Birth Control Forum - Tubes Tied

What is tubal ligation?
Tubal ligation is a surgical procedure designed to make a woman sterile by cutting, tying, clipping, cauterizing or blocking the fallopian tubes so sperm can't reach an egg and fertilize it. The surgery is considered permanent (even though it's occasionally reversible), so most states require a 30-day waiting period before you can schedule it. Prices vary, but expect to pay between $1,000 to $2,500. Most insurance companies will cover at least part of the cost of the procedure.

What's the operation like?
Tubal ligation used to be known as "getting your tubes tied" and it meant major abdominal surgery. These days it's usually a much less invasive outpatient procedure. First, the surgeon will give you a local, regional, or general anesthetic (whichever is best for you). Then, after inflating your abdomen with carbon dioxide gas, she'll make a small cut in or just below your belly button and insert a laparoscope — a narrow tube with a light and a tiny magnifying glass on the end. This tool allows the surgeon to find your tubes. She'll also make another small incision (usually near your pubic bone) to insert the instrument used to block the tubes. There are several options here — you can have the tubes cauterized, cut and stitched closed, or pinched shut with an elastic band or metal clip. When the doctor's finished, she'll stitch up the small incisions in your abdomen. The procedure generally takes about 30 minutes. It can also be performed right after giving birth — either vaginally or via c-section. The uterus is still high enough in the abdomen right after delivery that the doctor can see the tubes easily without inflating the area with carbon dioxide.

Regardless of when you have the procedure done, you'll probably be up and around within eight hours, but you may feel some pain for several days. (see your doctor if the abdominal pain or swelling gets worse instead of better.) you should give yourself a week before you start exercising or having sex again.

In november 2002, the u.S. Food and drug administration approved the first non-surgical method to permanently block fallopian tubes. In this procedure, a doctor inserts small metallic implants into the fallopian tubes by way of the vagina. No cuts or abdominal incisions are necessary. Once the implants are in place, scar tissue forms around each device, permanently blocking the tubes. This procedure requires a follow-up x-ray three months after the implants are inserted to make sure they're properly placed within the fallopian tubes. If you're interested in this method, talk to your doctor. It's still relatively new and not every woman can be implanted successfully.

Will this surgery affect my libido?
No. The procedure has no effect on your sex drive or your hormone production. You'll still ovulate each month, only the egg will never reach your uterus (it's reabsorbed by your body). You'll also continue to have menstrual periods.

Can I be absolutely sure an egg won't slip through?
Unfortunately, no. About one out of 400 women will get pregnant during the first ten years after their tubes are tied. (an egg has less chance of slipping through if you have your tubes closed by cauterization or burning.) if you do become pregnant, be sure to see your doctor right away; there's an increased risk that you'll have an ectopic pregnancy, where the egg implants itself outside of the uterus, typically in one of the fallopian tubes.

Can a tubal ligation be reversed?
In some cases, yes, but don't count on it. Reversals are expensive, and insurance companies rarely cover them. They're also much more complicated than closing or cutting the tubes in the first place, and your chances of being able to conceive after a reversal are uncertain. Only 20 to 40 percent of women who reverse a tubal ligation go on to give birth successfully (and your chances for an ectopic pregnancy increase). Tubes that are closed off by cauterization can't be put back together properly, because the heat destroys their delicate lining.

Is tubal ligation a good choice for postpartum contraception?
Pros
if you're 100 percent sure you don't want to have any more children, having your tubes blocked may be a good option for you. You don't have to remember to take a pill every day and you don't have to insert or apply anything before having sex — a real bonus for busy new moms. Plus, tubal ligation doesn't interfere with lactation, like some hormonal contraception methods.
Cons
as with all surgical procedures, tubal ligation has some rare, but possible, risks associated with it, including infection and excess bleeding. If you opt for the procedure right after giving birth and experience any of these side effects, it could make your recovery from childbirth that much harder. Also, having a tubal ligation might increase your risk of developing ovarian cysts, according to a study by researchers at the university of washington (published in the august, 2003 issue of obstetrics and gynecology). But the biggest downside to the procedure is its permanence. If you change your mind, the cost of reversing a tubal ligation is high, with no guarantee of success. To make sure you don't want to conceive any more children, ask yourself some tough questions: how would you feel if you lost your partner to death or through divorce or separation; is there any chance you might want to have a child with another person? Is there any scenario in which you could imagine ever having more biological children? If you think it's at all possible, it's probably best to choose another form of contraception.