Tubal Ligation and Vasectomy for Permanent Birth Control

Picture of a Fallopian tube that has been tied off.

• Sterilization is considered a permanent method of birth control that a man or woman may choose.
• Although sterilization, or a tubal ligation (tubes tied), for women and vasectomy for men can sometimes be reversed, the surgery is much more complicated than the original procedure and may not be successful.
• Thus, when choosing a sterilization method, you should be certain you do not desire future pregnancies.

About 600,000 American women each year elect to have surgery for sterilization, referred to as tying the Fallopian tubes or tubal ligation. Some women have a hysterectomy (removal of the uterus and sometimes also the tubes and ovaries) each year but, but this is usually not performed only for birth control.

Most US women who have undergone sterilization experience either a postpartum minilaparotomy procedure or an interval (timing of the procedure does not coincide with a recent pregnancy) procedure. A postpartum tubal ligation is usually performed through a small incision made through the navel immediately following vaginal delivery of an infant, or it may be performed through an open incision at the time of cesarean section. An interval tubal sterilization is usually done with the use of small instruments inserted into a woman's abdomen following laparoscopy wherein the a scope is inserted through the umbilicus. Interval minilaparotomy - a small abdominal incision in bikini area - is usually the procedure of choice when distortion of the abdominal contents or adhesions are anticipated, which might compromise the ability to complete the procedure laparoscopically.The majority of cases of surgical sterilization for women are performed under general anesthesia.

The Fallopian tubes (through which the egg passes from the ovaries and where the egg is fertilized by the sperm) may be blocked with silastic rings, clips, bands, segmental destruction with electrocoagulation, or suture ligation with partial salpingectomy (removal of a segment in each of the fallopian tubes). Female sterilization prevents fertilization by interrupting the passage of sperm upward through the Fallopian tube.

• How effective: Sometimes this method does not provide permanent birth control (i.e. tubal ligation failure). The United States Collaborative Review of Sterilization has examined the failure rate of female sterilization. Rates vary according to the procedure performed. Overall, about 18.5 women out of 1,000 women who have the procedure become pregnant within 10 years. This is likely caused by an incomplete closure of the tubes. If pregnancy does occur after the procedure, there is an increased risk for an ectopic pregnancy pregnancy in a location other than the anticipated position within the uterus).
• Advantages: Female sterilization does not involve hormones. It is a permanent form of birth control. There are no changes in libido (sexual desire), menstrual cycle, or breastfeeding ability. The procedure is usually performed as a same-day procedure done in an outpatient surgical facility.
• Disadvantages: The procedure involves general or regional anesthesia. It is permanent form of birth control, and some women may regret their decision at a later date. The two most common factors associated with regret are young age and unpredictable life events, such as change in marital status or death of a child. Regret also has been shown to correlate with external pressure by the clinician, spouse, relatives, or significant others.

Regret is difficult to measure because it encompasses a complex spectrum of feelings that can change over time. This helps to explain that while some studies have shown "regret" on the part of 26% of women, fewer than 20% seek reversal and fewer than 10% actually undergo the reversal procedure.

Female sterilization does not protect a woman from sexually transmitted diseases, and it involves all of the risks of surgery. Occasionally, sterilization cannot be done laparoscopically, and an abdominal incision may be necessary to reach the Fallopian tubes. There may be some short-term discomfort.

The Essure system involves a small metallic implant that is placed into the Fallopian tubes of women who wish to be permanently sterilized.

During the implantation procedure, the doctor inserts one of the devices into each of the two Fallopian tubes. This is done with a special catheter (tube) that is inserted through the vagina into the uterus, and then into the Fallopian tube. General anesthesia is not required, and the procedure can be performed in the doctor's office. The device works by making scar tissue form over the implant, blocking the Fallopian tube and preventing fertilization of the egg by the sperm. A similar system uses a silicone implant known as the Adiana system.

During the first three months, women cannot rely on the implants and must use alternate birth control. At the three-month point, women must undergo a final X-ray procedure in which dye is placed in the uterus and an X-ray is taken to confirm proper device placement. Once placement is confirmed, you do not need another form of birth control.

The Essure device has a reported effectiveness of 99.8%. Potential disadvantages of the system include the fact that not all women will achieve successful placement of both inserts. Side effects during or immediately following the procedure may include mild-to-moderate cramping, nausea, vomiting, dizziness, light-headedness, bleeding and/or spotting.

The procedure cannot be reversed. This is a permanent form of birth control. Sometimes doctors have difficulty placing the implants. There is risk of ectopic pregnancy, a life-threatening condition which frequently requires emergency medical care. Implants, like surgical sterilization do not protect against sexually transmitted diseases (STDs).

Vasectomy, the most common form of surgical sterilization in men, involves making a small incision in the scrotal sac, followed by cutting or burning of the vas deferens (the tubes that carry sperm), and blocking both cut ends. The procedure is usually performed under local anesthesia in an outpatient setting. Vasectomy prevents the passage of sperm into seminal fluid by blocking the vas deferens. More than 200,000 men in the US undergo vasectomy each year.

Following vasectomy, some men may develop bruising in their testicles. Because, some sperm may remain in the vas deferens for several months after the procedure, a man is not considered sterile until he has produced sperm-free ejaculations. Semen is tested in the lab several weeks after the procedure to determine if the semen is free of sperm. This usually requires 15 to 20 ejaculations. (The couple should use another form of birth control during this period, or the man may ejaculate by masturbation.)

• How effective: The failure rate is determined to be approximately 0.1%.
• Advantages: Vasectomy involves no hormones. It is permanent. The procedure is quick with few risks. It is performed as an outpatient procedure in a clinic or doctor's office.
• Disadvantages: Men may regret the decision later. Vasectomy does not prevent a man from contracting sexually transmitted diseases. Short-term discomfort usually follows the procedure.