Bilateral Tubal Ligation

Bilateral Tubal ligation (BTL), also called getting the tubes tied, is a permanent form of birth control for a woman. The BTL has a very low failure rate, less than 1% lifetime risk of pregnancy. It is done in the operating room under general anesthesia as an outpatient procedure. Vasectomy is permanent sterilization for a man.

The most important thing to consider before undergoing BTL is whether or not you are absolutely positive that you are done having children. Once the tubes are tied you can never have more children, it is permanent and considered irreversible. The are, however, two ways to get around a tubal ligation. One way is tubal reversal. This is a surgery where the tubes are sewed back together. This is a big surgery, it is very expensive and not covered by insurance. There is also a very high failure rate and a chance for an ectopic pregnancy. The other way to get pregnant after tubal ligation is called in vetro fertilization, or IVF. This is a procedure where an egg is taken from the woman’s ovary and placed in a dish with the man’s sperm. The fertilized egg is then put into the uterus of the woman. This bypasses the tubes completely. This is very expensive, very time consuming, and often does not work. So do not get your tubes tied unless you are certain that you are done having children.

The surgery itself is done in the operating room. General anesthesia is used to put the patient completely asleep. An instrument is placed in the vagina to allow the cervix and uterus to be moved around during surgery. A small incision is made in the belly button and the abdomen is filled with gas. A camera is placed through the incision and the tubes are tied. The gas is allowed out, the equipment is removed and the incision is closed. The patient is woken up and watched for about 2 hours before she goes home. There are many different techniques to actually tie the tubes. The tubes can be burned, they can be cut, they can be clipped, or they can be banded. These techniques are all fairly equivalent and which you get depends on the training and preference of the individual surgeon.

After the tubal ligation you can expect to have some bruising and pain. For most people this is not severe. For most patients, if the BTL is done on a Friday, they can return to work on a Monday. If the job is very strenuous you may need more time off. The BTL is functional right away but you should probably avoid sex for 1-2 weeks after the surgery.

The fallopian tubes are not hormonally active tissue. Interrupting the tube will not change anything about a woman’s physiology. It will not cause weight gain, mood changes, hair growth, change in libido, menstrual or any other changes except for preventing pregnancy. If you ask women who have had a BTL many will complain of menstrual changes. This is because many women are on hormonal contraception prior to the BTL. One of the main side effects of hormonal contraception is to lessen the periods. When the tubes are tied the other birth control is stopped and the menstrual periods return to “normal” which may be unpleasant.

The biggest risk of tubal ligation is regretting that the surgery was done. It is not uncommon for women to change their mind and desire another child sometime after the tubes are tied. This often happens when someone gets remarried or when the youngest child starts school. It is important to consider these life changes and how you might feel about them before the tubes are tied. The biggest risk factor for regrets is young age at the time of BTL. The reason is very logical. If you get your tubes tied at 41 there is not a whole lot of time left for life to change present you with an opportunity to have another child. If you are 21 when your tubes are tied, there are two decades for life to change. This is the reason many doctors feel uncomfortable doing sterilization procedures in young women. There are many forms of reliable long term birth control that are reversible. You may want to consider these options strongly before undergoing permanent sterilization.