Tubal ligation

Tubal ligation is a permanent voluntary form of birth control (contraception)in which a woman's Fallopian tubes are surgically cut or blocked off to prevent pregnancy. Tubal ligation is performed in women who definitely want to prevent future pregnancies. It is frequently chosen by women who do not want more children, but who are still sexually active and potentially fertile, and want to be free of the limitations of other types of birth control. Women whoshould not become pregnant for health concerns or other reasons may also choose this birth control method. Tubal ligation is one of the leading methods ofcontraception, having been chosen by over 10 million women in the United States-- about 15% of women of reproductive age. The typical tubal ligation patient is over age 30, is married, and has had 2-3 children.

Tubal ligation should be postponed if the woman is unsure about her decision.While it is sometimes reversible, the procedure should be considered permanent and irreversible. Up to 10% of sterilized women regret having had the surgery, and about 1% seek treatment in attempts to restore fertility.

The Fallopian tubes, which are about 10 cm long and 0.5 cm in diameter, are found on the upper outer sides of the uterus, and open into the uterus throughsmall channels. It is within the Fallopian tube that fertilization, the joining of the egg and the sperm, takes place. During tubal ligation, the tubes are cut or blocked in order to close off the sperm's access to the egg. Normally, tubal ligation takes about 20-30 minutes, and is performed under generalanesthesia, spinal anesthesia, or local anesthesia with sedation. The surgerycan be performed on either hospitalized patients within 24 hours after childbirth or on outpatients. The woman can usually leave the hospital the same day. Tubal ligation costs about $2,000 when performed by a private physician, but is less expensive when performed at a family planning clinic. Most insurance plans cover treatment costs.

Preparation for tubal ligation includes patient education and counseling. Before surgery, it is important that the woman understand the permanent nature of tubal ligation, and the risks of anesthesia and surgery. Her medical history is reviewed, and a physical examination and laboratory testing are performed. The patient is not allowed to eat or drink for several hours before surgery.

After surgery, the patient is monitored for several hours before she is allowed to go home. She is instructed on care of the surgical wound, and what signs to watch for, such as fever, nausea, vomiting, faintness, or pain. These signs could indicate that complications have occurred. While major complications are uncommon after tubal ligation, there are risks with any surgical procedure. Possible side effects include infection and bleeding. Rarely, death mayoccur as a complication of general anesthesia if a major blood vessel is cut.The death rate following tubal ligation is about 4 per 100,000 sterilizations.

After having her tubes ligated, a woman does not need to use any form of birth control to avoid pregnancy. Tubal ligation is almost 100% effective for theprevention of conception. The possibility for treatment failure is very low-- fewer than 1 in 200 women (0.4%) will become pregnant during the first yearafter sterilization. Failure can happen if the cut ends of the tubes grow back together; if the tube was not completely cut or blocked off; if a plasticclip or rubber band is loose or comes off; or if the woman was already pregnant at the time of surgery.

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