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.
where did you find
all that? 