Tubal ligation is a surgery that «ties» a woman’s fallopian tubes. This is a kind of female sterilization, a method of irreversible contraception. The purpose of ligation (which may also be a tubal ligation) is to block the movement of eggs from the ovaries to the uterus after ovulation and thus prevent pregnancy. How is this operation performed, will it be a 100% guarantee against conception, and what else do you need to know about tubal ligation?
Who can do tubal ligation?
Every year, about two million decide on female sterilization — tubal ligation. This is an operation that blocks the «road» of the egg and thus prevents pregnancy.
In the US, this method is almost as popular among women as oral contraceptive pills: 30.6% use hormonal contraceptives, while 27% opt for tubal ligation.
In Russia, there are two types of indications for tubal ligation: social, at the request of a woman, and medical.
- If desired, the operation is done for women over 35 years old with at least one child.
- Medical indications include cases when pregnancy is dangerous for a woman or in the presence of an infectious, genetic disease that will threaten the fetus. In such cases, the age and number of children do not matter.
Before the procedure, a mandatory examination is carried out, since there are a number of contraindications to dressing. These include:
- serious diseases of the cardiovascular and respiratory systems, kidneys, liver;
- blood clotting disorders;
- inflammatory diseases, tumor formations, infections of the reproductive system;
- pronounced obesity;
- the presence of multiple adhesions of the fallopian tubes.
What happens during the procedure?
Tubal ligation is most often performed using minimally invasive methods. These include laparoscopy, minilaparotomy, open laparotomy, hysteroscopy, colpotomy. The most sparing option is to use the laparotomy method (through a small puncture). Anesthesia helps you not feel anything during the procedure.
The surgeon will make one or two small incisions in the abdomen and use a long, thin device similar to a small telescope (called a laparoscope) to cut, block, tie, or clamp the fallopian tubes.
The doctor will then sew up the incisions. The whole procedure takes 30-40 minutes.
After a couple of days of stationary observation, it will be possible to go home.
Bandaging can be done in several ways. Pipes can:
- cut and tie with a special thread;
- block with special tapes or clips;
- cauterize with a discharge of electric current;
- block with small implants around which scar tissue will later form.
The choice of technique depends on the condition of the patient, her desire and the possibilities of the clinic. As with any invasive procedure, there is a possibility of infection, pain, or bleeding after this procedure.
How effective is the ligation and is it possible to “untie” the pipes?
Tubal ligation is almost 100% effective. There is only a very small risk of getting pregnant. This can happen if the tubes grow back together, which is very rare.
It is believed that tubal ligation is an extremely reliable way to prevent pregnancy. Less than 1 in 100 women who have regular unprotected intercourse become pregnant within a year after surgery. And the more time passes after the procedure, the higher the coefficient of reliability of contraception and the lower the chances of conception, since an additional scar is formed at the ligation site.
The method by which the dressing was performed affects the likelihood of pregnancy. Although all of them are good at blocking the movement of the egg through the tube, not all of them are equally effective in the long run. Those that cause the most tissue damage (tube excision) are the most consistent in terms of contraception.
Age also plays a role in the likelihood of renewed chances of pregnancy. The younger the woman at the time of the procedure, the higher the chance that the tubal patency can repair on its own, and the egg will meet with the sperm at some point.
Is it possible to «untie» the fallopian tubes if a woman changes her mind?
In some cases, it is possible to reverse the procedure to restore the patency of the fallopian tubes. But this is a major operation that requires several days in the hospital.
There is a fairly high chance that the result of tubal ligation will be irreversible. It depends on what method was used, how long ago it was, and whether the pipes are too damaged to repair.
It is important to remember that attempting to repair the fallopian tubes increases the likelihood of an ectopic pregnancy compared to patients who have not previously undergone tubal surgery.
An ectopic pregnancy occurs when a fertilized egg remains in the fallopian tube instead of being transported into the uterine cavity. It attaches itself to the wall of the pipe and grows there, threatening to burst the pipe at any moment.
This is a life-threatening condition.
Tubal ligation, health and disease: what is important to know
The operation does not affect libido, does not “remove” the menstrual cycle, and, according to studies, does not affect the onset of menopause. Although in some cases it can temporarily cause a feeling of menopausal «tides».
Tubal ligation does not help in the prevention of STDs. This procedure is aimed solely at preventing pregnancy. Thanks to its presence, you can not be protected from conception, but you can not forget about infections. The best way to protect against sexually transmitted diseases is the male condom.
An additional bonus of tubal ligation is the protective effect. According to a large-scale study (BioMed Central Cancer journal), it reduces the risk of developing cancerous changes in the endometrial layer of the uterus by 42%.
Obstetrics: national guidance / Kulakov V. I., Radzinsky V. E., Savelyeva G. M. and others. // Moscow: GEOTAR-Media — 2014
Tubal ligation in relation to menopausal symptoms and breast cancer risk. / Nichols HB, Baird DD, DeRoo LA, et al // Br J Cancer — 2013 Oct 3 — 109(5)
Tubal ligation and endometrial Cancer risk: a global systematic review and meta-analysis. / Loghmani L, Saedi N, Omani-Samani R, et al. // BMC Cancer — 2019 Oct 11 — 19(1)