Should I Get My Tubes Tied?

From the WebMD Archives

If you know you're definitely finished having babies, or you aren't interested in having any in the first place, never having to think about birth control again can give you a sense of freedom. That's why bilateral tubal ligation, also known as "getting your tubes tied," is the most popular form of birth control among married couples.

The procedure can be done any time, including in the hospital right after you have a baby. The doctor makes a small cut in your abdomen and seals off both of your Fallopian tubes by cutting, typing, banding or clamping them so your partner's sperm can't meet up with your eggs.

Sounds simple, right? Before you tie the fallopian knot, take a moment to consider if this is the best method for you.

The Pros

It lasts forever. Though there are other long-lasting forms of female birth control, such as implants (which last 3 years) and IUDs (which last 3 to 10 years), tubal sterilization is the only one that is permanent.

It works! You might forget to take a birth control pill, but once your tubes are tied, there's no chance of human error. It's one of the most effective forms of birth control available -- outside of not having sex.

Traditional "tube tying" has low rates of accidental pregnancy. Fewer than 5 women in 1,000 get pregnant the first year, and maybe 2 women in 100 will get pregnant over 10 years.

It doesn't affect your hormones. Unlike birth control methods such as the pill and the shot, tubal ligation doesn't change the levels of estrogen and progesterone flowing through your body. You'll still get your period, and it won't affect your mood or sex drive.

The Cons

It lasts forever. For the same reason so many women love tubal ligation, it's a method you should consider only if you're 100% sure you don't want to get pregnant again. This is especially true for women under 30, who have the highest rate of post-surgery regret, says Eve Espey, MD, a professor of obstetrics and gynecology at the University of New Mexico. "Things happen in life that you don't anticipate, and a 35-year-old may not be the same woman she was in her 20s."

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It's very expensive to reverse. Yes, you can change your mind later. Surgery can re-open your tubes, but the success rate depends on your age and how much of the tube was left over after the original surgery. Insurance rarely covers the cost, Espey says, so women often skip it and go straight to in vitro fertilization (IVF), which also costs several thousands of dollars per attempt.

There is some risk. Though tubal ligation is a safe procedure and complications are extremely rare, they do sometimes happen. Most often, it's an accidental injury to the bowel, bladder, or arteries.

Plus, there's still a very small risk of getting pregnant. And there's a greater chance that, if it does happen, the pregnancy will be ectopic, meaning the fertilized egg implants somewhere other than the uterus. An ectopic pregnancy can become life-threatening, and you'll need treatment as soon as you find out about it.

You still need to play it safe. One thing tubal ligation can't do is protect you from STDs, including HIV. Unless you're in a monogamous relationship and you've both been tested, you'll need to protect yourself every time you have sex. Use a barrier method, such as a condom.

What Else to Think About

Recovery time. When you have the procedure done with a C-section, you won't notice any extra pain or recovery time. After a vaginal delivery, your belly will be sore around the cut made during the surgery. Be sure to talk to your OB about your plans well before your due date.

If you're not having a baby, you'll need a little down time. Your doctor will pump some air into your belly so she can see your organs better. The bloating may need a day or two to go away afterward, which could be uncomfortable. And you may want to take it easy and avoid lifting heavy things for the next week.

"The ideal timing would be to schedule the surgery for a Friday, so you can rest for a couple of days and then go back to work on Monday," says Vanessa Cullins, MD. She's the vice president of external medical affairs for Planned Parenthood.

Cost. The surgery is completely covered through Medicaid, although you do need to sign consent forms at least 30 days in advance. With private insurance, the price tag can be anywhere between nothing and $6,000, depending on your plan.

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Other Options

If you're wavering even a little bit, consider using another long-term, reversible method such as an IUD until you're absolutely sure. Or ask your partner to get a vasectomy. "It's a safer procedure with a lower failure rate," Cullins says, "and it gives the man a chance to take responsibility for preventing pregnancy."

WebMD Feature Reviewed by Traci C. Johnson, MD on December 8, 2016

Sources

SOURCES:

Eve Espey, MD, chairwoman, department of OB/GYN, University of New Mexico.

Vanessa Cullins, MD, vice president for external medical affairs, Planned Parenthood Federation of America.

"Practice Bulletin No. 133: Benefits and Risks of Sterilization," Obstetrics & Gynecology, February 2013.

Planned Parenthood: "Sterilization for Women (Tubal Sterilization),"

American College of Obstetrics & Gynecology: "Sterilization by Laparoscopy."

Gariepy, A. Contraception, April 2014.

Gentile, G.P. Contraception, May 2006.

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