Tubal ligation, also called female sterilization, is a surgical procedure that irreversibly prevents future pregnancies. Before the 1960s, surgical sterilization was performed only when warranted by a medical condition or old age or if child-bearing was a health risk (1). However, sterilization procedures for contraceptive reasons came into use in the late 1960s. It is important to understand the process before considering this permanent birth control option. Read this post to learn about tubal ligation, how it works, and its advantages and disadvantages.
What Is Tubal Ligation (Tubectomy)?
Tubal ligation is a popular sterilization method adopted by women all over the world for family planning. In this surgical method, the fallopian tubes are sealed or blocked by tying them together, clipping, cauterizing or cutting. This prevents both the egg and sperm from traveling into the fallopian tube for union. This procedure will not affect your menstrual cycle or sex life. Formally, it is known as bilateral tubal ligation (BTL) (2) and is also referred to as ‘tying the tubes’, ‘female sterilization’ or ‘tubal occlusion’. Tubal ligation is usually done in a hospital or outpatient clinic. You will be either given general anesthesia or local or spinal anesthesia. You cannot become pregnant after the procedure. Though this procedure may be reversed, only 50% – 80% of women will be able to get pregnant after the reversal (3).
Why Might You Need A Tubal Ligation?
You may require this procedure if you do not want to get pregnant due to the following cases or more (3).
If you are an adult, and sure about not having another pregnancy ever If a pregnancy could create health risks to you Image: iStock If you or your partner have any genetic abnormality and do not want to transfer it to your baby
This birth control procedure is not a choice if you think you might want another baby in the future. Also, tubal ligation is ideal when you and your partner agree to the decision of not having children.
When Is Tubal Ligation Performed?
Tubectomy may be performed:
Following a vaginal delivery. It is performed in the first 24 hours, either on the same day or the following day. A tiny incision is made beneath the belly button (laparoscopy), and a part of fallopian tubes are removed. During a C-section. Your recovery will be the same with or without tubal ligation (4). Anytime at an outpatient surgical clinic, using a laparoscope and general anesthesia (interval tubal ligation).
Make sure you are thoroughly informed and prepared before going ahead with this procedure.
How Should You Prepare For A Tubal Ligation Procedure?
Before going ahead with the procedure, your doctor will ask why you want tubal ligation and review the following:
Benefits and risks of the procedure Detailed description of the procedure Causes and chances of failure
On the days before your surgery:
Tell the doctor about any medications you are taking. This includes over-the-counter medicines and herbal supplements. You may have to stop taking medications such as aspirin, warfarin, and ibuprofen that might result in blood thinning and bleeding. You should quit smoking if you have the habit.
On the day of your surgery:
You will be asked not to eat or drink anything from the night before the surgery. Take the regular medicines as instructed by your doctor, with just a small sip of water. Wear comfortable clothing to make it easy for you after the surgery (3).
How Is A Tubal Ligation Done?
Surgeons use many different ways of blocking the fallopian tubes. The two primary methods of tubal ligation are laparoscopy and minilaparotomy. An intravenous line is inserted into the vein for injecting medicines and fluids to keep you relaxed. General anesthesia is also given through the IV. In the case of local (spinal in this case) anesthesia, a numbing medicine is given to your spinal region (5). The main techniques of tubal ligation include (5) (6):
Laparoscopy:
Minilaparotomy:
Different methods of tubal ligation you should know about: Bipolar coagulation: This popular method of laparoscopy uses electrical current to cut the sections of the fallopian tube. Tubal damage spreads up to one to two centimeters, and has low long-term failure rates (7). Fimbriectomy: This procedure removes the portion of the tube close to the ovary(8) Chances of tubal reversal is very limited after fimbriectomy, thus this procedure is not widely performed anymore. Salpingectomy: It is a complete removal of the fallopian tube and if partly removed it is referred as partial salpingectomy. In this case, reversal is not possible. This is also the preferred method when you want to lower the risk of ovarian cancer (9). Irving: A proximal segment of the follapian tube is removed and sutured into the uterus posteriorly. The distal portion of the fallopian tube are tied sperately. This procedure leaves the sections healthy and is an effective alternative to fimbriectomy or salpingectomy (10). Unipolar coagulation: This is a less recommended procedure where the doctor uses electrical current to cauterize the tubes. It allows the current to damage the tubes much further from the original clamped site. Pregnancy rates drop to almost 45%, since the tubal damage is more (11). Tubal clip: Also called Hulka Clip technique, this procedure involves putting up a clip to the fallopian tube. It is fastened so that the passage of eggs is discontinued. Pregnancy rates upon reversal are high, at around 85%. Falope ring: It involves applying a silastic band or ring to the fallopian tube. Pregnancy rates are high since only a part of the tubal portion is inside the loop. Pomeroy tubal ligation: A loop of the fallopian tube is strangled by a suture, and then cut and cauterized. It is best for tubal reversal. Parkland method: Here, the tube is tied at two sites and the segment in between is cut off with an immediate separation of the tubal stumps (12). Essure: Two small metal coils are inserted into the Fallopian tubes. This causes formation of scar tissue around the coils that block the tubes and prevent sperm from meeting the egg. Adiana: Two silicone pieces are inserted into the Fallopian tubes. As with the above procedure, a scar tissue forms around the insert, thereby blocking the Fallopian tubes (13).
What Happens After The Tubal Ligation Procedure?
After the surgical procedure, you are kept under observation to check if you have recovered from anesthesia. You are given fluids to drink, and IV is removed. You could go home the same day of the procedure. Going for tubal ligation soon after childbirth will not involve a prolonged hospital stay (2).
You may be able to resume normal diet and activities gradually. Mild discomfort and pain is common, and your doctor may suggest medicines for it. Incision areas should be kept dry. Take care when bathing and dressing until the stitches are removed. Do not lift anything heavy for at least three weeks, and check with the doctor before resuming such activities. You might resume to sex in a week or so after the procedure.
Check with your doctor in the case of:
Any bleeding, drainage, swelling or redness at the incision site Fever or rash Increasing pain Severe and continuous abdominal pain Vomiting or nausea Image: iStock Difficulty in breathing Dizziness
How Long Will It Take To Recover From Tubal Ligation?
Recovery usually takes a day, but again it depends on your physical health. It is always better to take proper rest for at least a couple of days for complete recovery after the procedure.
What Are The Benefits Of Tubal Ligation?
Tubal ligation is effective, permanent and convenient. Some of its benefits are:
It is a permanent birth control method and prevents the eggs from reaching the ovaries, which means you won’t have to worry about pregnancy at all. It causes no hormonal changes, and is thus considered a natural method. It will not affect your menstrual cycle, menopause, or hormones in the body. It can make your sex life better as there is no need of using any birth control device or pill. It reduces the probability of contracting an infection called the pelvic inflammatory disease (PID).
Are There Any Risks Of Tubal Ligation?
The incidence of risk is one out of 1,000 women. Some possible risks are as follows (3):
Bleeding at the site of incision or internal bleeding in the abdomen Improper wound healing or infections Damage to abdominal organs Reaction to anesthesia Pelvic or abdominal pain Ectopic pregnancy, where fertilization happens outside the uterus Failure in the procedure, causing an unwanted pregnancy in the future
These conditions will increase the risk of complications after the surgery.
Diabetes Obesity Prior pelvic or abdominal surgery Pelvic inflammatory disease Lung disease Heart disease Image: iStock
Risks could also vary depending on your health condition. Therefore, discuss about your health with your doctor before the surgery.
What Are The Alternatives To Tubal Ligation?
Before going ahead with tubal ligation, it is highly essential that you consider the alternatives as well. The other long-acting reversible contraceptives include (14) (15):
An Intrauterine device (IUD), implanted inside your uterus, prevents pregnancy. Birth control implants such as Implanon or Nexplanon, implanted in your arm, release progestin hormone that prevents you from getting pregnant. Hysteroscopic sterilization, where a small coil is placed in the Fallopian tubes, causes tissue growth and prevents pregnancy. Vasectomy, or getting the man sterilized.
Can You Get Pregnant After Tubal Ligation?
Yes, there is a chance of pregnancy if the Fallopian tubes attaches back due to tubal ligation failure. The risk is higher in women who are sterilized at a younger age (16). There is also the possibility that a fertilized egg has been implanted into the uterus before the surgery. This is one of the reasons why tubal ligation is done after giving birth or soon after the menstrual period, when the risk of pregnancy is low.
Why Does Tubal Ligation Fail?
Tubal ligation could fail because of (17):
Luteal phase pregnancy, which goes undetected before ligation surgery Technical errors during the surgical process Inadequate or ineffective closing of Fallopian tubes during the procedure Wrong identification of Fallopian tubes and closing some other part for the tube. Natural recanalization post sterilization Misplaced device used in the occlusion process Failed identification of the tubes due to poor lighting operating Presence of pre-existing adhesion (internal scarring after surgeries) that do not give a clear image of the tubes Sudden development of tuboperitoneal fistulas between abdominal spaces because of incomplete healing of the tubes post-surgery
What Are The Symptoms Of Pregnancy After Tubal Ligation?
If your Fallopian tubes attaches back together, you can continue to have a full-term pregnancy with no issues. Pregnancy after tubal ligation is mainly associated with the following symptoms:
Missing your periods Breast soreness Frequent urination Unexplained fatigue Nausea with certain foods Morning sickness Food cravings
Take a home pregnancy test or get your doctor to confirm it with a blood test or ultrasound.
Pregnancy Post Tubal Ligation
Once ligation fails, there is every chance that you will get pregnant again.
1. Tubal Pregnancy – Accidental Pregnancy
You are more likely to experience ectopic pregnancy if you conceive post tubal ligation surgery (18).
Ectopic pregnancy happens when the egg fertilizes along anywhere else other than the uterine cavity. Ectopic pregnancy is risky and life threatening. The fetus will start growing in the Fallopian tube, which may eventually expand, rupture and cause severe bleeding and shock. Ectopic pregnancy will not see a full term. You will need to consult your doctor immediately if you conceive after ligation
2. Pregnancy by choice:
In case you wish to have a baby after you have undergone a successful tubal ligation, you can either go for tubal reversal surgery or opt for in-vitro fertilization.
a. Tubal Reversal Surgery:
This procedure may be done by laparoscopy or laparotomy and is also called Tubal Reanastomosis (19).
The ligated portion of the tube is cut and the fresh ends of the tube are attached back to each other. Post procedure factors like the sperm quality of the male, the status of any possible pelvic conditions, the tubal status, your age, and the quality and quantity of egg determines the chances of a pregnancy.
After a successful tubal reversal, normal intercourse without any medications or supplements is enough to get pregnant.
b. In-Vitro Fertilization:
This procedure helps you avoid any major surgery (20).
The eggs and sperm are collected and are transferred into a test tube for fertilization. After fertilization, some of the embryos are transferred back to the uterus so that one of them will be implanted. Within 14 days, you will know if the procedure is successful. You may have the risk of having multiple pregnancies.
Post Tubal Ligation Syndrome
Post Tubal Ligation Syndrome (PTLS) is a syndrome of certain symptoms reported by women who have undergone the tubal ligation. About 37% of women experience this syndrome and it most likely affect those who got the tubes tied at a younger age (21).
Symptoms of PTLS
The most predominant symptoms include:
Irregular or heavier periods Hot flashes Image: Shutterstock Loss of libido Chronic fatigue Sore joints and muscles Increased depression or anxiety Memory lapse Weight gain Increased headache Pelvic pain Irritability Mood swings Decreased libido Hair loss and brittle nails Feeling of apprehension Itchy skin Dizziness and vertigo
PTLS is associated with other medical conditions such as:
Hormonal imbalance Castrative menopause Ovarian isolation Hormonal shock Atrophic ovaries Osteoporosis or bone loss Dysfunctional uterine bleeding Severe pelvic adhesions Misplacement of female organs Endometriosis Decreased ability of lactation
Is there a treatment for PTLS?
Treatment for PTLS is only tubal ligation reversal. There have been cases of women whose health improved after the reversal procedure.
