Permanent Birth Control

At some point in life you may decide that you would not like to be pregnant again. Some women will choose permanent sterilization to prevent pregnancy for the remainder of their reproductive years.

Your options for sterilization or permanent birth control are tubal ligation (tying your tubes) or Essure. A tubal ligation is performed in an out-patient surgical center and requires 2-5 days off of work for recovery. An Essure procedure is performed in the office under sedation using a scope or camera in the uterus to place plugs in the fallopian tubes. Most women recover from this procedure rapidly and return to work in 2 days.

Before making a decision to permanently remove the possibility of future pregnancy, your physician will want to discuss your decision to choose permanent birth control. Your doctor wants to be certain that you have examined your choice from all angles and considered all other reversible methods of birth control. You should understand that tubal ligation or Essure procedures are non-reversible or permanent.

Modern sterilization procedures for women, although not 100% effective, are generally much more effective that typical birth control pill, depo-provera or condom use. Modern IUD’s are as effective as tubal ligation and may be an alternative method for you, offering 5-10 years of birth control without undergoing a surgical procedure.

An alternative to female sterilization is male sterilization, called vasectomy. A vasectomy is performed by a urologist and generally is felt to be safer, with less potential for complication than tubal ligation for women. A vasectomy is more effective than tubal ligation to prevent pregnancy providing the man submits two semen samples that are deemed to be absent of motile sperm. We can help with referral to urology if you need more information about this option.

Click on this link to learn more about Essure: www.essure.com

Tubal Ligation

Tubal ligation is a permanent sterilization procedure performed under general anesthesia at an out-patient surgical center.

Because reversible contraceptive methods such as birth control pills are less than perfect for pregnancy prevention, many women choose tubal ligation. In 2005 about 27% of women who had completed child bearing were relying upon tubal ligation for birth control. 9% of women relied upon their partner’s vasectomy for pregnancy prevention.

Surgical tubal ligation is 99.6 – 99.8% effective.

By comparison, male vasectomy is 99.9% effective.

When tubal ligation fails women often will have an ectopic pregnancy. An ectopic pregnancy is a pregnancy which has planted in your fallopian tube rather than the uterus. An ectopic pregnancy must be promptly treated by a physician since these pregnancies can result in life-threatening bleeding from the ruptured fallopian tube.

Tubal ligation has many advantages for some women:

• No future costs for birth control
• It is permanent.
• Eliminate daily pill use. Eliminate risks of pill use for women over 35, smokers, women with high blood pressure and diabetes.
• No impact on sexual functioning. Perhaps improved function without the worry of pregnancy.
• No change in menstrual function.
• Possible decreased risk of ovarian cancer.
• Can still take birth control pills or use IUDs if desired.

Tubal ligation has disadvantages for some women:

• Risks of general anesthesia
• Risks of the surgical procedure include, but are not limited to: infection, organ injury, hemorrhage, blood transfusion, open surgery, tubal failure, ectopic pregnancy, death.
• Costs involved with surgical procedure
• Time lost from work or family
• Discontinuing birth control pills may result in irregular periods, heavier bleeding and more pain.
• Regret is expressed by 2-5% of women within 1 year of tubal ligation. This is usually seen in women under 30 or women, regardless of how many children they had.
• Need more information? See your physician to review this information and help you develop a birth control plan.

Planning a tubal ligation

If, after discussion with your physician, you have decided upon a tubal ligation then you will be referred to the surgical scheduler to work out the details of your procedure.

Typically women are scheduled 2-6 weeks out from their consultation for their procedure. If you need birth control during this time your doctor can help you. If you have a birth control accident while waiting for your tubal ligation you can use emergency birth control (morning after pill) called Plan B which is readily available over the counter at your pharmacy.

The surgical scheduler will communicate with you about the date, time of arrival at the surgical center, costs you can expect to pay, what to bring. You must have a ride home from the surgical center. You will not be released in a taxi.

After arriving home you may want to lie down and rest while your anesthesia and sedation continue to wear off. You are unlikely to be able to take care of your household, cook, drive or take care of children in the afternoon or evening on the day of surgery.

Your discomfort will be mild to moderate. Your physician can offer you a prescription for pain relief. Pain, cramping and bowel changes may persist for up two weeks. Left shoulder pain is a common complaint for women undergoing laprascopic procedures because of the air that is trapped under the diaphragm during the procedure. A heating pad, massage and normal bowel function (allowing you to pass the gas) should help you get past this discomfort.

Most women are able to return to work in 2-5 days.

If you are taking birth control pills you can finish up the pack and discontinue it. A tubal ligation is effective immediately.