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| |    Tubal Ligation by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Permanent surgical sterilization is the most frequently used method of birth control in the United States. Vasectomy, the sterilization procedure for men, is slightly safer for the couple than is tubal ligation, the procedure for women that's more commonly referred to as "having your tubes tied." This is because vasectomy is performed under local anesthesia and the abdominal cavity is not entered during the surgical procedure, as it is for tubal ligation. Still, many men are unwilling to have this procedure, so more than twice as many tubals than vasectomies are done in the United States. The idea behind tubal ligation (or TL as it is commonly called) is that the fallopian tubes become obstructed so that sperm cannot reach the egg and fertilize it. Each month, a tiny egg is released and travels as far as it can down the tube. Once it reaches the obstruction, it simply remains there until it is absorbed by the body, like any other cell going through its natural life cycle. A permanent procedure Tubal ligation should be considered an irreversible procedure. While operations are available to try to reconnect the tubes, these operations often are not successful, require a much more major surgery than the tubal ligation itself, and usually are not covered by insurance. Failure rates Occasionally a woman still gets pregnant, despite having had her tubes tied properly. The tubes have evolved in such a way as to try to heal themselves, and sometimes a tract develops that allows egg and sperm to meet. Tubal ligation, regardless of whether the tubes are cut, burned, clipped, banded, or tied, is about 99 percent effective, meaning that about 1 percent of women will conceive an unplanned pregnancy after tubal ligation. This failure occurs slightly more frequently in younger women. Types of tubal ligation Three things must be considered when weighing the different methods of tubal ligation: whether the procedure is done immediately after a pregnancy or in the interim, how the surgeon reaches the tubes, and how the tubes become obstructed. Timing and surgical approach For new mothers who want to get a tubal ligation, the procedure can be done immediately after birth or at the time of cesarean. The greatest advantage to this timing is the ease of recovery, since you are recovering from the other procedure anyway. In addition, because you are already in consultation with a medical practitioner, the surgery is usually easy to arrange. The greatest disadvantage to this timing is that experts don't recommend making life-changing decisions during a time of stress, and many would agree that pregnancy is a time of stress. That said, postpartum tubal ligation is still a good choice for many couples. Tubal ligation done during cesarean section takes just a few extra moments during surgery and does not add significant risk or recovery time. After vaginal birth, if an epidural was used for labor, the same epidural can be dosed up and used for tubal ligation. If no anesthesia was needed for birth, the tubal can be done with an epidural or spinal anesthesia. One small incision, called a mini-laparotomy, is made below your belly button. Of course, tubal ligation can also be done at any time of your choosing, unrelated to recent pregnancy. The procedure typically involves about four hours in the hospital or clinic and a few days off from work for recovery afterward. The tubes can be reached with a surgical telescope (laparoscope) using one or two small incisions in your abdomen, by hand through a mini-laparotomy incision just above the pubic bone, or by entering the abdomen through an incision in the back of the vagina. Most physicians have one or two approaches that they prefer. Researchers are also looking at a method that reaches the tubes up through the cervix and the uterus, using a uterine telescope (hysteroscope) to inject a plastic or chemical to obstruct the tubes. This would avoid opening the abdomen and would diminish the amount of anesthesia needed for the procedure. However, because the method has shown inconsistent results, hysteroscopic procedures are not available in the United States. The process Doctors can surgically obstruct the fallopian tubes in numerous ways:
The risks of tubal ligation are the same as any surgery: bleeding, injury to other internal organ like bladder or bowel, and infection. Your practitioner will give you information specific to the procedure you may be having. Long-term risks Experts used to think that tubal ligation increased the chances of irregular menstrual cycles, but that turned out to be a misperception. Doctors found that if a woman tended to have irregular cycles before she began taking the Pill for an extended period of time (which would eventually regulate the menstrual cycle), she might consider herself to be regular. However, if she had a tubal and consequently stopped taking oral contraceptives, it wouldn't be unusual for her irregular cycles to return. Statistically, the surgery does not lead to any menstrual cycle abnormalities. The biggest risk has to do with regretting having gone through the surgery. You must be absolutely certain that you do not want to have any children in the future. Studies have shown that regret is more likely in people who remarry, people who make the decision while pregnant, and people who have the procedure when younger. Advantages:
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