Bilateral Tubal Ligation (Tubal Sterilization)
What is Tubal Ligation?
Tubal ligation refers to a surgical intervention meant for female sterilization. It involves the removal or permanent blocking of the fallopian tubes. It inhibits the fertilization of eggs by a sperm, thereby preventing conception. Tubal ligation is considered an irreversible or permanent method of birth control. Female sterilization is the most common method of contraception worldwide, used by 19 percent of all women ages 15 to 49 years who are married or in a relationship union. Reliance on female sterilization is highest in Asia (23.4 percent) and Latin America and the Caribbean (26 percent), and lowest in Africa (1.7 percent) and Europe (3.8 percent).
Female sterilization is one of the most commonly used methods of contraception in the United States; 25.1 percent of contracepting women, or 15.5 percent of all women ages 15 to 44 (9.4 million women), rely on sterilization. Female sterilization is second only to oral contraceptives, which are used by 25.9 percent of contraceptive users, or 16.0 percent of all women of childbearing age. Prevalence of having had a female sterilization increases with age, marital status (currently or previously married), and increasing parity.
How effective is the procedure of Tubal Ligation?
Tubal Ligation is more effective than most other contraceptive methods, including condoms and diaphragms. It is estimated that about 1 in 200 women become pregnant after undergoing tubal ligation.
Can Tubal Sterilization be reversed if you change your mind?
Tubal sterilization is an irreversible surgical procedure. Hence, women cannot have children after they have undergone tubal ligation. However, it should be noted that tubal sterilization can be reversed by another surgery. The procedure involves reattachment of the fallopian tubes to allow the passage of sperms and eggs. However, only 50-80% of women are able to get pregnant after the procedure. Hence, this method of contraception is considered suitable only for women who have had children and do not wish to have more children in the future.
Does Tubal Ligation protect against STDs?
No, Tubal Ligation does not protect against STDs. Hence, it is advisable to use condoms to prevent sexually transmitted diseases such as AIDS/HIV.
One needs to be 21 years and above to be eligible for this procedure. If you’re sure you don’t want kids, or more kids, a permanent birth control may be for you.
Doctors consider it to be a low-risk procedure and it is 99.5 % effective. Female sterilization permanently prevents pregnancy and you no longer need any type of birth control. Every day more women choose this definitive contraceptive method after having completed their family planning. Tubal ligation is also considered one of the most popular forms of birth control worldwide, according to the American College of Obstetricians and Gynecologists (ACOG).
How do you get ready for the procedure of Tubal Ligation?
Women should inform the physician about the medicines they are using including herbal supplements. They should also stop taking aspirin and other medications that cause thinning of the blood and prevent clotting in order to reduce the risk of excessive bleeding.
They should inform the physician if they smoke, or have a history of allergy to any anesthetic agent.
The patients would also receive instructions about how many hours before the procedure they should avoid eating food. Generally, if tubal ligation is to be performed in the morning, the patient is advised to avoid eating or drinking anything after midnight
What happens during Tubal Ligation?
There are few ways to do it:
- Laparoscopy : small incision by belly button with a camera
- Mini-laparotomy : small incision above the pubic hair line
- Post Partum: during c-section or after vaginal birth with in 48 hrs.
During Tubal Ligation, both the fallopian tubes are cut or blocked. The surgery is usually performed in the hospital or an outpatient surgical clinic. Generally, local or spinal anesthesia is administered before the procedure. Patients remain awake when spinal or local anesthesia is administered. The actual procedure takes about 30 minutes. In most cases, patients are able to go home on the day of surgery.
What happens after Tubal Ligation?
After the procedure, women can resume their normal diet after being discharged from the hospital. It is advisable to avoid lifting heavy weights for a few weeks.
Also, they continue to have their periods normally. In rare cases, they may develop a few complications due to the surgery such as bleeding from the incision.
What are the risks of Tubal Ligation?
Tubal ligation is generally safe. In rare cases, women may experience a few complications such as:
- Side effects of anesthesia
- Ectopic pregnancy
- Infection at the site of the incision
Sterilization Regret — Most women are satisfied with the decision to undergo sterilization, but some women experience regret. Rates of regret after sterilization vary widely among studies, ranging from 2 to 26 percent . Young age is a strong predictor of sterilization regret, but there is no established threshold of an age that is too young to undergo sterilization. Nulliparity does not appear to be associated with an increased risk of regret.
Vasectomy — Vasectomy, male sterilization, appears to be the safest method of sterilization, and efficacy rates are comparable with female sterilization. Vasectomy is also the most cost-effective method of permanent contraception . Given its safety and efficacy profile, vasectomy should be a preferred method of sterilization across both sexes but is significantly underutilized. While 25.1 percent of contracepting women rely on female sterilization, only 8.2 percent rely on male sterilization . Vasectomy requires the male partner’s willingness to undergo the procedure and assumes that the woman will not have any other male partners. In contrast to female sterilization procedures, vasectomy is not effective right away and requires back-up contraception until azoospermia is confirmed.
Long-term data for the efficacy of vasectomy are limited, and outcomes depend on whether there is confirmation of azoospermia. Pregnancy rates at one year with confirmed azoospermia have been reported as low as 0.02 percent and as high as 0.74 percent in retrospective surveys of women whose partners have had vasectomies but in which assessment of sperm count is not documented . In this latter group, the pregnancy rate was 1.1 percent at two, three, and five years.
Vasectomy is generally regarded as the safest method of permanent sterilization. Mortality rates are estimated at 0.5/100,000, major complications at 1 in 1250, and minor complications 1 to 6 percent. In one review, vasectomy was estimated to have 12 times lower mortality and 20 times lower major morbidity than tubal ligation. This comparison, however, is based on older data when the main driver of major complications for laparoscopic tubal ligation was conversion to laparotomy. With improvements in gynecologic laparoscopic skill over time, this complication has now become much less common. Nevertheless, it remains reasonable to assume that vasectomy, which is an outpatient procedure done without anesthesia, has lower morbidity and mortality than female sterilization via mini-laparotomy or laparoscopy.