Tubal Ligation

Tubal ligation is a surgical method wherein a female’s Fallopian tubes are slashed, tied or blocked. In the tubal implanting procedures, like Essure, a small spring is inserted in each of the two Fallopian tubes.  This is a non-surgical procedure wherein there is no involvement of slashing or incising.

Over a period of time, the scar tissues begin growing around each of the implants that permanently block the tubes. In either of the procedures, the passage of the egg is blocked for their travelling from the ovaries to the Fallopian tubes.

The purpose is to halt the egg fertilization by a sperm that happens in the Fallopian tubes. Both the tubal ligation and tubal implants are birth-controlling methods in females permanently. They are typically performed by a gynecologist, or a general surgeon.

Tubal ligation procedures

There are many different manners of sealing the Fallopian tubes – cutting, clipping, stitching or burning or binding them shut. Your operating surgeon may perhaps like performing one of the following procedures of tubal ligation. A tubal ligation may be performed using a:

These are performed by placing a viewing device and operating instruments through the two small cuts (laparoscopy) or one small cut (mini laparotomy) in the abdominal area.

  • Postpartum tubal ligation

This is generally performed as a mini-laparotomy after the birth of a baby.  The Fallopian tubes become higher in the abdominal area after the pregnancy.  And, the incision is made beneath the naval area.  The process is generally performed within one to two days after the delivery of the child. A laparotomy (open tubal ligation) is performed by making a bigger incision in the abdominal area.

It is suggested if you require a surgery for some other reason, like caesarean section or because of pelvic inflammatory disease (PID), endometriosis or abdominal or pelvic operation in the past. These situations may cause adhesion of organs and tissues or scars in the abdominal area. Both these conditions make the tubal ligation of any kind more risky and difficult. Laparoscopy is generally performed by with the help of general anesthesia.

Similarly, either laparotomy or mini-laparotomy can also be performed with the help of a general anesthesia or regional anesthesia, which is called an epidural. There is a possibility of reversing the tubal ligation.  But the chances of its being successful are very low. That is why the tubal ligation is seen as a permanent procedure for birth controlling.

Tubal implant procedures

Tubal implants, like Essure, are placed in your Fallopian tubes with no surgery or anesthesia. The procedure does not require your overnight stay in the Clinic and takes hardly about 10 minutes of time.

  • Before performing the method, your cervix of the uterus is dilated to make an opening for reducing the risk of any kind of injury to the cervix.  Your treating doctor may use a speculum, besides a dilating device for slowly opening your cervix before performing the procedure.
  • For performing the procedure, you are made to lie down as is done while doing a pelvic examination. The treating doctor may move a catheter (tiny tube) via your vagina and the cervix into your uterus. The catheter is placed eventually into your uterus, and afterwards into a Fallopian tube.
  • The same catheter is utilized for placing an implant into your Fallopian tube. Using the same method, an implant is inserted into your other Fallopian tube. You are likely to experience cramps afterwards similar to that during your menstruation.

After performing the procedure, an X-ray is done for ensuring that the implants have rightly been inserted for closing the tubes. In certain cases, a tubal implant is not easily inserted.

In such a case, a second procedure is required for blocking the tubes completely. During the initial three months after inserting the implant, you may be advised to use an extra birth controlling procedure. Afterwards,  hysteroslpingography is performed wherein a dye is introduced into your uterus and an X-ray is done for ensuring that the implants have rightly been inserted and the tubes have been fully blocked with the scar tissues.

If the results are found to be positive, you may no longer be required to use another birth controlling procedure.

What happens after the Surgery Tubal ligation

After going through the tubal ligation procedure, you may be allowed to go home the same day. The operating surgeon may feed you with instructions on what may happen and in what situations you need to call him or her after performing the surgery.

  • You may experience a slight bleeding from the vagina. It happens because of the uterus movement during the procedure.
  • In case a laparoscopy is performed, your stomach may get swollen. This happens because of the presence of gas, which was used for lifting your muscles and skin away from the organs of the abdomen.
  • This is done in facilitating the surgeon’s view of the organs in a better way.  It takes about a day or so for fading away, but sometimes it takes longer to go away. You may also experience some kind of pain in your shoulders or back from the presence of gas in your abdominal area. As the body starts absorbing the gas, these symptoms also fade away.
  • You are allowed to take a bath, but at least 24 hrs after performing the surgery.  Do not pull or rub your incisions for minimum one week.
  • You may copulate with your partner after one week after the surgery.  It may not cause pain.
  • Ensure that you take rest for at least one day before resuming your routine activities. It takes about one week for resuming all kinds of routine activities.
  • A standby birth controlling procedure is not required after the successful surgery.

Generally, a follow-up examination is slated after two weeks.  

Tubal implants

  • Mostly, females are allowed to resume their usual activities on the same day of the procedure.
  • Ensure that you continue to use additional birth controlling method for at least three months until the Fallopian tubes blockage is confirmed by an X-ray examination.

Why these procedures?

Both the tubal implant and the tubal ligation are the birth controlling procedures permanently. So, consider these methods if you are pretty sure you do not want to conceive in the future.

How Well It Works?

Tubal implants and ligation are not guaranteed procedures for averting pregnancies.

Tubal ligation

  • You run a small risk of getting pregnant even after the tubal ligation procedure.  Generally, 5 out of 1000 females get pregnant after a period of one year. After nearly five years undergoing the tubal ligation, about 13 among 1000 females get pregnant for one reason of the other. These pregnancies generally happen if:
    • The Fallopian tubes re-grow and form a fresh passage (re-canalization) for allowing an egg to get fertilized by a sperm. Your treating doctor may like to discuss the pros and cons of each procedure and suggest you the procedure that prevents the tubes most from re-growing.
    • The procedure was not performed correctly.
    • You happen to be already pregnant when the procedure was performed.

Tubal implants

  • Several studies have shown that over a period of two years, less than one among 100 females get pregnant even after placing implants.
  • At times, inserting a tubal implant is difficult. Many females undergo a repeat method so that the implants are correctly placed.

You are advised to consult your doctor at the earliest in case you happen to undergo tubal implants or ligation and you experience:

  • Pregnancy symptoms, like:
  • Uncomfortable pain in a side of the lower abdominal area and you happen to experience fainting or a feeling of dizziness.

Risks & complications Tubal ligation

The tubal ligation can be performed usually without any major complication.

  • Slight complications may include:
      • Developing an infection
      • Separation of wound
  • Major complications may be such as:
      • Unusual loss of blood
      • Issues arising out of General Anesthesia
      • Injured organ during the procedure
      • Requirement of a larger laparotomy cut during the procedure

There are less than fewer complications happening after undergoing laparoscopy than any other type of tubal ligation procedure. And, these complications could be more than serious.  For instance, your bladder or the bowl may get injured while inserting the laparoscope. You run a higher risk if you:

Tubal implants

The implants may rarely cause stubborn pain in the pelvic area, which will not go away. In such a case, the implants are removed from the Fallopian tubes nearly after six weeks. You run a higher risk developing infection in the pelvis because of tubal implants. For averting these risks you are examined before the procedure for any kind of sexually transmitted infection, such as Chlamydia, Gonorrhea and a vaginal infection.

Risk of Ectopic pregnancy

In case the tubal implant or the ligation fails and you get pregnant, you run an increased risk of getting an ectopic pregnancy. This may happen after several years of undergoing the ligation procedure.

Points to Ponder

With tubal implants or ligation, there comes no change in your periods. And, the females continue to get an ovulation (the release of an egg from your ovary) every month. You may attain menopause simultaneously in case you have not undergone the procedure. Your desire for having sex does not alter.  Rather, you feel more at ease when you do not have to be anxious about getting pregnant.

Advantages

Both Tubal Implants and Ligation are permanent procedures for controlling the birth of babies. Thus, you may remain sexually active without bothering about getting pregnant. Although both the procedures are costly, yet you are not paying for it periodically. Check with your insurance company, if the procedures are covered in your subscribed insurance policy. Moreover, the cost of other procedures of birth controlling like spermicide, pills or condoms may realistically be higher over a period of time.

Disadvantages

Neither Tubal implants nor ligation help you in protecting against any kind of sexually transmitted infections, like HIV or AIDS. So, you are advised to use a condom for protecting yourself from probably STIs each time you copulate with your male partner. Ensure that you are using another type of birth controlling procedure for at least three months after getting tubal implants.

Other points to ponder

Reversal of tubal ligation needs reconnection of the Fallopian tubes.  And, the chances of success of it are very rare. In case you are looking forward to having a tubal ligation, be absolutely clear that you will never be able to get your biological baby in the future. Some medical practitioners allow a gap between a female’s request for tubal ligation and its procedural performance. This is purely done for giving the female time to be sure about the requested decision.

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