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Tubal ligation is surgical procedure to prevent pregnancy. It has commonly been called "getting your tubes tied." It is also called a female sterilization.
During this surgery, both fallopian tubes are blocked or cut. It is usually done in the hospital or in an outpatient surgical clinic. In most cases, you will be able to go home on the day of surgery. You may have this surgery done under general anesthesia (being asleep), or local or spinal anesthesia (anesthesia that leaves you awake, but unable to feel pain). After the procedure, you will still have your periods and have sex normally. In fact, women may feel more at ease because they do not have to worry about unwanted pregnancy. Tubal ligation is permanent birth control. Although it may be reversed by another operation, only about 50% to 80% of women are able to become pregnant after having their fallopian tubes reattached. This surgery doesn’t prevent sexually transmitted disease. You will still need to practice safe sex. Why might I need a tubal ligation?Choosing this form of birth control may be a good choice if:
This form of birth control may not be the best choice for you if you are unsure if you will want to become pregnant in the future. It also may not be a good choice if you may have other partners in the future. Having a new partner might make you reconsider getting pregnant. What are the risks of a tubal ligation?Tubal ligation is safe, but all surgeries carry some risks. Serious problems occur in less than 1 out of 1,000 women. You will need to sign a consent form that explains the risks and benefits of the surgery and you should discuss these risks and benefits with your surgeon. Some potential risks include:
Even though tubal ligation is a safe and effective form of birth control, about 1 out of 200 women may still become pregnant after the procedure. Having the surgery just after your period starts may avoid the chance that an already fertilized egg will reach your uterus after surgery. These conditions may increase your risk for problems after surgery:
You may have other risks, depending on your specific health condition. Be sure to discuss any concerns with your healthcare provider before the procedure. How do I get ready for a tubal ligation?In the days before your surgery, tell your surgeon about any medicines you take. This includes herbal supplements and over-the-counter medicines. You may have to stop taking aspirin or other medicines that thin your blood and may increase bleeding. Other points to go over include:
What happens during a tubal ligation?Before the procedure starts you will have an intravenous line (IV) started so you can receive fluids and medicines to make you relaxed and sleepy. If you are having general anesthesia, you may get medicine through the IV to put you to sleep. A tube may be inserted in your throat so that you can inhale the anesthesia through your lungs. If you are having local or spinal anesthesia, you will be given a numbing medicine in your abdomen or in your spinal area. You may remain awake during surgery, but you should not feel any pain. The actual surgery takes about 30 minutes. Here is what typically happens during the procedure:
What happens after a tubal ligation?After your surgery, you will be taken to the recovery room to be watched while you recover from the anesthesia. Your IV will be removed once you can drink fluids. You will probably be able to go home in a few hours. Here is what you can probably expect at home:
Tell your surgeon about any of the following:
Next stepsBefore you agree to the test or the procedure make sure you know:
Tubal ligation is a permanent form of birth control.
While the patient is under anesthesia, one or two small incisions (cuts) are made in the abdomen (one usually near the navel), and a device similar to a small telescope on a flexible tube (called a laparoscope) is inserted through the incision. Using instruments that are inserted through the laparoscope or the second incision, the tubes (Fallopian tubes) are coagulated (electrocoagulation), cauterized (burned), or obstructed using a small clip. The skin is then closed with a few stitches. Most patients feel well enough to go home within a few hours after the procedure. The health care professional may prescribe analgesic medications to manage post-operative pain. Most women return to normal activities, including work, in a few days, although some women may be advised not to exercise for a short time. Sexual intercourse may resume when the patient is comfortable. A tubal ligation can also be performed immediately after childbirth through a small incision near the navel or at the time of a Cesarean section. Currently, laparoscopic tubal ligation is the most popular method of female sterilization in non-pregnant women. Periumbilical mini-laparotomy in which a segment of each tube is removed through a small incision in the umbilicus (Pomeroy, Parkland) is the most commonly used procedure immediately following childbirth. See Answer
Essure SystemThere is a device that acts as a form of tubal ligation by blocking the interior of the Fallopian tubes. The US Food and Drug Administration has approved a small metallic implant (called the Essure System) that is placed into the Fallopian tubes of women who wish to be permanently sterilized. Unlike other currently available tubal sterilization procedures for women, placement of the device does not require an incision or general anesthesia. During the Essure procedure, the healthcare professional inserts an obstructive device into each of the two Fallopian tubes at the time of hysteroscopy. This is done with a special catheter that is inserted through the vagina into the uterus and then into the Fallopian tube. The device works by inducing scar tissue to form over the implant, blocking the Fallopian tube and preventing fertilization of the egg by the sperm. Adiana SystemA system similar to the Essure, known as the Asiana System, is also available. With this technology silicone implants are introduced into the Fallopian tubes via hysteroscopy. These implants also induce scar tissue formation in the tubes, thus preventing the sperm from reaching the egg.
As with any surgery, there is always a risk when a person is given general anesthesia. The surgery itself may present problems with bleeding, infection, or damage to surrounding organs. However, tubal ligation is considered to be a very safe procedure and complications are rare. There is still a chance a woman may become pregnant after tubal ligation. About 1 in 200 women become pregnant who have their tubes tied. This may be caused by an incomplete obstruction of the tubes. If a woman conceives after the procedure, she is at increased risk for an ectopic pregnancy (the pregnancy develops outside of the uterus, most commonly in the Fallopian tube). An ectopic pregnancy may be dangerous and requires emergent medical care. Because the procedure is performed by tiny instruments inserted into the abdomen through small incisions, the patient may have the injury to other organs in the body.
Most women recover from the laparoscopic procedure with no problems. There are no tests required to confirm that the woman is now sterile (that is, unable to become pregnant) after a laparoscopic procedure. During the first 3 months after the Essure or Adiana procedure, the patient must use another form of birth control. At the 3-month interval, the patient must then undergo a final X-ray procedure (hysterosalpingogram) in which dye is injected into the uterus and an X-ray is taken to confirm that the Fallopian tubes are completely blocked.
If a woman feels she wants a permanent solution to birth control, she should discuss the options with a healthcare professional. Sometimes younger women who choose permanent sterilizations come to regret their decision later. The younger the woman, the more likely she will regret choosing a permanent form of contraception. The doctor will discuss your personal circumstances and your desire for future childbearing if your life should change. This is an important decision. Women with certain medical conditions may not be suited for this procedure. Tubal ligation is surgery. Couples, when considering their options for sterilization, should weigh the benefits and risks as to whether the woman would undergo tubal sterilization or the man should have a vasectomy. Tubal ligation is not intended to be temporary. Although tubal ligations can, in some cases, be surgically reversed, such a procedure represents a major surgical undertaking. A tubal reversal is only successful (i.e. the patient conceives after the procedure) about 40% to 80% of the time.
About 600,000 American women each year elect to have surgery for sterilization, referred to as tying the Fallopian tubes or tubal ligation. Some women have a hysterectomy (removal of the uterus and sometimes also the tubes and ovaries) each year but, but this is usually not performed only for birth control. Most U.S. women who have undergone sterilization experience either a postpartum minilaparotomy procedure or an interval (timing of the procedure does not coincide with a recent pregnancy) procedure. A postpartum tubal ligation is usually performed through a small incision made through the navel immediately following vaginal delivery of an infant, or it may be performed through an open incision at the time of cesarean section. An interval tubal sterilization is usually done with the use of small instruments inserted into a woman's abdomen following laparoscopy wherein the a scope is inserted through the umbilicus. Interval minilaparotomy - a small abdominal incision in bikini area - is usually the procedure of choice when distortion of the abdominal contents or adhesions are anticipated, which might compromise the ability to complete the procedure laparoscopically.The majority of cases of surgical sterilization for women are performed under general anesthesia. Read more about permanent methods of birth control »
Medically reviewed by Wayne Blocker, MD; Board Certified Obstetrics and Gynecology "Tubal Sterilization." MedscapeReference.
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