the fallopian tube to fertilize an egg—which means you will be unable to get pregnant.

This procedure usually is recommended for adult women who are certain that they do not want to get pregnant in the future. There are many questions to consider when choosing birth control, but for women who are done having children, a tubal ligation is a very popular choice due to it's convenience as well as lack of side effects that can occur with temporary birth control methods.

Are My Tubes Actually Tied?

Are your fallopian tubes really tied when you have a tubal ligation? Maybe. There are actually several ways in which your doctor can seal your tubes including:

  • Clamping them with rings, clamps, or clips
  • Cutting and sealing them shut with an electric current (electrocautery)
  • Tying your tubes, cutting them, and then stitching or electrically sealing them

Thinking about how your tubes will be sealed may sound painful, but the procedure is performed under anesthesia so you will not feel anything.

Surgical Tubal Ligation Options

There are several different options to choose from when it comes to tubal ligation procedures, and you and your doctor can discuss which option is best for you personally. Your doctor will consider factors such as your body weight and whether or not you have had previous abdominal surgery. The following are the different surgical options for having your tubes tied:

1. Laparoscopy

Laparoscopic sterilization is one of the two most common methods of having your tubes tied and is usually done under general anesthesia (you will be asleep in the operating room.) During this procedure, a small incision is made in or near your belly button to allow for a laparoscope (a small, telescope-like instrument with a light) to be inserted. Carbon dioxide gas is injected in order to elevate your abdominal wall off of your pelvic organs, allowing your surgeon to see your fallopian tubes. The surgeon may insert another device through the laparoscope to seal your fallopian tubes (or will tie your tubes through another small incision). Then the incisions are closed. A tubal laparoscopy procedure only takes about 30 minutes. There is usually minimal scarring, and you will most likely get to go home the same day.

2. Mini-Laparotomy

A mini-laparotomy (or mini-lap) tubal ligation is the other most common method of having your tubes tied. Most women will have this procedure done right after giving birth. During a postpartum mini-laparotomy, your surgeon makes a small incision just below your belly button. Because your uterus is still enlarged from being pregnant, your fallopian tubes are right at the top of the uterus—which is located just under your belly button. Your fallopian tubes are then pulled up into or out of the incision and closed off, then put back into place, and the incision is stitched shut.

3. Laparotomy (Open Tubal Ligation)

A laparotomy procedure (also known as an open tubal ligation) is considered to be major surgery—so it is not used as commonly as laparoscopy and mini-laparotomy. The surgeon will make a larger incision (about two to five inches long) in the abdomen. The fallopian tubes will then be pulled up into or out of the incision, closed off/sealed shut, and put back into place. The incision will then be stitched closed. An open tubal ligation is usually performed right before or after some other type of unrelated abdominal surgery, such as a Cesarean section.

4. Culdoscopy and Colpotomy

Culdoscopy and colpotomy are two types of incisions that are used during vaginal sterilization approaches. Having your tubes tied by a vaginal method was once the preferred technique. But, since culdoscopy and colpotomy have higher risks, laparoscopic surgery is now the more common way to have your tubes tied. Your doctor may choose to do a culdoscopy or colpotomy if you are obese (or very overweight) or if you have a retroverted uterus (tilted uterus.) Both of these are small incisions made into vaginal wall—but they may be more difficult to perform because you must be in lithotomy position (legs in stirrups) while under anesthesia.

5. Hysterectomy

A hysterectomy is a procedure in which your uterus is removed and is considered to be major surgery. A hysterectomy is technically not a tubal ligation procedure. But, once your uterus is removed, there is nowhere for an egg to implant (so you cannot become pregnant). A hysterectomy can be performed through the vagina (vaginal hysterectomy) or abdomen (abdominal hysterectomy). In the past, a hysterectomy was sometimes done as a medical procedure when a tubal ligation was considered taboo for religious reasons.

Medical and Non-Contraceptive Advantages of Getting Your Tubes Tied

If you have surgically had your tubes tied, you may have received an extra medical benefit. Research suggests that having a tubal ligation reduces your risk for ovarian cancer but up to 30 percent. Although the exact reason for this is unknown, there are two main theories for this finding:

  • When you have your tubes tied, the blood supply to your ovaries is interrupted. This may alter your hormone levels, which results in the reduced risk of ovarian cancer.
  • The closing off of the fallopian tubes may, perhaps, protect the ovaries from environmental agents that could cause cancer.

Yet another benefit of tubal ligation is that having your tubes tied may lower your chances of developing pelvic inflammatory disease (PID.) While the risk of PID may be reduced, however, a tubal ligation does not provide any protection against sexually transmitted diseases.

Risks of Tubal Ligation

As with any surgical procedure, a tubal ligation carries some risk. Possible problems can be broken down into three categories:

  • Risks due to the actual procedure: These may include incomplete closure of the tubes (resulting in pregnancy in roughly 1 out of 200 women,) injury to nearby organs or structures caused by surgical instruments, and an increased risk of ectopic pregnancy if pregnancy occurs after tubal ligation.
  • Risks related to the use of anesthesia: The type of anesthesia used depends on the surgical approach chosen. Tubal ligation may be performed with either conscious sedation (a form of anesthesia where the woman is awake, but relaxed and drowsy) or deep sedation (a general anesthetic is given and the woman is asleep.) Anesthesia can be local, regional (the body is numb from the navel down,) or general (involving the entire body,)
  • Risks of surgery in general: General risks of surgery include infection and bleeding.

What to Expect After a Tubal Ligation Procedure

Most women can return to work within a few days after having a tubal ligation. Pain medication can help to relieve any discomfort. It is recommended that women avoid strenuous exercise for several days. In general, most women feel ready to have sex again within a week.

The majority of women recover from this procedure with no problems. Unlike with male sterilization (vasectomy), no tests are required to check for sterility.

A tubal ligation does not decrease a woman's sexual pleasure and doesn't affect her femininity. Since no glands or organs are removed or changed and all hormones will still be produced, a tubal ligation should not change sexuality or interfere with the functioning of a woman's sexual organs.

Costs of a Tubal Ligation

The one-time cost of a tubal ligation, as compared to other contraceptive methods, could save you hundreds of dollars over time. The cost of a having a tubal ligation can range between $1,000 to $3,000, but may be higher if you have any complications. A woman should check with her health insurance policy as coverage for birth control varies. Medicaid and private health insurance might cover the costs of a tubal ligation.

How Effective Is a Tubal Ligation?

Tubal ligation is more than 99 percent effective. The small failure rate occurs because occasionally the fallopian tubes may reconnect by themselves. If a pregnancy does occur after a tubal ligation, there is a 33 percent chance of it being an ectopic pregnancy. However, the overall rate of pregnancy is so low, that a woman’s chance of having an ectopic pregnancy is much lower than it would be provided she did not have the tubal ligation done in the first place.

Tubal Ligation Reversal

A woman should carefully consider whether or not a tubal ligation (permanent sterilization) is the best method for her. Even with careful consideration, however, some women who have a tubal ligation end up regretting their decision later. A woman is more likely to regret having her tubes tied if:

  • She is young
  • She has few or no children
  • She chose this method not because she wanted it but because her partner wanted it done
  • She decided on a tubal ligation because she believed it would solve money issues or if she thought the procedure would help fix relationship problems

A tubal ligation should not be thought of as temporary. Sometimes a tubal reversal can take place if a woman later decides that she wants to become pregnant. However, a tubal reversal is a major surgical procedure that doesn't always result in pregnancy. Roughly 50 percent to 80 percent of women who have their tubal reversed may become pregnant.

Permanent Contraception Alternatives to Tubal Ligation

A tubal ligation can be an excellent form of permanent birth control, with a very good success rate at preventing pregnancy. It also has the added advantages of possibly reducing your risk of ovarian cancer or pelvic inflammatory disease.

That said, not everyone wishes to go through this procedure and the related (though small) risks of surgery and general anesthesia.

There are many temporary birth control options if this is the case. There are also two major permanent alternatives. One, is a vasectomy. Compared head to head, a vasectomy carries much less risk than a tubal ligation, but some men are not interested in this approach for a number of reasons.

For woman, there is an alternative non-surgical permanent birth control option called Essure. The Essure procedure (also called hysteroscopic sterilization) is a technique in which small metal inserts are inserted through the cervix and into the fallopian tubes to plug them. The Essure procedure has been around since 2002, but is not available everywhere as doctors need special certification to perform the procedure. As of November 2016, Essure has a boxed warning intended to make sure that people are educated about the potential risks of the procedure as well as alternatives.

Effectiveness Comparison of Tubal Ligation Methods

There does not seem to be any significant difference in the effectiveness of laparoscopy, lapartomy, or hysteroscopy with regard to effectiveness though the need for a repeat procedure may be somewhat greater for those who have the Essure procedure.

Bottom Line on Methods for Tubal Ligation

There are different ways in which a tubal ligation can be performed, and the right choice for you is something you will need to discuss carefully with your doctor. The best option will depend on many factors, such as if you are currently pregnant, have had previous abdominal surgeries, if you are overweight, or if you have a tilted uterus. While a tubal ligation may have secondary benefits, such as a reduced risk of ovarian cancer, there are other permanent birth control options available.

Sources:

Antoun, L., Smith, P., Gupta, J., and T. Clark. The Feasibility, Safety, and Effectiveness of Hysteroscopic Sterilization Compared with Laparoscopic Sterilization. American Journal of Obstetrics and Gynecology. 2017 July 27. (Epub ahead of print).

Jokinen, E., Heino, A., Karipohia, T., Gissler, M., and R. Hurskainen. Safety and Effectiveness of Female Tubal Sterilisation by Hysteroscopy, Laparascopy, or Laparotomy: A Register Based Study. BJOG. 2017 May 2. (Epub ahead of print).

Rice, M., Murphy, M., and S. Tworoger. Tubal Ligation, Hysterectomy and Ovarian Cancer: A Meta-Analysis. Journal of Ovarian Research. 2012. 5(1):13.

U.S. Food and Drug Administration. Essure Permanent Birth Control System by Bayer Healthcare: FDA Announcement - Label Changes. 11/15/16. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm529241.htm

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