What's tubal ligation?
It's an operation designed to make a woman sterile. If you're certain that you don't want to have any more children, you can have your Fallopian tubes closed off to prevent your partner's sperm from making it to the egg. Because this surgery is difficult to reverse, most states require a 30-day waiting period before you can schedule it, so that you'll have time to be sure of your decision. Most insurance companies will cover at least part of the cost of the procedure, which can range from $1,500 to $6,000.
What's the operation like?
Getting your tubes tied used to mean that the surgeon had to open up your abdomen to reach the Fallopian tubes. These days, it's usually a much less invasive outpatient procedure. You may be given a local, regional, or general anesthetic. After inflating your abdomen with carbon dioxide gas, the surgeon makes a small cut in or just below your belly button and inserts a narrow tube with a light and a tiny magnifying glass on the end. This tool allows the surgeon to find your tubes without opening you up. He or she can then close them off by burning or clipping them shut with another tool inserted through a small cut in your abdomen. You'll need a few stitches to close up the cuts. The procedure generally takes about 30 minutes.
You'll probably be up and around within 8 hours, but you may feel some pain in the days following surgery, so take it easy. (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 2002, the Food and Drug Administration approved a method of tubal sterilization that doesn't require an incision at all. In this method, called Essure, two tiny metallic coils are inserted into the fallopian tubes by going through the vagina, cervix, and uterus. Once the coils are positioned, they cause tissue to grow, blocking the tubes and preventing any eggs from getting through. It takes about three months for the coils to become effective, so another form of birth control must be used during that time. Essure costs about $1,200 to $3,000 and must be performed by a doctor who has been properly trained in the procedure. Because of Essures safety, effectiveness and lower cost, it is quickly replacing laparoscopy as the preferred method of sterilization.
Will this surgery affect my libido?
No. The procedure has no effect on your hormone production. You'll still ovulate each month, only the egg will never reach your uterus. You'll also continue to have menstrual periods.
Can I be absolutely sure an egg won't slip through?
Unfortunately, no, but tubal ligation is considered highly effective. Some studies have shown that up to 2 out of 100 women will get pregnant during the first 10 years after their tubes are tied, but most studies show a higher success rate. A recent review of the effectiveness of Essure found that it had a 5-year effectiveness rate of 99.8 percent. If you do become pregnant, be sure to see your doctor right away; there's an increased risk that the egg will be implanted in your Fallopian tubes or abdomen, rather than in your uterus.
Can a tubal ligation be reversed?
In some cases, but don't count on it. Reversals are expensive ($5,000 to $10,000), 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. Tubes that were closed by cauterization can't be reopened, because the heat destroys their delicate lining and seals them closed. The Essure procedure is also irreversible.
Sterilization for Women (Tubal Sterilization). Planned Parenthood. 2010
Essure. Planned Parenthood of the Pacific Southwest. 2010
Brigham Narins, Editor. World of Health:1195. The Gale Group 2000.
Connor VF. Essure: A review six years later. Journal of Minimally Invasive Gynecology 2009 May-Jun; 16(3): 282-90.