Tubal ligation, often referred to as "having your tubes tied," is a surgical procedure in which a woman's fallopian tubes are blocked, tied, or cut. Tubal implants, such as Essure, are small metal springs that are placed in each fallopian tube in a nonsurgical procedure (no cutting is involved). Over time, scar tissue grows around each implant and permanently blocks the tubes. Either procedure stops eggs from traveling from the ovaries into the fallopian tubes, where the egg is normally fertilized by a sperm.
Tubal ligation and tubal implants are considered to be permanent methods of birth control for women. They are usually done by a gynecologist. They may also be done by a family medicine doctor or a general surgeon.
There are several different ways of closing the fallopian tubes, including clipping or banding them shut or cutting and stitching or burning them closed. Your surgeon will probably prefer one of these tubal ligation methods.
A tubal ligation can be done using a:
An open tubal ligation (laparotomy) is done through a larger incision in the abdomen. It may be recommended if you need abdominal surgery for other reasons (such as a cesarean section) or have had pelvic inflammatory disease (PID), endometriosis, or previous abdominal or pelvic surgery. These conditions often cause scarring or sticking together (adhesion) of tissue and organs in the abdomen. Scarring or adhesions can make one of the other types of tubal ligation more difficult and risky.
Reversing a tubal ligation is possible, but it isn't highly successful. This is why tubal ligation is considered a permanent method of birth control.
Implants, such as Essure, are inserted in the fallopian tubes without surgery or general anesthesia. The procedure is done in a doctor's office, an outpatient surgery center, or a hospital, and it doesn't require an overnight stay. The implant procedure itself takes about 10 minutes.
After the procedure, an X-ray is taken to make sure the implants are in place and the tubes are closed.
In some cases, a tubal implant can be difficult to insert. Should this happen, a second procedure is needed to completely block both tubes.
For the first 3 months after insertion, you must use another method of birth control. At 3 months, dye is injected into your uterus and an X-ray is taken (hysterosalpingography) to make sure that the implants are in place and the tubes are fully blocked by scar tissue. If they are, you will no longer have to use another method of birth control.
After a tubal ligation, you will most likely go home the same day. Your surgeon will give you instructions on what to expect and when to call after the surgery.
A follow-up exam in 2 weeks is usually scheduled.
A tubal ligation or tubal implant placement is a permanent method of birth control. Only consider this method when you are sure that you will not want to become pregnant in the future.
Tubal ligation and tubal implants are not 100% effective at preventing pregnancy.
Call your doctor immediately if you have had tubal ligation or tubal implants and you have:
Tubal ligation. Major complications of tubal ligation aren't common.
Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, in rare cases, the bowel or bladder is injured when the laparoscope is inserted.
The general risks of surgery are greater if you have diabetes, are overweight, smoke, or have a heart condition.
Tubal implants. There are rare reports of implants causing pelvic pain that doesn't go away. In these cases, the implants were removed 6 weeks after they were placed in the fallopian tubes.2 The risk of pelvic infection is greater with tubal implants. Before you receive implants, you will be tested to make sure that you don't have a vaginal infection or a sexually transmitted infection (STI).
If a tubal ligation or implant fails and you become pregnant, you have an increased risk of having an ectopic pregnancy. Ectopic pregnancies can occur years after the tubal ligation and are most likely 3 or more years after the procedure.3 To learn more, see the topic Ectopic Pregnancy.
Tubal ligation and tubal implants do not change your monthly menstrual cycle. You will still release an egg each month (ovulate) and have menstrual periods. You will go through menopause at the same time that you would have if you hadn't had the surgery. Your sexual desires won't change, although you may feel more relaxed about having sex because you don't have to worry about becoming pregnant.
Tubal ligation and tubal implants are permanent methods of birth control and allow you to be sexually active without worrying about becoming pregnant.
Although tubal ligation and tubal implants are expensive, it is a one-time cost. These procedures are usually covered by medical insurance, and there are no costs after the surgery is done. The cost of other birth control methods, such as pills or condoms and spermicide, may be greater over time.
Tubal ligation and tubal implants do not protect against sexually transmitted infections (STIs), including infection with the human immunodeficiency virus (HIV). To help protect yourself and your partner from possible STIs, use a condom every time you have sex.
You must use another form of birth control for 3 months after receiving tubal implants.
Reversing tubal ligation requires reconnecting the fallopian tubes, and success rates for reconnecting are very low. If you are considering tubal ligation, be absolutely certain that you will never want to have a biological child in the future.
- Pollack AE, et al. (2007). Female and male sterilization. In RA Hatcher et al., eds., Contraceptive Technology, 19th ed., pp. 361–401. New York: Ardent Media.
- Lannon BV, et al. (2007). Techniques for removal of the Essure* hysteroscopic tubal occlusion device. Fertility and Sterility. Published online August 2007. 88(2): 497.e13–e497.e14. (doi:10.1016/j.fertnstert.2006.11.072).
- Speroff L, Darney PD (2011). Sterilization. In A Clinical Guide for Contraception, 5th ed., pp. 381–404. Philadelphia: Lippincott Williams and Wilkins.
Last Revised: August 14, 2012
Author: Healthwise Staff
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