Tubal ligation

Overview

Tubal ligation is a type of permanent birth control. It's also known as having your tubes tied or tubal sterilization. During this surgery, the fallopian tubes most often are cut and tied to prevent pregnancy for the rest of your life.

Tubal ligation prevents an egg from moving from the ovaries and down to the uterus through the fallopian tubes. It also blocks sperm from traveling up the fallopian tubes to the egg. The procedure doesn't affect your menstrual cycle.

Tubal ligation can be done at any time. This includes after childbirth or along with another surgery through the lower stomach area, such as a C-section. Most tubal ligation procedures cannot be reversed. Trying to reverse it requires major surgery. And the surgery doesn't always work.

If you're thinking about getting a tubal ligation, your surgeon may offer you another treatment option for permanent birth control. It's a surgery in which the fallopian tubes are completely removed, called salpingectomy (sal-pin-JEK-tuh-me). Having both tubes fully removed may greatly lower the risk of ovarian cancer.

Why it's done

Tubal ligation is one of the most common surgeries for permanent birth control in women. Once you get the procedure, you no longer need to use any type of birth control pill or device to prevent pregnancy. But it does not protect against sexually transmitted infections.

Tubal ligation also may lower the risk of ovarian cancer. This risk may fall even more if the fallopian tubes are completely removed. These surgeries seem to lower the risk of ovarian cancer because the disease often appears to start in the fallopian tubes, rather than in the ovaries.

Tubal ligation and salpingectomy aren't right for everyone. Talk with a member of your health care team to make sure you fully understand the risks and benefits of the procedure.

Your health care professional also might talk to you about other options. For example, some types of birth control last for years and can be removed if you decide to get pregnant. These include an intrauterine device (IUD) that's placed in the uterus or a small implant that's placed under the skin of the upper arm.

Risks

Tubal ligation is a surgery that involves making one or more small cuts in the lower stomach area, also called lower abdomen. The procedure uses medicine that keeps you from feeling pain, called anesthesia.

Risks linked with tubal ligation include:

• Damage to the bowel, bladder or major blood vessels.
• Reaction to anesthesia.
• Improper wound healing or infection.
• Ongoing pain in the pelvis or abdomen.
• Bleeding from incisions.
• Rarely, an unwanted pregnancy in the future if the procedure doesn't work.

Things that make you more likely to have complications from tubal ligation include:

• Past surgery through the abdomen or pelvis.
• History of ruptured appendix.
• Endometriosis.
• Obesity.
• Diabetes.

How you prepare

Before you have a tubal ligation, your health care professional will likely ask you about your reasons for wanting permanent birth control. Together, you'll also likely talk about factors that could make you regret the decision. These include young age and a change in relationship status.

Your health care professional also reviews the following with you:

• Risks and benefits of reversible and permanent methods of birth control.
• Details of the procedure.
• Causes and likelihood of the procedure not working.
• Ways to prevent sexually transmitted infections, including use of condoms.
• The best time to do the procedure. For instance, if you're pregnant, you can get a tubal ligation shortly after you have your baby, whether you have a vaginal delivery or C-section.

If you do not plan to have a tubal ligation right after childbirth or during a C-section, use birth control until the time of your tubal ligation procedure.

What you can expect

Tubal ligation or fallopian tube removal can be done:

• The day after giving birth through the vagina.
• During a C-section once the baby is delivered.
• After an abortion.
• Anytime you want outside of a pregnancy.

Before the procedure

You may be asked to take a pregnancy test to make sure you're not pregnant.

During the procedure

The type of sterilization surgery that is right for you depends on your circumstances and preferences:

• If you have a tubal ligation the day after vaginal childbirth, your surgeon does a procedure called a mini-laparotomy. A small cut is made under the bellybutton, also called the navel. This provides easy access to the uterus and fallopian tubes. The tubes are partly removed, rather than fully removed, because of the small size of the cut. You may receive medicine that prevents pain and puts you in a sleep-like state, called general anesthesia. Or you might receive medicine that blocks pain in the surgery area, called regional anesthesia.
• If you have a tubal ligation during a C-section, your surgeon uses the incision that was made to deliver the baby. Often, the entire fallopian tube on each side is taken out if possible. This is called a complete salpingectomy. The ovaries are left in. This prevents menopause from starting earlier than usual. Often, regional anesthesia is used to keep you from feeling pain.

• About six weeks after childbirth, a procedure called laparoscopy can be done to remove the fallopian tubes. The surgeon makes a small cut in or near the bellybutton. The abdomen is inflated with gas, such as carbon dioxide or nitrous oxide. This gives the surgeon more space to operate. A thin tool with a light and a camera called a laparoscope is inserted through the cut. This lets the surgeon view the pelvic organs.

  One or two more small incisions may be made in the lower abdomen so that other laparoscope tools can reach the fallopian tubes. The goal is to remove each fallopian tube entirely and leave the ovaries in place. General anesthesia is used to prevent pain and place you in a sleep-like state during surgery. Often, you're able to go home the same day, also known as an outpatient procedure.

• Any other time outside of a pregnancy, surgery can be done to remove or close off fallopian tubes. This is also known as interval tubal ligation. It's often done using the laparoscopy procedure with general anesthesia. In the past, methods to seal the fallopian tubes during laparoscopy were common. Parts of the tubes can be burned with an electric current, called cautery. Or the tubes can be blocked with titanium or spring-loaded clips.

Factors that can prevent the complete removal of the fallopian tubes include:

• Bands of scar tissue from a past C-section or other surgery of the female reproductive tract.
• A condition in which certain tissue grows outside the uterus, called endometriosis.
• A female reproductive tract that has an irregular structure.

After the procedure

If you received carbon dioxide in your abdomen during surgery to help your surgeon see inside your body, the gas is removed when the procedure is done. Some of this gas may be trapped under the muscle that helps you breathe in and out, called the diaphragm. This can cause shoulder pain for a short time as the gas is reabsorbed over the next few days. Often, you are allowed to go home a few hours after an interval tubal ligation. Having a tubal ligation right after childbirth usually doesn't involve a longer hospital stay.

You'll likely have some pain at the incision site. You also might have:

• Pain or cramping in the stomach area.
• Fatigue.
• Dizziness.
• Gassiness or bloating.
• Shoulder pain.

Before you go home, a member of your health care team talks with you about how to manage any pain. Often, medicines such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin IB, others) can ease mild discomfort after the surgery.

You may shower 48 hours after the procedure. Carefully pat the incision dry. Do not take a bath or use a hot tub for 10 days. Also, don't strain or rub the incision.

Do not lift heavy objects until your health care professional tells you that it's safe to do so. You might be told not to have sex due to discomfort for a few weeks. But a tubal ligation is effective right away. Also, sex is not recommended for six weeks after a vaginal delivery or a C-section. You can slowly get back to your usual routine as you start to feel better. Often, the stitches used during surgery dissolve on their own. Check with a member of your health care team to see if you need a follow-up appointment.

Call your health care professional if you have any concerns that you aren't healing properly. Call for help right away if you have:

• A temperature of 100.4 F (38 C) or higher.
• Fainting spells.
• Stomach pain that is serious, or pain that continues or gets worse after 12 hours.
• Bleeding from your wound through your bandage.
• Discharge from your wound that is foul smelling.

Results

In general, tubal ligation is a safe and effective form of permanent birth control. But it doesn't work for everyone. Fewer than 1 out of 100 women will get pregnant in the first year after the procedure. The younger you are at the time that the surgery is done, the more likely it won't work. If a salpingectomy or complete removal of the tubes is done, pregnancy will not occur.

If you do conceive after a tubal ligation, there's a risk that the fertilized egg could attach to tissue outside of the uterus. This is called an ectopic pregnancy. It needs to be treated right away, and the pregnancy cannot continue to birth. If you think you're pregnant at any time after a tubal ligation, call your health care team at once. The risk of ectopic pregnancy is lower if both fallopian tubes are removed.

A tubal ligation may be able to be reversed if part of the tubes are left in. But the reversal procedure is complex, costly and it might not work. Surgery to fully remove the fallopian tubes cannot be reversed.