What is Female Sterilization?

Female sterilization is meant as a permanent and irreversible form of pregnancy prevention. There are two types of procedures: tubal ligation and the insertion of tubal implants (commonly referred to as its brand name Essure). There are two common types of tubal ligation surgeries, the mini-laparotomy, and the laparoscopy. Both tubal ligation and tubal implant procedures work by preventing the movement of the egg to the uterus and the sperm up the fallopian tubes. By blocking the fallopian tubes, the sperm is unable to fertilize the egg. Tubal ligation (or “having your tubes tied”) is an operation in which a female’s fallopian tubes are closed off by being cut and tied.² The insertion of tubal implants is a non-surgical procedure in which coils are inserted to promote scar tissue buildup to block the fallopian tubes. Both procedures are performed by a healthcare provider (typically a gynecologist or general surgeon). It is uncommon that either procedure will have any effect on a female’s menstrual cycle. While tubal-ligation-reversal procedures do exist, female sterilization is largely irreversible.³

About the Procedures

Laparoscopy

A laparoscopy is a common form of tubal ligation that is considerably less invasive than the mini-laparotomy. First, the patient is given general or regional anesthesia: general anesthesia causes you to fall asleep and not experience any pain, while local anesthesia, usually administered in the form of an epidural, causes you to remain awake. With local anesthesia, a patient usually receives medication that makes him or her drowsy.² The surgeon then inflates the abdomen with carbon dioxide (a non-toxic gas) in order to get an unobstructed view of the pelvic organs. The surgeon makes two small incisions (about one centimeter each in length) in the abdomen. One incision is placed below the navel and one above the pubic bone. The surgeon then inserts a thin viewing tube called a laparoscope into one incision and instruments used for operating in the other. The surgeon locates the fallopian tubes using the laparoscope and uses the operating device to clamp or cut the tubes. The fallopian tubes may also be sealed shut with an electric current (electrocautery). The laparoscope is then removed and the two small incisions are stitched closed.

The laparoscopy method is generally less painful than the mini-laparotomy and results in minimal scarring. The procedure takes about 30 minutes, and most females can return home the same day.¹

Mini-Laparotomy

A mini-laparotomy is another form of tubal ligation. This method is considered a major surgery and is done under general anesthesia. A “mini-lap” is commonly performed during the first 24-36 hours following childbirth. It can also be performed during a cesarean birth (“C-section”).¹

During surgery, one small incision (less than five centimeters in length) is made just above the pubic hairline. The surgeon then locates the fallopian tubes and closes them using ties, clips, or an electrical current. No laparoscope or carbon dioxide gas is used during surgery. Full recovery generally occurs within a few days.

Tubal Implants (Essure)

Tubal implants, such as Essure, involve the insertion of a small metal spring through the cervix and uterus until it reaches the fallopian tube. The insertion of tubal implants is different from a surgical tubal ligation in that it does not involve any cutting or incision-making. Over time, scar tissue forms around the metal springs to permanently block the tubes so that the egg and sperm are unable to fertilize. This scar tissue growth takes approximately 3 months and thus Essure is not an immediately effective form of sterilization, as are the mini-lap and the laparoscopy. This procedure is performed by a healthcare provider and requires neither general anesthesia nor incisions. Tubal implants may be preferable for females who do not want to undergo surgery.

With this method, the healthcare provider inserts small metal springs into the fallopian tube. The insertion of tubal implants is different from a surgical tubal ligation in that it does not involve any cutting. Over time, scar tissue forms around the metal springs to permanently block the tubes.

Advantages of Female Sterilization

• Female sterilization is a permanent method of birth control requiring no action on the part of the female. After undergoing the procedure, the female will no longer have to worry about becoming pregnant. This fact alone can bring quite a bit of peace of mind.
• Sterilization causes absolutely no hormonal changes to the body and thus can be considered more “natural” when compared to hormonal birth control methods.

Disadvantages of Female Sterilization

• The procedure is very difficult or impossible to reverse. If there is even a slight chance that you will decide to have children in the future, this procedure is not right for you.
• Tubal ligation and tubal implants do not protect against sexually transmitted infections (STIs), so it is important to use a male or female condom during sexual intercourse.
• For the first three months following tubal-implant insertion, you must use an alternate form of contraception. This is required so that the tubes can build up an adequate amount of scar tissue.
• If tubal ligation or implant fails and you become pregnant, you have an increased risk of an ectopic pregnancy.
• Complications can occur with any type of surgery. Tubal-ligation surgery carries the risks of reaction to anesthetics, infection, bleeding, and injury to the bowels, bladder, or uterus. The surgery may also result in permanent scarring at the incision site.

Effectiveness

About five every 1,000 (0.5%) females will become pregnant after one year following tubal ligation. About thirteen of every 1,000 (1.3%) females will become pregnant after five years following tubal ligation. Pregnancy may occur if the tubes grow back together and reconnect so that the egg and sperm are able to fertilize, if the surgery was not performed correctly, or if you were already pregnant at the time of surgery. There is less information on the effectiveness of tubal implants since they are a relatively new form of female sterilization. Studies have shown that less than one in every 100 females (<1%) will become pregnant within two years of tubal-implant surgery. Tubal implants can be difficult to insert, so a repeat procedure may be necessary before both implants are correctly inserted.²

Cost

The cost of female sterilization varies from $1,500 to $6,000, depending on the type of procedure and where you reside. Although tubal ligation and implants can be expensive, the procedure is a one-time cost and may be less expensive over time compared to the long-term costs of other birth control methods. Tubal ligation and implant procedures are usually covered by medical insurance. Many doctors and health care insurance providers require a waiting period between 48 hours and 30 days from the female’s request of surgery to when it is actually performed. This waiting period is meant to allow the female to become certain that sterilization is right for her.

Things to Consider

Female Sterilization is generally an irreversible form of birth control. As with any permanent change to your body, it is important to consider the impact this will have on your (and possibly your partner’s) life. Before finalizing your choice, consider whether or not there are any circumstances in which you may want to have more children in the future. If you are unsure about female sterilization, consider which other forms of birth control might be a better alternative. For more information on various other types of contraceptives, see our birth control comparison chart. Finally, if in a committed relationship, be sure to discuss female sterilization with your partner before going through with the procedure.

Tubal Ligation Reversal

A tubal ligation reversal is a procedure to restore fertility to a female after tubal ligation surgery. Tubal ligation reversal is most successful for females under the age of 35 who had undergone sterilization procedures with the least amount of damage to the fallopian tubes. These procedures include sterilization methods that involve rings or clamps to block off the fallopian tubes. Since tubal implants create scarring to seal the fallopian tubes, the tubal implant insertion procedure is generally irreversible. Pregnancy rates following tubal ligation reversal vary between 30% and 85%. These rates are determined by a multitude of factors, including the female’s age at the time of the surgery, the type of tubal ligation procedure that was performed, whether or not the fallopian tubes still work correctly, and the surgeon’s skill level.⁵ Females who have undergone tubal ligation reversal have an increased risk of ectopic pregnancy, a life-threatening condition in which the fertilized egg develops outside of the uterus. Tubal reversal is usually not covered by insurance and can be expensive. The surgery is typically a few thousand dollars and requires the additional costs of general anesthesia and hospital fees.⁴

During a tubal ligation reversal procedure, the surgeon will use a laparoscope with microscopic instruments attached to the end. The laparoscope allows the surgeon to look at the fallopian tubes as he or she removes any clips or rings that were put in place to block the tubes. The surgeon will then use small stitches to reconnect the fallopian tube ends to the uterus. Tubal ligation reversal surgery takes about two to three hours and is performed with general anesthesia. The surgery is more difficult than the original tubal ligation operation, and females may need to stay overnight in the hospital for one to three days. About three months after surgery, the patient will need a follow-up X-ray dye test to ensure that the reversal surgery was successful and the fallopian tubes are functioning correctly.⁴

In-vitro fertilization, in which eggs and sperm are fertilized in a laboratory and then placed inside of the uterus, may be an alternative option for females who wish to conceive without going through tubal ligation reversal or for females who have had unsuccessful reversal procedures.⁵

References

1. “Sterilization for Women (Tubal Sterilization)” Planned Parenthood. Planned Parenthood Federation of America, 2012. Web. 26 March 2014. <http://www.plannedparenthood.org/health-topics/birth-control/sterilization-women-4248.htm>.
2. “Tubal Ligation and Tubal Implants.” WebMD. N.p., 13 May 2010. Web. 18 Feb. 2014. <http://www.webmd.com/sex/birth-control/tubal-ligation-and-tubal-implants>.
3. “Tubal Ligation.” MedlinePlus. U.S. National Library of Medicine, 26 Feb. 2012. Web. 20 Feb. 2014. <http://www.nlm.nih.gov/medlineplus/ency/article/002913.htm>.
4. “Tubal Ligation Reversal: Procedure, Success Rates, Cost and Insurance.” WebMD. N.p., n.d. Web. 20 Feb. 2014. <http://www.webmd.com/infertility-and-reproduction/guide/tubal-ligation-reversal?page=2>.
5. “Tubal Ligation Reversal.” Definition. N.p., 2 Feb. 2012. Web. 20 Feb. 2014. <http://www.mayoclinic.org/tests-procedures/tubal-ligation-reversal/basics/definition/PRC-20020246>.

Last Updated 20 February 2014.