What is Sterilization and is it Right for me?

Sterilization for both men and women is a safe and effective method to prevent accidental or unplanned pregnancy used by more than 220 million couples worldwide.  In the United States, every year about 600,000 women undergo tubal ligation and 200,000 men have a vasectomy.

For women, the tubal ligation procedure generally involves a surgical procedure in which an experienced Ob/Gyn surgeon makes an incision in the belly to tie or cut the fallopian tubes.  This procedure may be done after pregnancy in the postpartum period.  A tubal ligation is often done at the time of a cesarean section since this would avoid having another surgical procedure at a later time.  Women having a vaginal delivery may opt for a postpartum surgery through an incision at the belly button.

An interval sterilization procedure is done as a procedure not associated with a recent pregnancy.  Generally, this can be done laparoscopically to minimize recovery time and allow for inspection of the abdominal and pelvic organs during the procedure.  General anesthesia in the hospital setting is often used for this same-day outpatient procedure. Since the incision is small, the recovery is rapid and it is very effective.  A disadvantage is some risk of injury to organs such as the bladder, bowel, or major vessels; however, the overall risk of complication is low (about 1.6 in 100 cases). Many patients choose the laparoscopic tubal ligation option and data suggests it may also reduce the risk of future ovarian cancer.  This benefit may be even greater with the complete removal of both fallopian tubes.  

Undergoing a sterilization procedure is permanent; therefore candidates must have completed childbearing.  A great alternative to permanent sterilization is long-acting reversible contraception such as an intrauterine device (IUD).  While tubal sterilization is more effective than condoms or birth control pills, it is comparable to the effectiveness of an IUD (>99%).  Of note, about 12.4% of women using condoms, birth control pills or other reversible method have an unplanned pregnancy in the first year of use.  This high failure rate is why the IUD and permanent tubal sterilization may be a better option for many women.  

For men, the vasectomy procedure is often done by a urologist as an outpatient procedure to permanently block the sperm from entering the penis.  The vasectomy is not immediately effective therefore a semen analysis must be repeated until no sperm is seen. This usually takes 3-6 months during which an alternate form of contraception must be used.  

 

Sources:

ACOG Practice Bulletin, Number 208, January 2019 – “Benefits and Risks of Sterilization”

 

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