Tubal ligation and tubal implants

Tubal ligation , often referred to as "having your tubes tied," is a surgical procedure in which a woman's fallopian tubes are blocked, tied, or cut. Tubal implants are small metal springs that are placed in each fallopian tube in a nonsurgical procedure (no cutting is involved). Over time, scar tissue grows around each implant and permanently blocks the tubes. Either procedure stops eggs from traveling from the ovaries into the fallopian tubes, where the egg is normally fertilized by a sperm.

Tubal ligation and tubal implants are considered to be permanent methods of birth control for women. They are usually done by a gynecologist. They may also be done by a family medicine doctor or general surgeon.

Tubal ligation method

There are several different ways of closing the fallopian tubes , including clipping or banding them shut or cutting and stitching or burning them closed. Your surgeon will probably prefer one of the following methods. See a picture of tubal ligation methods .

A tubal ligation can be done in the following ways:

• Laparoscopy involves inserting a viewing instrument and surgical tools through small incisions made in the abdomen. See a picture of a laparoscopic procedure .
• Mini-laparotomy ("mini-lap") is done through an incision that is less than 2 in (5 cm) long. See a picture of a mini-laparotomy procedure .
• Postpartum tubal ligation is usually done as a mini-laparotomy after childbirth. The fallopian tubes are higher in the abdomen right after pregnancy, so the incision is made below the belly button (navel). The procedure is often done within 24 to 36 hours after the baby is delivered. See an illustration of a postpartum tubal ligation .

An open tubal ligation (laparotomy) is done through a larger incision in the abdomen. It may be recommended if you need abdominal surgery for other reasons (such as a cesarean section) or have had pelvic inflammatory disease (PID), endometriosis, or previous abdominal or pelvic surgery. These conditions often cause scarring or sticking together (adhesion) of tissue and organs in the abdomen. Scarring or adhesions can make one of the other types of tubal ligation more difficult and risky.

Laparoscopy is usually done with a general anesthetic. Laparotomy or mini-laparotomy can be done using general anesthesia or a regional anesthetic, also known as an epidural.

Reversing a tubal ligation is possible, but it is not highly successful. This is why tubal ligation is considered a permanent method of birth control.

Tubal implant method

Implants are inserted in the fallopian tubes without surgery or general anesthesia. The procedure is done in a doctor's office, an outpatient surgery center, or hospital and does not require an overnight stay. The implant procedure usually takes about 30 minutes.

• Before the procedure, your cervix is first opened (dilated) to reduce the risk of injury to the cervix. Your health professional will use a speculum and a dilating instrument to gradually open the cervix just before the procedure.
• For the procedure, you are positioned as you would be for a pelvic exam. Your health professional passes a thin tube (catheter) through your vagina and cervix, into the uterus, and then into a fallopian tube. The catheter is used to place an implant into a fallopian tube. An implant is then placed in the other fallopian tube the same way. You may have some menstrual-like cramping afterwards.

After the procedure, an X-ray is taken to make sure the implants are in place and the tubes are closed.

On occasion, a tubal implant can be difficult to insert. Should this happen, a second procedure is needed to completely block both tubes.

For the first 3 months after insertion, you must use another method of birth control. At 3 months, dye is injected into your uterus and an X-ray is taken (hysterosalpingography) to make sure that the implants are in place and the tubes are fully blocked by scar tissue. If they are, you will no longer have to use another method of birth control.

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