When women decide they are done having children there are many options to prevent pregnancy. One of the most popular choices is tubal ligation, more commonly referred to as having your tubes tied.
Tubal ligation or female sterilization remains extremely common — the American College of Obstetricians and Gynecologists (ACOG) notes that sterilization is the most popular form of birth control worldwide and the Centers for Disease Control and Prevention says 13% of women age 15 to 44 have had their tubes tied. Yet many women are confused about what it is and how it works.
What happens when you get your tubes tied?
“It is a surgical way to basically occlude or prevent an egg from getting fertilized by sperm. It is the most common birth control worldwide and the most common single form of birth control that people use,” said Dr. Donna Mazloomdoost, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network in Bethesda, Maryland.
It differs from other long-term forms of birth control, such as intrauterine devices or implants, because “it is permanent,” she added.
Types of tubal ligation
Women can undergo sterilization immediately following the birth of their child or weeks or months after their last birth. Most of the time doctors perform a minimally-invasive procedure where they do one of the following, according to ACOG and experts:
- Remove the fallopian tubes
- Cut and tie the fallopian tubes with special thread
- Close the tubes shut with bands or clips
- Seal the tubes with an electric current
- Block the tubs with scar tissue formed by small implants
- Insert metal coils into the tubes
In each case the goal is the same: to create a barrier of scar tissue to prevent the egg from traveling down the fallopian tube into the uterus.
“When you do a tubal ligation you block off the tubes and there’s no flow of fluids out of the tubes,” Dr. John Harris, assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the University School of Medicine in Pittsburgh, told TODAY.
Most of the procedures are outpatient and performed by an OB-GYN at a hospital or an outpatient surgical center.
“For most women it is pretty quick,” Mazloomdoost explained. “You can probably go back to normal daily activities in the next day.”
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What to expect during the procedure
Doctors can perform sterilization in different ways with varied recovery times.
Coil insertion: Doctors often use a local anesthesia to numb the area. The patient leaves soon after with few side effects from the anesthesia, and is usually permitted to drive themselves home.
Minilaparotomy: According to ACOG, this minimally invasive procedure involves a small incision in the abdomen. The fallopian tubes are brought up through the incision, and a small section of each tube is removed, or both tubes can be removed. Patients receive an epidural or spinal block to control the pain. The patient isn't asleep for this procedure so they're less impacted by the anesthesia. Though, a bigger incision can lead to longer recovery time.
Minilaparotomies occur most often when moms undergo tubal ligation following delivery, but this procedure is less popular.
Laparoscopy: Patients receive a small incision near the belly button. The laparoscope is inserted through the incision, allowing doctors to see the pelvic organs. Doctors close off the fallopian tubes using instruments passed through the laparoscope.
For this procedure, patients are under general anesthesia, meaning they are not awake. Anesthesia can cause lingering drowsiness but recovery for minimally invasive surgeries are quicker than with traditional surgeries. A patient will likely need a friend or family member to take them home.
Risks with tubal ligation
Any surgery comes with a risks but tubal ligation is considered a relatively safe procedure. Common complications to the procedure include a reaction to anesthesia or an infection.
“I would still say most clinicians would agree that a tubal ligation is a safe method of contraception,” Mazloomdoost said. “The risks are immediate, not long-term."
But long-term complications include regret by couples who wish they could have more children and accidental pregnancy.
“There is a chance of pregnancy, and I remind people that it is somewhere about the same as having an IUD,” Harris said.
The CDC says typical failure rate for tubal ligation is 0.5%. A small fraction of those who do become pregnant will have an ectopic pregnancy, a dangerous complication where the egg implants outside the uterus that can cause internal bleeding or a ruptured fallopian tube.
Some women believe that tubal ligation causes something called post tubal ligation syndrome, but Mazloomdoost notes that studies do not show significant changes to a woman’s menstruation or other abnormalities after the procedure.
“There is no reason why a tubal ligation should cause these issues,” Mazloomdoost said. “There is probably a subset of women who have a reaction or scar tissue and have disruptions. It is not common enough for research to be able to come up with what is causing these symptoms.”