Tubal Ligation

A tubal ligation, often called having your tubes tied, is the surgical female sterilization procedure that can be done to prevent unwanted pregnancy. Ligation means to tie off and tubal refers to the Fallopian tubes from the ovary to the uterus. Thus, a tubal ligation is the procedure in which the Fallopian tubes are tied closed to prevent the egg in the woman from moving from the ovary and into the uterus. By closing these tubes, the egg and the sperm are unable to meet up to result in conception – and pregnancy is prevented.

Why Is Tubal Ligation Done?

If an adult woman does not want to ever get pregnant again, her healthcare provider is likely to recommend the tubal ligation. Because this procedure usually cannot be reversed, healthcare providers are hesitant to recommend the procedure for women who are young and may change their minds about wanting additional children in the future. The surgery to try to reverse a tubal ligation is major surgery that may or may not restore a woman’s ability to conceive a child, so most healthcare providers will have extensive discussions with a couple that makes the decision to have this procedure done.

There is also some risk of becoming pregnant after a tubal ligation. In fact, as many as 1 out of 100 women may become pregnant within a year after a tubal ligation. This may occur when:

• The surgery was not done by a skilled surgeon;
• The tubes grow back together;
• A new passage forms from the ovary to the uterus;
• The woman was already pregnant when the tubal ligation was performed.

What Are the Risk Factors of Tubal Ligation?

Tubal ligation is a surgical procedure so there are risks associated with it. Your surgeon and anesthesiologist should fully explain the following risks to you before you sign the surgical consent:

• Because the surgery is in the lower abdomen, there is risk of damage to the woman’s bladder, bowel, or blood vessels in the abdomen.
• As with any surgical procedure, there are risks associated with anesthesia.
• Any time the skin is cut, there is a chance that the wound will become infected or that healing will be slow.
• Pain is a risk after any surgery. However, pain that continues for more than a few days after a tubal ligation should prompt a visit to your surgeon.
• The risk of an ectopic pregnancy increases after tubal ligation. An ectopic pregnancy is a pregnancy that develops outside of the uterus – often in one of the Fallopian tubes.
• The chance of having a complication after a tubal ligation is higher if you have had any abdominal or pelvic surgery or if you have a history of diabetes or pelvic inflammatory disease.
• Remember, a tubal ligation will NOT protect you from sexually transmitted diseases from unprotected sex.

How Should You Prepare for Tubal Ligation?

Tubal ligation is usually permanent and non-reversible. For this reason you, your partner, and your physician should have a detailed discussion covering the following topics:

• You should review the pros and cons of a tubal ligation as opposed to other methods for preventing pregnancy. Your doctor should explore your reasons for wanting a tubal ligation, particularly if you are young and unsure about whether or not you might want more children in the future.
• Your surgeon should help you understand all information about how tubal ligation can be reversed – and whether the surgeon will even attempt that procedure.
• You should understand all the potential risks of the surgery and how it will be done.
• Your doctor should help you to understand the risks of failure and the resulting possibility of pregnancy after a tubal ligation.
• If you are having other abdominal surgery, your physician will probably recommend that the tubal ligation be done at the same time to prevent the need for two procedures.
• If you are not having the tubal ligation at the same time as another procedure, your physician will probably recommend that the procedure be done during or immediately after your menstrual period.
• For the month before the procedure and the month following the procedure, you should continue to use your current method of contraception.

What to Expect from Tubal Ligation Surgery?

During the Procedure

A tubal ligation not associated with another abdominal surgery will usually be done through a laparoscope. In this procedure, the surgeon will make three small incisions – one to inflate your abdomen with gas, one for the laparoscope, and one for any other instruments that are necessary during the procedure. Typically, the surgeon will either cut the Fallopian tubes or block them off with clips. If you have the tubal ligation with another abdominal surgery, your physician will simply use the same incision and do both procedures while your abdomen is open.

After the Procedure

Unless you had another major abdominal procedure, you will likely be discharged the same day. You will get specific instructions from the surgeon who did the procedure, but the instructions will usually include:

• Rest for a day or two with no heavy lifting for at least a week.
• Talk to your doctor about when you can begin to have sex after a tubal ligation.
• Most doctors prefer that you not soak in a bath for at least 48 hours after the procedure. Be sure to dry the incision line very well after a shower.
• Incision pain, mild abdominal cramping, bloating, shoulder pain, and fatigue are common for a day or two after the procedure.
• Take an over-the-counter pain medicine such as acetaminophen for any pain you might have. Avoid any medication (such as aspirin) that might lead to bleeding.
• Follow up with the surgeon as directed – usually about a week after the procedure.

When to See a Doctor

Call your doctor immediately if you notice any of the following:

• Fever over 100 degrees F;
• Severe abdominal or pelvic pain that will not subside;
• Uncontrolled bleeding or purulent discharge from your incision site;
• Fainting spells;
• Any signs or symptoms that you might be pregnant.