Tubal ligation is an effective, permanent method of birth control. If you and your partner have decided against future pregnancies, either because you have reached your desired number of children or you’ve decided not to have any children at all, permanent sterilization might be worth considering. Tubal ligation is not something to rush into because reversing a tubal ligation, although sometimes possible, is very expensive and has no guarantee of success. It should be considered permanent, so you should not have a tubal ligation with the intention to someday have it reversed.

To understand how a tubal ligation works, it will help you to understand how a woman becomes pregnant. The woman has eggs that are kept in her ovaries. Each month, an egg is released by an ovary and travels down to the fallopian tube. During sexual intercourse, millions of the man's sperm are released and move up through the uterus and into the fallopian tubes. If sperm meets an egg in one of the fallopian tubes, the egg will be fertilized. This is how pregnancy begins. One way of preventing pregnancy is to make sure that the egg and the sperm cannot meet.

How does tubal ligation work?

When tubal ligation is done, the two fallopian tubes are blocked. This makes it impossible for the sperm to meet an egg in the fallopian tube, so pregnancy cannot happen.

How is tubal ligation done?

The operation is performed in the hospital. It takes about 20-30 minutes and usually the woman goes home the day of the surgery. Tubal ligation is done with either a local or a general anesthetic. The woman and her doctor decide which type of anesthetic is best. Various types of procedures can be used in tubal ligation. They include laparoscopy (which will be described here). In deciding on the best method, the woman needs to consult with her doctor.

Laparoscopy is one of the most common methods of tubal ligation. In this procedure, the doctor makes a small incision (about one inch long) near the woman's navel. A type of gas is put into the abdomen to push the intestines away from the uterus and fallopian tubes. The doctor then puts a small metal tube with a light on it (called a laparoscope) through the cut or through a smaller, second cut. By looking through the laparoscope, the doctor can clearly see the fallopian tubes.

The doctor blocks off the fallopian tubes by cauterizing (burning) them. This cuts and seals the tubes and blocks them off so that the man's sperm cannot meet the woman's egg. The woman can no longer become pregnant.

Can tubal ligation be reversed?

Since tubal ligation is a permanent form of birth control, it should be considered an irreversible procedure. While operations are available to try to reconnect the tubes, these operations often are not successful, require a much more major surgery than the tubal ligation itself, and is usually not covered by insurance.

When does tubal ligation start to prevent pregnancy?

As soon as the operation is done, it will be effective in preventing pregnancy. You will not have to use any other method of birth control. The doctor may want you to wait a short time before having intercourse so that your body will heal. Tubal ligation is successful in preventing pregnancy for almost 100% of the women who have it. However, one woman in 200 will accidentally become pregnant after tubal ligation.

How will I feel after the operation?

Minor Discomforts:  After a tubal ligation, you could have a few discomforts that are not serious and should go away in several days. Some possible discomforts are:

• Sore throat or sore stomach (from anesthesia)
• Pain in the shoulder or neck (from gas used during laparoscopy)
• Vaginal bleeding or discharge
• Low blood pressure
• Nausea and vomiting
• Light cramps

Serious Complications:  A very small number of women have serious problems after tubal ligation. Even though these problems happen rarely, it is important for you to know about them. These problems include:

• Infection
• Gas in blood vessels
• Heart or breathing problems

Danger Signs:  If you have any of these signs, you should call your doctor immediately:

• Heavy bleeding or bleeding that will not stop
• Intense pain
• Fever

What should a couple know before choosing tubal ligation?

• A couple should understand that this is a permanent method of birth control. They must be sure that they do not want any children in the future.
• The couple must understand the tubal ligation procedure and the possible problems that can happen with it. Although pregnancy is unlikely, there is a slightly higher risk of ectopic pregnancy after a tubal ligation. An ectopic pregnancy occurs when a fertilized egg attaches and grows outside the uterus. This can be dangerous and requires immediate medical attention.
• Because it is a big decision for a family, it is recommended that the husband and wife talk together about tubal ligation.
• The woman should ask herself what could happen if she remarried in the future and whether she might want children with her new husband.
• The couple should ask themselves what would happen if one of their children dies. Will they want more children?

There are many other things to think about when you are making a decision about tubal ligation. Your doctor will talk to you and help you to decide if tubal ligation is right for you. But, you are the one who has to make the decision. Remember that no one can force you to have a tubal ligation.

Does a woman change after a tubal ligation?

Some women are concerned that tubal ligation will change their femininity. Other women wonder if the operation will change their sex lives. Actually, a woman who has a tubal ligation is exactly the same as she was before the operation, except that she can no longer become pregnant. Consider the following:

• You'll still have your period each month.
• The operation will not affect a woman's physical ability to have sex.
• Many women feel that their enjoyment of sexual activity increases because they no longer have to worry about becoming pregnant.
• Hormone levels will not change after tubal ligation.

Post Tubal Syndrome

Some women notice that their first 2-3 menses after a tubal ligation they experience more cramping or spasm in the tubes. This is short term and resolves as the body adjusts to the tubal ligation.