Tubal Ligation Surgery: Everything You Need to Know

In This Article

Tubal ligation surgery is an elective procedure that involves cutting, sealing, clipping, or tying off a woman's Fallopian tubes—which connect the ovaries to the uterus—to prevent sperm from reaching an egg. Also known as getting your tubes tied or female sterilization, a tubal ligation is a permanent form of contraception that is effective in almost all cases.

Tubal ligation surgery can be done on its own, but it is also sometimes done in the hospital very soon after a woman gives birth—particularly via Cesarean (C-section), as surgeons can use the same incision to reach the Fallopian tubes.

What Is Tubal Ligation?

The procedure seals off the Fallopian tubes by either clamping, snipping and sealing, or tying then cutting and sealing them.

The Fallopian tubes carry a released ovum (egg) from the ovaries to the uterus, and are usually the place where an egg is fertilized by a sperm. Once the tubes are closed or "tied," sperm will not be able to reach an egg, so pregnancy cannot take place.

Tubal ligation is more than 99% effective in preventing pregnancy. Failure can occur if the Fallopian tubes reconnect themselves, which happens occasionally. If a pregnancy does occur after a tubal ligation, there is a 33% chance of it being a non-viable ectopic pregnancy.

Tubal ligation is often performed within hours of childbirth (postpartum), but can also be done on its own (interval).

The procedure can be done either laparoscopically or as an open surgical procedure, as is the case when done after a C-section or a myomectomy.

Contraindications

The main contraindication for tubal ligation is a woman's desire to have children. The procedure is only recommended for adult women who are absolutely certain that they do not want to get pregnant in the future.

Every woman is different, but according to 2012 study of women who got the procedure, subjects were more likely to regret having their tubes tied if:

  • They were young
  • They had few or no children
  • They only chose this method because their partner wanted it
  • They thought the procedure would help fix relationship problems
  • They decided on a tubal ligation because they believed it would solve financial issues

For women who have a tubal ligation and change their minds later, a tubal reversal may be possible. However, it requires major surgery that isn't always effective. Roughly 40% to 60% of women who have their tubal reversed become pregnant.

Additional contraindications apply to certain procedures. Women who are obese, have an adhesive disease, or have medical comorbidities may not be good candidates for abdominal or laparoscopic surgery.

In women whose Fallopian tubes are anatomically abnormal, procedures that use clips or rings to close off the tubes may not be appropriate.

Potential Risks

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 you are awake, but relaxed and drowsy) or deep sedation (a general anesthetic is given and you are 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 any surgery include infection and bleeding.

Purpose of Tubal Ligation

While the purpose of tubal ligation is to make it so that a woman cannot get pregnant, why women seek this end result can differ and is highly personal.

For example, some women may not have children and may not want any in the future. Others may already have children but not want to add to their family for a variety of reasons. Still, others may be advised against future pregnancies due to serious health concerns.

Some aspects women who opt for the procedure consider amongst its benefits:

  • It is convenient and effective: Once you heal, you don't need to worry about contraception again.
  • It has a very good success rate of pregnancy prevention.
  • It does not have any of the hormonal side effects associated with some other birth control options.

Tubal ligation also has the added advantages of possibly reducing your risk of certain diseases.

Research published in 2012 suggests that having a tubal ligation reduces your risk for ovarian cancer by up to 30%. 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, resulting in a 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, remember that tubal ligation does not provide any protection against sexually transmitted diseases.

How to Prepare

Preparation for tubal ligation always involves confirming that you are certain that you want the procedure performed. If you choose to proceed, your doctor will then review technique options and logistics to help plan for your surgery.

Counseling and Consent

In the United States, sterilization procedures require informed consent. Prior to tubal ligation surgery, you will be provided with counseling to ensure you understand the procedure is permanent and not intended to be reversed. The discussion will include alternative methods of long-acting contraception (such as an IUD) and the risks and benefits of the procedure.

A consent form must be signed by the patient and doctor performing the surgery at least 30 days and no more than 180 days prior to a tubal ligation. The only exception is if a woman scheduled for sterilization following childbirth goes into labor early. In that case, 72 hours is required.

Surgery Planning

Tubal ligations can be performed in a few different ways. In determining the right method for you, your doctor will (in advance) consider factors such as your body weight, any previous abdominal surgery, and whether you will be having the procedure immediately following a vaginal birth, C-section, or other surgery.

Among the options your doctor will consider:

An open procedure requires a much larger incision and, on its own, would be major surgery. As such, open tubal ligation is rarely done in the absence of another procedure also being performed.

Be sure you ask your doctor why a particular technique is being recommended and get answers to any questions you may have.

Location

Tubal ligation surgery can be performed in a hospital or outpatient surgical clinic. If you are having a laparoscopic procedure that is not being performed immediately after giving birth, it can be performed as same-day surgery.

What to Wear

During the procedure, you will be wearing a hospital gown. Whether you are coming to the hospital for childbirth or for stand-alone/same-day tubal ligation, it is recommended you wear something comfortable that is easy to change out of.

You will not be allowed to wear jewelry during the procedure and you should leave anything of value at home.

Food and Drink

Your doctor will instruct you on when you will need to stop eating and drinking prior to the procedure. It is typically recommended to consume anything for at least eight hours before any surgery.

Medications

Your doctor will let you know what medications you can and cannot take in the days leading up to surgery. If you are pregnant and planning to have the procedure after giving birth, these directions may/may not differ from those you've been instructed to follow throughout gestation.

Certain drugs and supplements should not be taken prior to any surgery. Blood thinners, in particular, may cause problems with blood clotting during such a procedure. Tell your doctor about all prescription and over-the-counter medications and supplements you use so you receive the proper guidance.

Don't assume that your entire surgical team knows what medications you are taking. Repeat it to them on the day of your tubal ligation so they are aware of what you have been on and how much time has passed since you last took it. 

What to Bring

Most interval tubal ligations will not require a hospital stay. You will not be allowed to drive after the procedure, so be sure to make arrangements in advance so you have a ride home. Do not forget to bring your insurance documents and identification.

If you are planning a postpartum procedure, it is wise to put a hospital bag together in advance. In addition to items for bringing home baby, include some necessities and comfort items for yourself.

What to Expect on the Day of Surgery

If your tubal ligation is being done on its own or in conjunction with a planned C-section, you will know exactly when to report to the medical facility. If the surgery is planned to follow spontaneous childbirth, the exact date of your procedure will, obviously, not be known.

Given your circumstance, do all you can to arrive to your surgery having followed all of your doctor's pre-op instructions.

Before the Surgery

Pregnant women will give birth first, either vaginally or by C-section. Those who are not pregnant will check in to the hospital or ambulatory care facility and be taken to a room to change into a hospital gown.

A member of the surgical team will review your medical history, ask questions about the last time you ate or drank, and take your vital statistics. You may also be given a pregnancy test to confirm you are not pregnant.

You will be connected to an IV for fluids and medications and brought into the operating room, which will be set up with an operating table, surgical equipment, computers and screens, and other medical machinery. Sedation will be administered by either general or regional anesthesia, such as an epidural.

During the Surgery

What happens next depends on the type of tubal ligation procedure being done.

Laparoscopic

For a laparoscopic tubal ligation, the surgeon makes an incision in the lower abdomen and possibly a second small incision in or near the naval.

A laparoscope (a small, telescope-like instrument with a light) is then inserted through the incision. The Fallopian tubes are closed up by either cutting and sealing them, clamping them, or removing them entirely. The laparoscope is then withdrawn and the incisions are closed with stitches or special tape.

Mini-Lap

Within 24 hours after giving birth, you will be taken to an operating room for the procedure. 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.

A small incision is made in or near the naval, the Fallopian tubes are brought up through it, and a small section of each tube is removed. Alternately, both tubes can be removed completely, and sometimes clips are used to close off the tubes. The laparoscope is then removed and the incision closed with stitches or tape.

Open Laparotomy

An open laparotomy is performed immediately after a preceding surgery is complete. The surgeon will use the incision already made to remove or cut and seal both Fallopian tubes before closing up your abdomen.

Regardless of the type of tubal ligation you have, the procedure takes about 30 minutes to complete.

After the Surgery

Once the procedure is complete, you will be taken to the recovery room and monitored closely until the anesthesia has worn off. If you came for a same-day procedure, it can take up to four hours before you are ready to be discharged.

If you had a baby before your tubal ligation, you will either return to the labor and delivery department for additional monitoring (if necessary) or moved to a hospital room to recover.

Recovery

For women who have a postpartum tubal ligation, the procedure will not add any additional recovery time than childbirth. The only difference is you will have a small incision on your abdomen that your doctor will advise you on how to care for.

Following an interval tubal ligation, most women can return to work within a few days. Pain medication can help to relieve any discomfort.

It is recommended that you avoid strenuous exercise for several days. And in general, most women feel ready to have sex again within a week. Follow your doctor's specific instructions in your case.

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

The ovaries are not removed during a tubal ligation. This means hormone levels will continue to fluctuate throughout the month and you will still get your period. A tubal ligation will not interfere with sexual function or desire.

A Word From Verywell

Female sterilization is an effective and cost-effective form of birth control for women who are absolutely certain they do not want to become pregnant in the future. The decision to have a tubal ligation should not be taken lightly. While a tubal ligation is reversible, only about half of women who have the procedure reversed go on to become pregnant.

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Article Sources
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