Birth Control with Tubal Ligation

In light of recent legislation and so much talk on social media and the news about a woman’s right to her own body and reproductive rights, Dr. Fliedner felt it important to update his patients on current methods of contraception. We are providing a three-part blog series which will present the most up-to-date information on the various birth control methods.

This first article presents tubal ligation as the most effective form of birth control. We will discuss tubal ligation, tubal ligation reversal, tubal ligation side effects, and pregnancy after tubal ligation. Let’s dive in.

What Is Tubal Ligation?

Known by many of us as “having your tubes tied,” tubal ligation is a permanent (yet reversible) form of birth control. “Tubal” refers to a woman’s fallopian tubes, and “ligation” is the process of cutting off. 

The fallopian tubes are the thin tubes that act as a main highway connecting a woman’s ovaries to her uterus. Unfertilized eggs and sperm are the travelers on this highway.  During tubal ligation, the fallopian tubes are cut, tied, or blocked, preventing an egg from traveling from the ovaries through the fallopian tubes and blocking sperm from traveling up the fallopian tubes to the egg. The surgery prevents eggs released by your ovary each cycle from meeting up with sperm and becoming a fertilized egg.

The Pros of Tubal Ligation

• It is permanent (but reversible). Tubal ligation is a safe, effective, and permanent form of birth control. If you don’t want to have children or you don’t wish to have any more, this is a great form of birth control and often performed after delivery.
• It is effective. Planned Parenthood says that it is the most effective form of pregnancy prevention. With fewer than 1 out of 100 women getting pregnant after tubal ligation surgery, it has a 99% success rate, and no other form of contraception will deliver those statistics.
• It doesn’t affect hormones. Your ovaries continue doing their work, and your hormones are not affected like they are with hormonal forms of contraception, such as the pill. You won’t experience mood swings, weight gain, headaches, cramps, heavier periods, or spotting. And it does not bring on menopause, like many have been lead to believe.
• There is no preparation before intercourse. You don’t need to remember to do anything. You don’t have to put in a diaphragm, take a pill, use a condom, or count days on the calendar to avoid pregnancy. 
• It lowers the risk of ovarian cancer. According to the National Library of Medicine, “epidemiological studies have consistently found that tubal ligation (also known as sterilization, in which the fallopian tubes are clipped, cut, or tied) is associated with an overall reduced risk of ovarian cancer.”

The Cons of Tubal Ligation

• It increases the risk of an ectopic pregnancy. An ectopic pregnancy is one where a fertilized egg implants itself outside the uterus, usually in a fallopian tube. The pregnancy cannot continue to birth and may cause the tube to burst and require immediate medical treatment. If you think you’re pregnant at any time after a tubal ligation, contact your healthcare provider immediately.
• There are risks with surgery. As with any surgery, a tubal ligation comes with its own set of risks. Problems are very rare, but this type of surgery can cause bleeding or damage your bowel, bladder, or major blood vessels. The cut made during your surgery can get infected, or you might react negatively to the anesthesia. There’s also a small chance of lingering belly pain. Your risk for these types of issues is higher if you’re overweight, have had surgery in the same area before, or have diabetes, lung disease, or pelvic inflammatory disease.

Preparing for a Tubal Ligation

Dr. Fliedner recommends that you visit your healthcare provider and talk to him about your questions and reasons for tubal ligation. Together, you’ll discuss factors that could make you regret the decision, such as a young age or a change in marital status.

During such visits, Dr. Fliedner will discuss the following with you:

• Risks and benefits of tubal ligation as a form of contraception
• Details of the procedure
• Causes and probability of sterilization failure
• The best time to do the procedure — for instance, shortly after childbirth or in combination with another abdominal surgery, such as a C-section

Can I Have Tubal Ligation Reversal Surgery?

Tubal reversals are definitely possible; however, your doctor will need to consider several things before deciding if it is right for you. Such deciding factors are your age, the type of surgery you had to tie your tubes, your overall health, and the health of your ovaries, uterus, and fallopian tubes.

Your doctor will want to know your pregnancy history and if you have had surgery for endometriosis, fibroids, pelvic inflammatory disease (PID), or other gynecological disorders. Surgery can cause scar tissue and may affect the success of a tubal ligation reversal.

In general, a tubal reversal could be right for you if you had only small parts of your fallopian tubes removed or if your tubes were closed with rings or clips. The best candidates for tubal reversal are women younger than 40 who had their tubes tied right after childbirth in a procedure called postpartum tubal ligation.

Pregnancy After Tubal Ligation

For a woman who has decided some years after the surgery that she now wants to become pregnant, two popular options exist: tubal ligation reversal surgery and in vitro fertilization.

Tubal Ligation Reversal Surgery

A tubal ligation reversal is a procedure that unblocks the fallopian tubes and restores the normal reproductive functioning of the fallopian tubes to enable fertilization. The opening of the tubes allows sperm to reach the egg in the fallopian tube for fertilization and also enables a fertilized egg, or embryo, to progress to the uterus and implant for pregnancy.

Tubal ligation reversal is more successful when a sizable portion of the fallopian tubes has been left intact after the original ligation procedure. Previous tubal ligations that cause minimum damage to the fallopian tubes are more successfully reversed. When considering a tubal ligation, talk to your doctor about the type of ligation you want that will provide you with the most options in the future, should you decide to reverse the surgery. 

Tubal ligation reversal can be all that is needed for a woman to achieve pregnancy. In other instances, a woman may require other assisted reproductive procedures, such as in vitro fertilization discussed below.

In Vitro Fertilization (IVF)

IVF is a great option when trying to get pregnant after a tubal ligation surgery. A fertility specialist can perform IVF on a woman who has undergone tubal ligation, allowing a woman to give birth to a healthy baby.

During IVF, viable eggs are harvested from a woman’s body and fertilized in a lab. The fertilized egg develops into an embryo that is transferred to a woman’s uterus, where it is carried to term. The IVF process bypasses the blocked fallopian tubes and makes pregnancy possible.

Choosing Tubal Ligation

Choosing to have a tubal ligation is a personal decision that should be considered carefully. For women who are sure they do not want to have children in the future and want to have full control of their reproductive health, tubal ligation is a safe and effective form of birth control.

If you have any questions about whether a tubal ligation procedure is right for you, please reach out to our office and set up an appointment with Dr. Fliedner to discuss your options.