Tubal ligation (commonly known as having one's "tubes tied") is a surgical procedure for female sterilization in which the fallopian tubes are permanently blocked, clipped or removed. This prevents the fertilization of eggs by sperm and thus the implantation of a fertilized egg. Tubal ligation is considered a permanent method of sterilization and birth control.
Medical uses
Female sterilization through tubal ligation is primarily used to permanently prevent a patient from having a spontaneous pregnancy (as opposed to pregnancy via in vitro fertilization) in the future. While both hysterectomy (the removal of the uterus) or bilateral oophorectomy (the removal of both ovaries) can also accomplish this goal, these surgeries carry generally greater health risks than tubal ligation procedures.
Less commonly, tubal ligation procedures may also be performed for patients who are known to be carriers of mutations in genes that increase the risk of ovarian and fallopian tube cancer, such as BRCA1 and BRCA2. While the procedure for these patients still results in sterilization, the procedure is chosen preferentially among these patients who have completed childbearing, with or without a simultaneous oophorectomy.
Benefits and advantages for use as contraception
High effectiveness
Most methods of female sterilization are approximately 99% effective or greater in preventing pregnancy. These rates are roughly equivalent to the effectiveness of long-acting reversible contraceptives such as intrauterine devices and contraceptive implants, and slightly less effective than permanent male sterilization through vasectomy. These rates are significantly higher than other forms of modern contraception that require regular active engagement by the user, such as oral contraceptive pills or male condoms.
Avoidance of hormonal medications
Many forms of female-controlled contraception rely on suppression of the menstrual cycle using progesterones and/or estrogens. For patients who wish to avoid hormonal medications because of personal medical contraindications such as breast cancer, unacceptable side effects, or personal preference, tubal ligation offers highly effective birth control without the use of hormones.
Reduction of pelvic inflammatory disease risk
Occluding or removing both fallopian tubes decreases the likelihood that a sexually transmitted infection can ascend from the vagina to the abdominal cavity, causing pelvic inflammatory disease (PID) or a tubo-ovarian abscess. Tubal ligation does not eliminate the risk of PID, and does not offer protection against sexually transmitted infections.
Reduction of ovarian and fallopian tube cancer risk
Partial tubal ligation or full salpingectomy (a tubal ligation method that relies upon the physical removal of the fallopian tube) reduces the lifetime risk of developing ovarian or fallopian tube cancer later in life. This is true both for patients who are already known to be at high risk for ovarian or fallopian tube cancer secondary to genetic mutations, as well as females who have the baseline population risk.
Risks and complications
Risks associated with surgery and anesthesia
Most tubal ligation procedures involve accessing the abdominal cavity through incisions in the abdominal wall and require some form of anesthesia. Major complications from laparoscopic surgery may include need for blood transfusion, infection, conversion to open surgery, or unplanned additional major surgery, while complications from anesthesia itself may include hypoventilation and cardiac arrest. Major complications during female sterilization are uncommon, occurring in an estimated 0.1–3.5% of laparoscopic procedures, with mortality rates in the United States estimated at 1–2 patient deaths per 100,000 procedures. These complications are more common for patients with a history of previous abdominal or pelvic surgery, obesity, and/or diabetes.
Failure
While female sterilization procedures are highly effective at preventing pregnancy, there is a small continuing risk of unintended pregnancy after tubal ligation. Several factors influence the likelihood of failure: increased time since sterilization, younger age at the time of sterilization, and certain methods of sterilization are all associated with increased risk of failure. Pregnancy rates at 10 years after sterilization vary depending on the type of procedure used, documented as low as 7.5 per 1,000 procedures to as high as 36.5 per 1,000 procedures.