The need for birth control options is a booming and growing business. Between 2011 and 2013, 61.7 percent of women aged 15 to 44 in the United States were using some type of birth control method, per the Centers for Disease Control and Prevention. Women who opt for more permanent birth control measures are typically older than 30 and done having children.
Tubal ligation is a procedure that involves stopping the ability for an egg and sperm to meet after the egg is discharged from the fallopian tubes. In order to make this possible, the passageway in the fallopian tubes must be blocked. Sterilization via tubal ligation is achieved in one of several ways:
- Cutting the fallopian tubes
- Removing the fallopian tubes
- Placing stitches in the fallopian tubes
- Clipping the tubes and then burning the edges
- Cut off by way of a silicone band
- Cut off by way of tubal ligation clips or clamps
- By way of coil insertion
The method of ligation that is performed will have lasting effects for some women. For example, when the tubes are simply cut and left alone, they can potentially be fused back together in the future should the patient want a tubal reversal. However, if the edges are burnt with an electrical current, then reversal will not be possible.
Sterilization can be done laparoscopically or vaginally. Through laparoscopy, a tiny incision will be made in the woman’s abdomen and a laparoscope — which is a small device fitted with a camera at the end — is inserted. While this procedure isn’t very invasive, going through the vagina to perform a tubal ligation is less so. For both procedures, general anesthesia is required.
The mini-laparotomy can be performed shortly after childbirth and may be the most convenient for women who must have a cesarean section and don’t desire any more children in the future. Otherwise, women must wait at least six weeks to let the interval abdominal cavity, uterus and reproductive system heal following childbirth before sterilization can be performed.
The clamping method is a good option for women who are seeking a less invasive form of sterilization. However, its biggest selling point is that it can be reversed. That being said, the process isn’t exactly easy. While it sounds like the clamps just close the opening of the tube and removing them would open it back up, it’s not that simple.
The clamps apply pressure to the tubes enough that the blood supply is cut off to them. This causes the tissue to die and be absorbed by the body. To reverse this, the clamp must be removed and the compressed tubes must be reopened and then stitched back together intricately to allow for the passage of eggs. Healthy Women notes pregnancy rates range from 55 to 85 percent among women who complete the expensive reversal procedure.
While some damage may occur to fallopian tubes, it is rare. Blockages may be more common after a reversal procedure, but these can be cleared through HSG procedures and flushed out. In addition, tubal clamps are the best route to take if there is any chance that Mom will want more babies in the future, though if any such chance is precipitated, it’s best not to go through with tubal ligation at all. The University of Iowa reports as many as 26 percent of women who get the surgery end up wanting it undone.
There are fewer risks when tubal ligation clamps are being used. Since cauterization isn’t needed, the risk of burning the skin or bowel doesn’t exist. Likewise, there is no risk of nicking the bowels either, because no cutting is happening.
- The Hulka clip was created by Dr. Jaroslav Hulka of Chapel Hill, North Carolina. It is created out of plastic and houses a gold spring lock that took tubal ligation procedures to the next level. This clip reduces the amount of fallopian tube that must be damaged for the procedure to be effective. It is placed around the narrowest part of the tube to clip it off andobstruct the pathway for eggs to be released.
- The Filshie clip is an older mechanical process for performing tubal ligation, but it’s still effective and widely used. This clip is manufactured from titanium and silicone. These tubal clamps are placed around the thinnest part of each fallopian tube and also aim to pinch the fallopian tube closed so that eggs are not able to pass through them.
Sterilization procedures do not protect against sexually transmitted infections and diseases. In addition, clip and clamp sterilization procedures take time to become fully effective. Initially, the efficacy rate is roughly 76 percent by one year post-procedure. Over time, this rate will continue to rise until it reaches 99 percent. No sterilization procedure is 100 percent effective short of performing a complete hysterectomy.
Both the Hulka and Filshie methods of tubal ligation can typically be performed on an outpatient basis. Insurance coverage varies for both. Women interested in the procedures will need to consult their insurance provider and the doctor they intend to seek the procedure through to determine their exact coverage benefits.
Women who use tubal clamps are at increased risk of ectopic pregnancies, but it is a lower risk than if they’d just had their tubes cut and tied. The problem is that the remaining piece of tube that exists and juts out from the uterus lends just enough room to house eggs that could become fertilized. When a pregnancy occurs in a fallopian tube or part of it, it is very dangerous for the mother. Hemorrhaging that can be fatal is the most severe consequence. No ectopic pregnancies are viable.
With any tubal ligation procedure, there is a risk of developing scar tissue or post-tubal ligation syndrome. PTLS is a widely misunderstood diagnosis that is rendered when women suffer from physical and cognitive issues following the procedure. It can be debilitating and cause severe depression, as well as pain.
There are many types of tubal ligation to choose from. Women and their partners should research their options thoroughly prior to deciding on which procedure is best for them.