Tubal Ligation: Having Your Tubes Tied

Tubal ligation (also commonly referred to as "having your tubes tied") is surgery that closes off a woman's fallopian tubes. The fallopian tubes help carry a released egg from the ovaries to the uterus, and they 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 may also be referred to as:

• Tubal sterilization
• Female sterilization
• Having your tubes tied
• Tube tying
• Sterilization surgery (female)
• Permanent infertility

There are several options for tubal ligation surgery.

Tubal Ligation Is Permanent Birth Control

A tubal ligation procedure results in making a woman permanently sterile (unable to get pregnant). This procedure usually is recommended for adult women who are certain they do not want to get pregnant in the future.

Tubal ligation is considered a permanent birth control method. It tends to be a popular choice because women realize that this method can offer extremely effective pregnancy protection for the rest of their reproductive years. Many are also attracted to its convenience and the fact that it doesn't present the side effects associated with some temporary birth control methods.

Tubal Ligation Reversal

A woman should carefully consider whether or not a tubal ligation is the best method for her. Some women who decide to have this procedure end up regretting their decision later.

A woman will be more likely to regret having her tubes tied if she has the procedure done:

• When she is young
• If she has few or no children
• If she chose this method because her partner wanted her to
• A change in relationship status
• If she decided on a tubal ligation because she believed it would solve money issues or that this option would fix relationship problems

This decision should be made with the understanding that future pregnancies are not intended. 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 45% to 85% of women who have their tubal ligation reversed may become pregnant, and it is strongly associated with the age of the patient.

The Tubal Ligation Procedure

A tubal ligation occurs in a hospital or outpatient clinic. The type of anesthesia used depends on the surgical approach chosen. Tubal ligation may be performed with either conscious sedation (a form of anesthesia in which a patient is awake, but relaxed and drowsy) or deep sedation (the patient is asleep). Anesthesia can be local, regional (the body is numb from the navel down), or general (involving the entire body).

During the procedure, the fallopian tubes are closed. Some may require a few small incisions made in the abdomen. In these procedures, the tubes are clipped, cut, and/or cauterized (sealed shut).

Which Tubal Ligation Procedure to Use

The status of a woman’s health may signify which tubal ligation option she is best suited for. Two factors when deciding the safest procedure include a woman’s body weight and whether or not she has previously had surgery.

More than half of all tubal ligations are done right after vaginal childbirth through a small cut near the belly button, or during a cesarean section or abortion. The decision to have a tubal ligation done at this time is made in advance with your healthcare provider.

Risks of Tubal Ligation

Generally, there are three types of risks associated with tubal ligation.

• Risks due to the actual procedure: These can include incomplete closure of the tubes, which could result in a woman becoming pregnant in the future (this affects approximately 1 out of 200 women), injury to nearby organs or structures caused by surgical instruments, and an increased possibility of an ectopic pregnancy if pregnancy occurs outside the fallopian tubes after a tubal ligation.
• Risks stemming from the use of anesthesia: These can include reactions to medication and breathing problems.
• Risks of surgery, in general: These 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 having a tubal ligation can range between $0 to $6,000. A woman should check with her health insurance policy, since 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% effective in the first year. This means that out of every 100 women who have this procedure done, less than 1 will become pregnant during the first year of use.

Up to 1 out of every 100 women will become pregnant in each subsequent year following the first year (when the procedure was done). This is due to a slight possibility that the fallopian tubes may reopen where they are tied or severed; in some cases, the surgeon may tie or sever a similar-looking structure called the round ligament.

Of every 1,000 women who have undergone tubal ligation, approximately 18.5 will become pregnant within 10 years, according to statistics compiled by the U.S. Collaborative Review of Sterilization in their landmark Crest study. However, depending on the method used and the age of the woman when she has the procedure done, this rate might be higher or lower.

If a pregnancy does occur after a tubal ligation, there is a 10-20% chance of it being an ectopic pregnancy due to the structural changes and damage in the fallopian tube. However, the overall rate of ectopic pregnancy after tubal ligation is very low—lower than it would be had she not had the tubal ligation done in the first place.