Tubal Ligation: Your Questions Answered

Tubal ligation, or tubal sterilization, is a permanent birth control option for women. Sometimes it is called having your "tubes tied," but there are various methods to close the fallopian tubes to prevent pregnancy.

And while in some cases the procedure can be reversed, it should be considered permanent birth control.

What is tubal ligation?

The fallopian tubes connect the ovaries to the uterus. During tubal ligation surgery, the fallopian tubes are cut, clamped or tied closed. In some cases, various methods are used to form scar tissue in the fallopian tubes to block passage of the egg or sperm through the tube. As a result, the egg released by the ovary can't reach the uterus and sperm can't reach the egg for fertilization. This will permanently prevent pregnancy.

Why get a tubal ligation?

Tubal ligation is a birth control option for women who do not want or can't have any children or more children. This is a permanent birth control method. If there is even the slightest chance you may want children one day, there are many reversible birth control methods you can use. Sometimes a tubal ligation can be reversed, but not always. Discuss any concerns with your doctor.

How is a tubal ligation performed?

Tubal ligation surgery is usually done using a laparoscope. This means one or more small cuts are made in the abdomen, then a small scope and surgical tools are inserted. This is done in place of a large incision in the abdomen. You will be given anesthesia (you may or may not be awake) so you won't feel any pain.

There are two types of procedure:

• Laparoscopic tubal ligation. For this,the abdomen is first inflated with gas to create room to perform the procedure. Next a fiber-optic scope and small tools are inserted through a very small incision in your abdomen. The fallopian tubes are sealed using a ring, clip or electric current. All of these methods cause scarring that affects the tube's ability to transport sperm or eggs
• Minilaparotomy. This involves making a small incision in the abdomen and lifting the tubes slightly out of the incision. Part of the tube is removed and the remaining part is sealed with stitches, bands, clips or an electric current that creates scar tissue to block the tube.

Some women choose to have tubal ligation postpartum. Postpartum sterilization is typically done one or two days after childbirth or right after delivery. For women who deliver by cesarean (C-section), the procedure can often be done through the same abdominal incision right away after delivery of the baby.

How long does the surgery take?

The surgery is short and often takes less than 30 minutes. Women usually go home the same day if there are no major problems.

What are the risks of surgery?

Tubal ligation is considered a low-risk operation. Mild side effects can occur, but they will likely subside after a few days:

• Abdominal pain or cramps and bloating
• Tiredness
• Dizziness
• Nausea
• Sore throat (if a tube has been inserted for general anesthesia)

Serious side effects are very rare, but can happen:

• Infection
• Reaction from anesthesia
• Bleeding, either inside the abdomen or at the incision site
• Bowel or bladder burn or injury

There is the unlikely chance that tubal ligation will not work right away. One out of three women, who in the unlikely event become pregnant after a tubal ligation, have an ectopic pregnancy. This is a dangerous but rare condition in which the pregnancy implants outside of the uterus and inside the tube.

What are the benefits of a tubal ligation?

It is effective in preventing pregnancy immediately after surgery. You do not need to temporarily use other birth control.

• It does not affect sexual sensation
• It does not impact your menstrual cycle. You'll still have periods
• It may slightly lower the risk of ovarian cancer and pelvic inflammatory disease (PID)

Who should not have a tubal ligation?

Tubal ligation is not safe for everyone. Talk to your doctor to see if you're a candidate for the operation. If you have one of the following conditions, you're at an increased risk for problems from the surgery:

• Diabetes
• Lung disease
• Previous pelvic or abdominal surgery
• History of pelvic inflammatory disease (PID)
• Obesity

Does tubal ligation prevent sexually transmitted diseases (STDs)?

Tubal ligation only prevents pregnancy. It will not protect you from STDs. Use a barrier method of birth control, like the condom, if you are not in a monogamous relationship where both you and your partner are free from any STDs.

Are there alternatives?

Two other types of permanent birth control are available:

• Essure is an option for women. Tiny metal coils (called microinserts) are placed into both fallopian tubes through the cervix. This can even be done in the doctor's office. Scar tissue builds up around the microinserts. This blocks the eggs from passing through the fallopian tubes and the sperm from traveling up the fallopian tubes
• Vasectomy is available to men. During this surgery, the vas deferens (small tubes that sperm use to travel from the testes to the penis) are tied, cut or sealed. This stops sperm from being released during ejaculation. Vasectomy is often less risky and costly than a tubal ligation.

Keep in mind that there are highly effective types of reversible birth control available, too.