OP: Tubal Ligation / getting your tubes tied

Tubal ligation, more commonly referred to as ‘getting your tubes tied’, is a surgical method of permanent birth control. While the Pill, Intra-uterine Device (IUD), barrier, and other methods of Birth Control are all readily available methods of preventing pregnancy, the most popular method of birth control for women over the age of 30 remains to be tubal ligation. Although it is regular practice, it is not without its complications. Women considering this form of contraception must be sure of their decision not to have any more children because there are a number of risks associated with this procedure.

Procedures

Simply put, tubal ligation is a surgical procedure that is intended to permanently block sperm from reaching the egg released by the ovary. Keep in mind that after the surgery eggs continue to be released, just as they would during a normal Menstrual Cycle. Tubal ligation surgically modifies the fallopian tubes that carry the egg from the ovary to the uterus.

There are a variety of tubal ligation procedures available; either they are cut and sealed via cauterization, or closed with a clip, or pinched shut with a band. The surgery does not remove organs, nor does it introduce additional hormones into the body. The procedures are performed in hospital and, most of the time, can be done on an outpatient basis. Tubal ligations can be executed under general anaesthetic, but some procedures allow for the option to use local anaesthetization. The procedures are:

Laparoscopic Tubal Sterilization - The most commonly used method of sterilization in the USA; this is a minimally invasive procedure. It involves a surgeon using incisions that are small in comparison to traditional surgical procedures. The other defining component is the use of a small lighted surgical instrument called a laparoscope. This procedure is minor, recovery time is minimized, post operative is reduced, and there are no scars.

Laparotomy - this involves an incision made through the abdominal wall, giving access to the reproductive organs encased in the abdominal cavity. This procedure is done when the abdomen is opened for another surgical reason, such as a caesarean section.

Minilaparotomy - also known as a “mini-lap”, this utilizes a minimal incision made above the pubic hairline to access the fallopian tubes. The tubes are then grasped through the small incision site and blocked off. This procedure is inexpensive as well as simple, taking twenty minutes or less to complete. The mini-lap more commonly performed outside the USA.

Transvaginal Tubal Sterilization - this is much less common and is usually performed by surgeons who are familiar with vaginal surgery. General anaesthesia is required and complications tend to occur more frequently with this method than with a laparotomy or a laparoscopy.

Effectiveness

Tubal ligation is immediately effective; women no longer need to use other forms of birth control, but they still need to protect themselves against Sexually Transmitted Diseases/Infections (STDs/STIs). Women will still experience periods, but there is some controversy as to the effect the procedure has on the menstrual cycle.

It is possible for a woman to get pregnant after a tubal ligation, although the chances are extremely slim. The failure rate is around one percent, but it can range anywhere between one to six percent. This statistic is dependent on factors such as the type of procedure performed and the age of the patient when the procedure was done.

Positive Benefits

There are a number of advantages to this process that are particularly significant to those couples who have finished raising children. The woman no longer has to rely on any other birth control to prevent pregnancy. Moreover, a woman needn’t have to remember details such as what day, or what time, she needs to take her pill. The worry and fear over possibly getting pregnant is greatly diminished because the failure rate is so low. Interestingly, the Journal of Women's Health & Gender-Based Medicine noted another positive benefit of this procedure; there has been growing evidence that this form of surgical sterilization can protect women against ovarian cancer. (http://www.liebertonline.com/doi/abs/10.1089/15246090050073602)

Risks

Because tubal ligation is a significant procedure it comes with the risks usual to any surgery, along with its own specific hazards: damage to blood vessels, bowel/bladder infections, bleeding at the surgical site, reaction to the anaesthesia, and haemorrhage. Although the occurrence of complications is very low, patients must provide written consent before surgery, acknowledging that they understand the risks.

If a woman should become pregnant after having tubal ligation, there is a chance of her having an ectopic, or tubal, pregnancy. This means that the fertilized ovum becomes implanted into tissue other than in the uterus, usually in the fallopian tubes. This state is not only dangerous to the mother; the baby cannot grow and develop normally under these conditions. However, doctors can spot this circumstance fairly early on, and can recommend the appropriate course of action. As it currently stands, the rate of ectopic pregnancies after tubal ligation is approximately seven per thousand procedures.

Reversal

It is possible to reverse tubal ligation by microsurgery. The most favourable pregnancy yields are cited at approximately seventy five percent but there are a number of factors that impact its success. The major ones depend on the type of surgery that was initially performed, as well as the patient’s age, and the amount of fallopian tube that was initially modified or damaged. Once a female is over thirty-five years of age and has less than four centimetres of tubal length, the success rate of pregnancy is fairly compromised.

There are also other considerations. The surgery is specialized and may be quite expensive. There is still a risk of ectopic pregnancy afterwards, and some doctors may recommend that couples additionally consider in-vitro fertilization, which is another costly affair. Furthermore, due to health reasons, some women may be unsuitable candidates for reversal. Also, the procedure carries the same risk of surgical complication and negative reaction to anaesthesia.

The Effect on Hormones

Although the medical community state that tubal ligation is a safe procedure, there is some controversy as to how it affects a woman’s hormones. Specifically, there is a concern that it’s possible for women to go into early menopause and experience all of the physical and emotional distress that goes with it. Unfortunately, the results of many medical studies regarding this incidence have been either inconsistent or inconclusive.

Numerous studies have been published in such medical journals as the Journal of Fertility and Sterility and the New England Journal of Medicine that found no positive correlation between tubal ligation and menopausal-like symptoms. Some practitioners attribute this effect to a combination of age-related factors and discontinuation of birth control pills.

Published in 2006, Susan Bucher’s book, “What Doctors Don't Tell You about Tubal Ligation and Post Tubal Ligation”, contends that women are not properly informed about the risks of tubal ligation by their doctors. Her research alludes to women suffering from menopausal like symptoms such as: pain, bleeding, hot and cold flashes, loss of libido, hormone changes, and mood swings. She contends that the procedure damages the blood vessels that nourish the ovaries. It is the lack of blood supply that partially (and in some cases completely) distresses the female gonads, so much so that the female body goes into hormone shock.

Considerations

It is important for couples to discuss all methods of birth control available to them. If permanent birth control is desired, but the woman does not favor undergoing this surgery, then it would be useful to explore her male partner having a Vasectomy.

Permanent sterilization is best suited for those who have finished growing their families. It is imperative to consider how this significant decision would impact if a couple’s life situation were to change, e.g. losing a child, or splitting up with the current partner and meeting another later on. Although age isn’t the only factor, it ought to be taken into account, especially if the woman is quite young. If she feels that there is some possibility that she might want another child in the future, a different method of birth control should be deliberated.

Final Thoughts

The decision to undergo sterilization is an emotionally charged one. It carries some risk to a female and requires a great deal of consideration before committing to it. Do your research and discuss all the advantages and drawbacks with your doctor. If you are not sure if you want to have another child, you may want to consider a less permanent method of contraception. Although it is physically possible to ‘untie the tubes’, there is no guarantee that a woman will be able to conceive without any complications. When reflecting on whether or not to undergo the procedure, base your choice on the assumption that you intend it to leave you permanently sterile.

Posted: 23 Aug 19:37