- What is tubal ligation (tubectomy)?
- Why might you need a tubal ligation?
- When is tubal ligation performed?
- How should you prepare for a tubal ligation procedure?
- How is a tubal ligation done?
- What happens after the tubal ligation procedure?
- How long will it take to recover from tubal ligation?
- What are the benefits of tubal ligation?
- Are there any risks of tubal ligation?
- What are the alternatives to tubal ligation?
- Can you get pregnant after tubal ligation?
- Why does tubal ligation fail?
- What are the symptoms of pregnancy after tubal ligation?
- Pregnancy post tubal ligation
- Post tubal ligation syndrome
Before the 1960s, women underwent sterilization procedures only due to medical conditions or if they were considered too old or at risk to have children. But a change occurred in the late 1960s, when sterilization procedures were only done on demand, for contraceptive use (1).
Sterilization is now done to prevent future pregnancies. If you are also considering it, you should first have an understanding about this irreversible and permanent birth control method.
What Is Tubal Ligation (Tubectomy)?
Tubal ligation is a popular sterilization method adopted by women all over the world for family planning. In this surgical method, the fallopian tubes are sealed or blocked by tying them together, clipping, cauterizing or cutting. This prevents both the egg and sperm from traveling into the fallopian tube for union.
This procedure will not affect your menstrual cycle or sex life. Formally, it is known as bilateral tubal ligation (BTL) (2) and is also referred to as ‘tying the tubes’, ‘female sterilization’ or ‘tubal occlusion’.
Tubal ligation is usually done in a hospital or outpatient clinic. You will be either given general anesthesia or local or spinal anesthesia. You cannot become pregnant after the procedure. Though this procedure may be reversed, only 50% – 80% of women will be able to get pregnant after the reversal (3).
Why Might You Need A Tubal Ligation?
You may require this procedure if you do not want to get pregnant due to the following cases or more (3).
- If you are an adult, and sure about not having another pregnancy ever
- If a pregnancy could create health risks to you
- If you have a family history of ovarian cancer
- If you or your partner have any genetic abnormality and do not want to transfer it to your baby
This birth control procedure is not a choice if you think you might want another baby in the future. Also, tubal ligation is ideal when you and your partner agree to the decision of not having children.
When Is Tubal Ligation Performed?
Tubectomy may be performed:
- Following a vaginal delivery. It is performed in the first 24 hours, either on the same day or the following day. A tiny incision is made beneath the belly button (mini-laparotomy), and a part of fallopian tubes are removed.
- During a C-section. Your recovery will be the same with or without tubal ligation (4).
- Anytime at an outpatient surgical clinic, using a laparoscope and general anesthesia (interval tubal ligation).
Make sure you are thoroughly informed and prepared before going ahead with this procedure.
How Should You Prepare For A Tubal Ligation Procedure?
Before going ahead with the procedure, your doctor will ask why you want tubal ligation and review the following:
- Benefits and risks of the procedure
- Detailed description of the surgery
- Causes and chances of failure
- Ways to avoid sexually transmitted infections
On the days before your surgery:
- Tell the doctor about any medications you are taking. This includes over-the-counter medicines and herbal supplements.
- You may have to stop taking medications such as aspirin, warfarin, and ibuprofen that might result in blood thinning and bleeding.
- You should quit smoking if you have the habit.
On the day of your surgery:
- You will be asked not to eat or drink anything from the night before the surgery.
- Take the regular medicines as instructed by your doctor, with just a small sip of water.
- Wear comfortable clothing to make it easy for you after the surgery (3).
How Is A Tubal Ligation Done?
Surgeons use many different ways of blocking the fallopian tubes. The two primary methods of tubal ligation are laparoscopy and minilaparotomy. In both the procedures, an intravenous line is inserted into the vein for injecting medicines and fluids to keep you relaxed. General anesthesia is also given through the IV. In the case of local (spinal in this case) anesthesia, a numbing medicine is given to your abdomen or spinal region (5).
- Your surgeon will make an incision near the belly button or in the lower abdomen.
- Gas is pumped into the abdomen to inflate it. This gives more room for the surgeon to work.
- A laparoscope (a narrow tube with a light and camera) is inserted into the abdomen.
- Another small incision is made in the abdominal wall to insert special instruments which grab and seal the fallopian tubes.
- The tubes may be tied, cut, clamped, sealed or banded using electric current.
- After the procedure, the incisions are closed through one or two stitches, and the area is covered with a dressing.
- The procedure will take about half an hour.
- Your surgeon will make one tiny incision (of less than five centimeters) just above the pubic hairline.
- The fallopian tubes are located through the cut and are closed using clips or tied using electrical current.
- It does not involve the use of a laparoscope or carbon dioxide gas.
Different methods of tubal ligation you should know about:
Bipolar coagulation: This popular method of laparoscopy uses electrical current to cut the sections of the fallopian tube. Tubal damage spreads up to one to two centimeters, and has low long-term failure rates (6).
Fimbriectomy: This procedure removes the portion of the tube close to the ovary, thus eliminating the ovary’s ability to hold eggs. Pregnancy rates for tubal reversal following fimbriectomy are higher than 40% (7).
Salpingectomy: It is a partial removal of the fallopian tube and is also referred to as partial salpingectomy. In this case, reversal is not possible since the success rate of pregnancy is very less. This is also the preferred method when you want to lower the risk of ovarian cancer (8).
Irving: A segment of the tubing is removed and sutured to the ends. The ends of the tube are then connected to the uterus and connective tissue respectively. This procedure leaves the sections healthy and is an effective alternative to fimbriectomy or salpingectomy (9).
Unipolar coagulation: This is a less recommended procedure where the doctor uses electrical current to cauterize the tubes. It allows the current to damage the tubes further from the clamped site. Pregnancy rates drop to almost 45%, since the tubal damage is more (10).
Tubal clip: Also called Hulka Clip technique, this procedure involves putting up a clip to the fallopian tube. It is fastened so that the passage of eggs is discontinued. Pregnancy rates upon reversal are high, at around 85%.
Falope ring: It involves applying a silastic band or ring to the fallopian tube. Pregnancy rates are high since only a tubal portion is damaged.
Pomeroy tubal ligation: A loop of the fallopian tube is strangled by a suture, and then cut and cauterized. It is best for reversal since the part that is burnt will be lost during the reversal procedure.
Parkland method: Here, the tube is tied at two sites and the segment in between is cut off with an immediate separation of the tubal stumps (11).
Essure: Two small fiber and metal coils are inserted into the Fallopian tubes. This causes formation of scar tissue around the coils that block the tubes and prevent sperm from meeting the egg.
Adiana: Two silicone pieces are inserted in the Fallopian tubes. Before inserting, heat is passed into the tubes. As with the above procedure, a scar tissue forms around the insert, thereby blocking the Fallopian tubes (12).
What Happens After The Tubal Ligation Procedure?
After the surgical procedure, you are kept under observation to check if you have recovered from anesthesia. You are given fluids to drink, and IV is removed. You could go home the same day of the procedure. Going for tubal ligation soon after the childbirth will not involve a prolonged hospital stay (2).
- You may be able to resume normal diet and activities gradually.
- Mild discomfort and pain is common, and your doctor may suggest medicines for it.
- You may experience shoulder pain for a few days, as a result of gas in the belly. Lying down will offer relief from this pain.
- Incision areas should be kept dry. Take care when bathing and dressing until the stitches are removed.
- Do not lift anything heavy for at least three weeks, and check with the doctor before resuming such activities.
- You might resume to sex in a week or so after the procedure.
Check with your doctor in the case of:
- Any bleeding, drainage, swelling or redness at the incision site
- Fever or rash
- Increasing pain
- Severe and continuous abdominal pain
- Vomiting or nausea
- Difficulty in breathing
How Long Will It Take To Recover From Tubal Ligation?
Recovery usually takes a couple of days, but again it depends on your physical health. It is always better to take proper rest for at least a couple of weeks for complete recovery after the procedure.
What Are The Benefits Of Tubal Ligation?
Tubal ligation is effective, permanent and convenient. Some of its benefits are:
- It is a permanent birth control method and prevents the eggs from reaching the ovaries, which means you won’t have to worry about pregnancy at all.
- It causes no hormonal changes, and is thus considered a natural method. It will not affect your menstrual cycle, menopause, or the hormones in the body.
- It can make your sex life better as there is no need of using any birth control device or pill.
- It reduces the probability of contracting an infection called the pelvic inflammatory disease (PID).
Are There Any Risks Of Tubal Ligation?
The incidence of risk is one out of 1,000 women. Some possible risks are as follows (3):
- Bleeding at the site of incision or internal bleeding in the abdomen
- Improper wound healing or infections
- Damage to abdominal organs
- Reaction to anesthesia
- Pelvic or abdominal pain
- Ectopic pregnancy, where fertilization happens outside the uterus
- Failure in the procedure, causing an unwanted pregnancy in the future
- Does not prevent spread of sexually transmitted infections (STIs)
These conditions will increase the risk of complications after the surgery.
- Prior pelvic or abdominal surgery
- Pelvic inflammatory disease
- Lung disease
Risks could also vary depending on your health condition. Therefore, discuss about your health with your doctor before the surgery.
What Are The Alternatives To Tubal Ligation?
- An Intrauterine device (IUD), implanted inside your uterus, releases copper that prevents pregnancy.
- Birth control implants such as Implanon or Nexplanon, implanted in your arm, release progestin hormone that prevents you from getting pregnant.
- Hysteroscopic sterilization, where a small coil is placed in the Fallopian tubes, causes tissue growth and prevents pregnancy.
- Vasectomy, or getting the man sterilized.
Can You Get Pregnant After Tubal Ligation?
Yes, there is a chance of pregnancy if the Fallopian tubes grow back due to tubal ligation failure. The risk is higher in women who are sterilized at a younger age (15). There is also the possibility that a fertilized egg has been implanted into the uterus before the surgery. This is one of the reasons why tubal ligation is done after giving birth or soon after the menstrual period, when the risk of pregnancy is low.
The risk rate of pregnancy is one in 1000 after the first year, and 2 to 10 after five years of tubal ligation.
Why Does Tubal Ligation Fail?
Tubal ligation could fail because of (16):
- Luteal phase pregnancy, which goes undetected before ligation surgery
- Technical errors during the surgical process
- Inadequate or ineffective closing of Fallopian tubes during the procedure
- Wrong identification of Fallopian tubes and closing some other part for the tube.
- Recanalization, which is the sudden regeneration of the Fallopian tubes at the ends forming slits that do not close properly
- Misplaced device used in the occlusion process
- Failed identification of the tubes due to poor lighting while scanning
- Presence of pre-existing adhesion (scars after surgeries performed for endometriosis and other pelvic diseases) that do not give a clear image of the tubes
- Sudden development of tuboperitoneal fistula between abdominal spaces because of incomplete healing of the tubes post-surgery
What Are The Symptoms Of Pregnancy After Tubal Ligation?
If your Fallopian tubes grow back together, you can have a full-term pregnancy. Some women also go for tubal ligation reversal, where the Fallopian tubes are reattached. It may not be effective always, and pregnancy after tubal ligation is mainly associated with the following symptoms:
- Missing your periods
- Breast soreness
- Frequent urination
- Unexplained fatigue
- Nausea with some foods
- Morning nausea
- Food cravings
Take a home pregnancy test or get your doctor to confirm it with a blood test or ultrasound.
Pregnancy Post Tubal Ligation
Once ligation fails, there is every chance that you will get pregnant again. Possible pregnancy post failed sterilization will not be a normal one.
1. Tubal Pregnancy – Accidental Pregnancy
You are more likely to experience ectopic pregnancy if you conceive post tubal ligation surgery (17).
- Ectopic pregnancy happens when the egg fertilizes along the exterior of the uterus and implants itself on one of the tubes.
- Other locations could be the cervix or abdominal cavity.
- Ectopic pregnancy is risky and life threatening. The fetus will start growing on the Fallopian tube, which will eventually expand, rupture and cause severe bleeding and shock.
- Ectopic pregnancy will not see a full term.
- You will need to consult your doctor immediately if you conceive after ligation
2. Pregnancy by choice:
In case you wish to have a baby after you have undergone a successful tubal ligation, you can either go for tubal reversal surgery or opt for in-vitro fertilization.
a. Tubal Reversal Surgery:
This procedure involves a laparotomy method, and is also called Tubal Reanastomosis (18).
- The doctor will make a large incision of about four to six inches in length on your abdomen.
- This is an extremely uncomfortable procedure that requires a longer recovery time.
- You may need hospitalization for about three to four days after the surgery.
- You would need complete rest and leave from work for about three to four weeks after the surgery.
- The procedure takes into account factors like the sperm quality of the male, the status of any possible pelvic conditions, the tubal status, your age, and the quality and quantity of egg.
After a successful tubal reversal, normal intercourse without any medications or supplements is enough to get pregnant.
b. In-Vitro Fertilization:
This procedure helps you avoid any major surgery (19).
- The eggs and sperm are collected and are transferred into a test tube for fertilization.
- After fertilization, some of the embryos are transferred back to the uterus so that one of them will be implanted.
- Within ten days, you will know if the procedure is successful.
- You may have the risk of having multiple pregnancies.
Post Tubal Ligation Syndrome
Post Tubal Ligation Syndrome (PTLS) is a syndrome of certain symptoms reported by women who have undergone the tubal ligation. About 37% of women experience this syndrome and it most likely affect those who got the tubes tied at a younger age (20).
Symptoms of PTLS
The most predominant symptoms include:
- Irregular or heavier periods
- Hot flashes
- Loss of libido
- Chronic fatigue
- Sore joints and muscles
- Increased depression or anxiety
- Memory lapse
- Weight gain
- Increased headache
- Pelvic pain
- Mood swings
- Decreased libido
- Hair loss and brittle nails
- Feeling of apprehension
- Itchy skin
- Dizziness and vertigo
PTLS is associated with other medical conditions such as:
- Hormonal imbalance
- Castrative menopause
- Ovarian isolation
- Hormonal shock
- Atrophic ovaries
- Osteoporosis or bone loss
- Dysfunctional uterine bleeding
- Severe pelvic adhesions
- Misplacement of female organs
- Decreased ability of lactation
Is there a treatment for PTLS?
Treatment for PTLS is only tubal ligation reversal. There have been cases of women whose health improved after the reversal procedure.
Discuss with your doctor to understand more about tubal ligation and the life after. If you wish to get pregnant again, your doctor needs to re-investigate you thoroughly for the same. Accurate tubal ligation will rule out the worry of unwanted pregnancy. Getting regular checkups with your health care experts should rule out the possibilities of ectopic pregnancy as well.
Did you also opt for family planning through tubal ligation? Do share your experience with us. Tell us about it in the comments section.
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17. Ectopic Pregnancy; University of Rochester Medical Center (2018)
18. Tubal Ligation Reversal; Baylor College of Medicine
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20. Post Tubal Ligation Syndrome; NCCRM