Female Sterilization

 

Is sterilization right for me?

If you want a highly effective, permanent method of birth control, you may be considering female sterilization. Sterilization is chosen by individuals and couples who are sure they do not want any more children. Male sterilization (vasectomy) is also a permanent birth control choice. Vasectomy is a simpler, safer, and less expensive procedure than tubal sterilization. In addition, it can provide greater protection against unwanted pregnancy. Although you may have heard that the operations can be "reversed," tubal sterilization for women and vasectomy for men should be considered permanent methods of birth control.

How sure can I be that I won't get pregnant?

Female sterilization is one of the most highly effective methods of birth control currently available. Nevertheless, overall, about 2% of women will get pregnant within 10 years after their tubal sterilization. About a third of these pregnancies are ectopic (tubal) pregnancies, which can be dangerous.

Studies suggest that a few women may get pregnant long after their operation and that the youngest women (those 18 to 27 when sterilized) are at greatest risk. Therefore, if you decide sterilization is for you, you should continue to be alert for possible signs or symptoms of pregnancy, even years after your operation. If you suspect you might be pregnant, contact your health care provider.

Long-Term Reversible Options

Some long-term, reversible methods of contraception can be as effective as sterilization, but have the advantage of being reversible. The copper T intrauterine device (IUD) and subdermal levonorgestrel implants (small rods that are placed under the skin of the upper arm) fit into this category. These temporary methods are as effective as sterilization and require replacement only after years of use.

The copper T IUD has been shown to be safe and highly effective and can be used for up to 10 years. Subdermal implants are also highly effective and can be used for up to 5 years. Both methods are easily reversible if you change your mind and want to become pregnant. Injections of a hormone called DMPA (depot medroxyprogesterone acetate) or "the shot," also provides excellent contraception, yet is a reversible method that requires only that you visit your clinician every three months for the next injection.

Before deciding on sterilization, ask your health care provider to discuss all the risks, side effects, and benefits of both permanent and long-term permanent contraceptive options.

Once you have decided on sterilization, your doctor will choose one of several methods.

The method of sterilization used is based on many considerations, most of which have to do with your medical needs and with the timing of your procedure. Some women are sterilized while still in the hospital following childbirth or an abortion. Many are sterilized at a time unrelated to childbirth at a medical clinic rather than a hospital.

Ask your clinician to discuss the various methods of sterilization available. All methods close or cut the fallopian tubes (the tubes that carry the eggs from the ovary to the uterus) so that your partner's sperm cannot move through them to fertilize an egg.

The following are descriptions of various types of sterilization. The type chosen by your surgeon depends on many factors, including your medical history. It is important to be aware that during the operation your doctor may need to modify or change the type of procedure to accommodate your particular medical needs.

Tubal ligation:

A portion of the fallopian tube is cut and tied or stitched with suture material. This is often done in the hospital after the delivery of a baby.

Sterilization using electrical current:

Carefully controlled electrical current is used to seal the tube shut. The surgeon makes a tiny incision in the abdomen and then inserts an instrument with a ˝" telescope (a laparoscope) to find the fallopian tubes. Then another instrument is used to apply the electrical current.

Silicone band (tubal ring):

An elastic band is slipped over a small fold of the fallopian tube, clamping it shut. The surgeon uses a laparoscope and a tiny incision. Through it, the surgeon inserts a special applicator that stretches the ring, picks up a loop of fallopian tube, and places the ring over the loop.

Spring clips: Two types are available.

In one, a small-toothed clamp, like a clothespin, is placed over the fallopian tube and held closed by its spring clamp. This device is also inserted through a laparoscope and applied to the tube with a special tool.

In the other, a round clamp is closed over the fallopian tube and the clamp's plastic liner expands to keep the tube closed as it flattens. This clip is also applied using a special applicator and a laparoscope. This device will soon be available in the United States. It is now used primarily in Great Britain and Canada.