, 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
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.
Laparoscopy is usually done with a
general anesthetic. Laparotomy or mini-laparotomy can
be done using general anesthesia or a
regional anesthetic, also known as an epidural.
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
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
Be sure to get checked early if you have these signs
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
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 For more information, see the topic
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
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.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
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):
Speroff L, Darney PD (2011). Sterilization. In A Clinical Guide for Contraception, 5th ed., pp. 381–404. Philadelphia: Lippincott Williams and Wilkins.
August 14, 2012
Sarah Marshall, MD - Family Medicine
& Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
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