Everything You Need to Know Before Getting Your Tubes Tied

In the past few months, ever since the draft decision overturning Roe v. Wade was released, searches for female sterilization have quadrupled, a trend that is likely to continue now that the right to a legal abortion has been overturned by the Supreme Court. Given that Supreme Court Justice Clarence Thomas stated in an opinion his desire to reconsider previous decisions by the Court, including the right to access contraceptives, you may be wondering if sterilization, which is a permanent form of birth control, may be the right decision for you.

If you are still of child-bearing age and are 100% certain you don’t want any more kids, sterilization may be the best option for preventing any unwanted pregnancies. The procedure is more invasive and requires a longer recovery time than having your partner get a vasectomy, but the advantage is that, as the person who can become pregnant, getting one directly eliminates the risk.

The two types of tubal sterilization

To start with, there are two types of tubal sterilization procedures, which vary according to how the fallopian tubes are blocked. To give a refresher course on reproductive anatomy, every month, an egg will be released from one of your ovaries and travels through your fallopian tube, where it might be fertilized. If the egg is fertilized, it can then implant in your uterus.

Sterilization surgeries work by blocking or removing the fallopian tubes, which prevents sperm from getting to an egg. There are two types of surgeries that do this: a tubal ligation or a bilateral salpingectomy. Tubal ligations work by closing, cutting, or removing a small part of your fallopian tube. Bilateral salpingectomies work by removing your fallopian tubes altogether.

Bilateral salpingectomies used to be relatively rare compared to tubal ligations, but in previous years, the proportion has been increasing, as research has shown they are more effective at reducing the risk of ovarian cancer.

Is sterilization right for me?

Planned Parenthood does not recommend sterilization for people who have doubts about whether or not they’ll want kids in the future; people who are being pressured by friends, family, or a partner; or people who think sterilization will solve temporary issues, such as marital or money problems. It also won’t protect against STDs.

In terms of how well it works, sterilization is more than 99% effective at preventing pregnancy. If you want a birth control option that is reversible but has a similar level of effectiveness, IUDs and implants are also more than 99% effective at preventing pregnancy.

What if I end up regretting my decision?

Given that sterilization is permanent, there is always the risk you might end up regretting the decision. According to a study published in March of this year, roughly 10% of women who undergo sterilization have regrets.

Although reversal is technically possible with tubal ligation, this is not a practical option, as the surgery is expensive and insurance often won’t cover it. Pregnancy success rates after a reversal range between 40-85%, and that’s only if you are a candidate for the surgery.

Another option for getting pregnant after sterilization is in vitro fertilization, where they fertilize your eggs in a lab, and then implant them in your uterus. However, that comes with a hefty price tag, ranging from $15,000 to $30,000 for a single cycle, which has no guarantee of working.

How do I get a sterilization procedure done?

If sterilization is the right option for you, you will need to discuss this with your doctor. When it comes to getting the procedure, many women often have to jump through a lot of (very sexist) hoops. Women have reported being denied the procedure because they are too young, don’t have children or don’t have enough children. Some doctors require that a husband approve the procedure. For women who are on Medicaid, there is a 30-day waiting period.

If a doctor does give you trouble, it might be worth referring them to the opinion on ethical sterilization practices that was issued by the American College of Obstetricians and Gynecologists’ Committee on Ethics. This statement, which was developed in 2007, and reaffirmed in 2020, outlines best practices for evaluating the appropriateness of sterilization as an option.

As per their issued opinion, the ACOG recommends that “respect for an individual woman’s reproductive autonomy should be the primary concern,” “coercive or forcible sterilization practices are unethical and should never be performed,” and that “obstetrician–gynecologists should provide presterilization counseling that includes a discussion of a woman’s reproductive desires and places her wishes at the center of care.”

The ACOG also considers it ethically permissible to sterilize women who don’t have children, as long as it is their wish, and advises that a request from a young woman without children should not be considered grounds for a mental health consultation. As they note, “Although physicians understandably wish to avoid precipitating sterilization regret in women, they should avoid paternalism as well.”

Unfortunately, paternalism is still alive and well in medicine, just like it is everywhere else, so if your doctor refuses, you will need to find another—preferably one with a healthy respect for a woman’s right to bodily autonomy. Some childfree organizations have crowdsourced lists of doctors who are willing to perform sterilizations without unnecessary hurdles.

What to expect during the procedure

If you decide to get the procedure, it will most likely be a laparoscopic procedure, where the surgeon makes several small cuts, through which they’ll insert a camera and surgical instruments. This cuts down on the amount of cutting requires, making for a faster recovery time.

With a laparoscopic sterilization, the surgeon will make a small incision near the navel, to insert the laparoscope, and a second small incision to close off or remove the fallopian tubes.

The recovery time, this will depend on your overall health, but the worst should be over within a few days, although you should hold off on lifting anything heavy for at least a week. In terms of sterilization, the surgery is effective immediately, although you should talk to your doctor about when it is safe to have sex again.