How Does Tubal Sterilization Work?

Tubal ligation is a method of permanent sterilization.

Tubal sterilization is also called tubal ligation. It is a form of permanent birth control for women. During conception, the ovaries release the eggs into the fallopian tubes. The sperm enters the vagina, uterus and then fallopian tubes to fertilize the egg. Following fertilization in the fallopian tubes, the fertilized egg leaves the fallopian tubes and moves into the uterus and implants in the uterine wall, where the fetus develops.

Tubal sterilization works to permanently prevent pregnancy by cutting and tying or clipping the fallopian tubes, hence preventing the egg from traveling from the ovaries through the fallopian tubes. It also blocks the sperm from entering the fallopian tubes to fertilize the egg. Reversal surgery may be attempted, but the surgery is invasive and not usually effective. Tubal sterilization does not affect the menstrual cycle.

A woman can undergo tubal sterilization at any time, including right after normal childbirth, cesarean delivery or along with other abdominal surgeries. The best time to undergo tubal sterilization is following childbirth or combined with other abdominal or pelvic surgeries. Another alternative to tubal sterilization, which is also permanent, is hysteroscopic sterilization that involves the doctor placing a small coil into the fallopian tubes that causes scar tissue to form and blocks the tubes.

Before the procedure

The woman would have to undergo a pregnancy test to ensure she is not pregnant. If the woman is pregnant, she may discuss her options whether to continue the pregnancy before undergoing sterilization. Routine blood and radiological tests would be performed to assess fitness for surgery.

During the procedure

The procedure is performed under anesthesia. The procedure is usually performed laparoscopically. Two to three small incisions are made in the abdomen under the umbilicus (belly button) through which a thin tube with a light and camera (laparoscope) and surgical instruments are inserted. 

The fallopian tubes are sealed off by cutting them and tying the ends. Part of the fallopian tubes may be removed. The fallopian tubes may also be blocked, destroying parts of the tubes or blocking them with rings or clips.

If the procedure is being combined with other open or laparoscopic surgeries of the abdomen or pelvis or cesarean delivery, the surgeon would perform the sterilization procedure using the incisions made for the abdominal or pelvic surgery or cesarean delivery. If tubal sterilization is being done after vaginal childbirth or isolated at any time, the procedure would be performed laparoscopically.

After the procedure

Patients are usually discharged the same day and occasionally the next day. Patients may experience pain, discomfort, giddiness and bloating that usually resolve in a few days. Painkillers and antibiotics are usually prescribed. Patients can resume their daily activities the next day after surgery because they feel better and more comfortable, but should avoid straining. Patients may bathe 48 hours after surgery. Patients can resume exercise, sports, heavy lifting and sexual intercourse after consulting the doctor. Recovery would take longer (six to eight weeks) if other abdominal or pelvic surgeries or cesarean delivery has also been performed.

Tubal sterilization may not be ideal for all women. Hence, it is important to discuss the advantages, disadvantages and risks of the procedure with the doctor.

Advantages of tubal sterilization

• Tubal sterilization can permanently prevent pregnancy with a good success rate. Hence, women need not use other types of birth control.
• It reduces the risk of ovarian cancer, especially if the fallopian tubes are cut.

Disadvantages of tubal sterilization

• The procedure is irreversible.; Hence, women who may want to get pregnant in the future can discuss with the doctor and opt for other long-acting contraceptive options such as intrauterine contraceptive devices/intrauterine devices (IUCDs/IUDs).
• The procedure does not prevent sexually transmitted diseases (STDs).
• Although tubal sterilization is relatively safe, it’s still a surgical procedure requiring anesthesia. Hence, there is a risk of complications. Some complications that may occur include
  • Bleeding 
  • Infection
  • Pelvic pain 
  • Improper wound healing
  • Scarring 
  • Damage to the surrounding structures such as the bowel, bladder, muscles, major blood vessel, and other tissues
  • Reaction to anesthesia
  • Failure of the procedure, resulting in unwanted pregnancy in the future, especially tubal pregnancy (implantation of the fertilized egg in the fallopian tubes).

The risk of complications increases in the following cases

• History of major pelvic or abdominal surgery
• Chronic smoking
• Obesity
• Diabetes and other major systemic illnesses 
• Age, that is the younger the woman, the higher the risk of failure of the procedure