Tubal ligation is a form of female sterilization in which a doctor or surgeon blocks or removes the fallopian tubes to prevent pregnancy permanently. Some people refer to this as “having your tubes tied.”
In this article, we discuss when and how doctors perform the procedure. We also describe the recovery, as well as considerations such as possible alternatives.
The purpose of tubal ligation is to prevent pregnancy. The procedure makes it impossible for an egg to travel from the ovary, through a fallopian tube, and into the uterus. If an egg cannot reach the uterus to be fertilized by a sperm, pregnancy cannot occur.
A doctor or surgeon can perform a tubal ligation as a standalone procedure or during a cesarean delivery. They will cut, tie, clip, or otherwise seal the fallopian tubes.
When a tubal ligation is the only procedure that a person is undergoing, the doctor will make small incisions in the lower abdomen to access the fallopian tubes.
A doctor can attempt to reverse a tubal ligation with another surgery, but according to the American College of Obstetricians and Gynecologists (ACOG), many women are not able to become pregnant after a reversal, and the risk of complications such as ectopic pregnancy is increased.
Having a tubal ligation can be a big decision, and a person should consult a healthcare provider about the possible benefits, risks, and implications beforehand. ACOG caution against having the procedure during times of stress or under pressure from a partner.
In the United States, most states require a doctor to document their counseling before a tubal ligation, particularly if the person wants to have the procedure during a cesarean delivery.
A person may undergo tubal ligation at an outpatient surgery center or a hospital. They will receive instructions about how to prepare, which may include:
- not eating after midnight before the procedure
- not taking certain medications before the procedure
- arranging a ride home after the procedure
Consult the doctor about any concerns or questions.
Whether a person is undergoing tubal ligation on its own or alongside another procedure can influence how the medical team performs it.
After a cesarean delivery
A cesarean involves making an incision in the lower abdomen and uterus to deliver one or more babies. During the procedure, the uterus is outside of the body and the fallopian tubes are clearly visible.
If the woman has arranged to have a tubal ligation during this time, the doctor may cut or tie the fallopian tubes before replacing the uterus within the body and closing the abdominal incision.
Doctors usually use regional anesthesia for this type of tubal ligation. This means that the woman receives an injection of a local anesthetic in her back to numb the area and that she is awake during the procedure. Regional anesthesia usually wears off in a few hours.
As a standalone procedure
People generally undergo standalone tubal ligation under general anesthesia. This renders them completely asleep and a device supports their breathing.
To perform a standalone tubal ligation, a surgeon or doctor:
- washes the lower abdomen with antibacterial soap to prevent infection
- makes small incisions and brings the fallopian tubes through them
- cuts or ties the fallopian tubes
- replaces the tubes
- sews the incisions closed or seals them with surgical adhesive
- applies small bandages over the incisions
A tubal ligation tends to take around 30 minutes. Having this surgery soon after childbirth does not usually make the hospital stay any longer.
As a standalone surgery, tubal ligation is an outpatient procedure. If it follows a cesarean delivery, the doctor will assess various factors before estimating the length of the hospital stay.
Most people who undergo it do not consider tubal ligation to be especially painful. In the immediate aftermath of the procedure, a person may experience:
The doctor may advise against driving immediately after a tubal ligation, but the person can usually return to their regular routine the following day.
Consult the doctor if significant bleeding occurs or any pain gets worse after the procedure.
The medical community considers tubal ligation to be safe and effective. The risk of complications is low, and these issues primarily stem from the use of general anesthesia.
However, some people experience pain, infection, or bleeding as a result of tubal ligation. While these risks are minimal, a person should discuss any concerns with a doctor before the procedure.
A person may opt for tubal ligation because it can offer:
- Highly effective contraception: Fewer than 1 in 100 women become pregnant each year after undergoing sterilization, making it more effective than methods such as the pill or condoms.
- Reduced cancer risk: A large-scale study found that women who underwent tubal ligation had reduced risks of fallopian tube, ovarian, and peritoneal cancers.
Some potential downsides may include:
- Difficult reversion: A doctor can attempt to reverse a tubal ligation, but the success rate is low.
- Surgical risks: The procedure carries risks such as bleeding, infection, and pain, though these are uncommon.
- Failure: In rare cases, a portion of one or both fallopian tubes may remain functional, increasing the chances of pregnancy and ectopic pregnancy.
Tubal ligation is not the only method of female sterilization or birth control.
In terms of surgical options, a person may opt for a bilateral salpingectomy. This involves the removal of both fallopian tubes, which permanently prevents pregnancy.
Some doctors recommend this procedure because it may further reduce the risks of ovarian cancer, according to an article in the journal Obstetrics & Gynecology.
People looking for long-acting contraception may prefer an intrauterine device (IUD). An IUD can be effective for years at a time, and if a person wishes to become pregnant, a healthcare provider can remove it.
A doctor should thoroughly discuss a person’s birth control and sterilization options and help them make an informed decision.
Tubal ligation is a safe and effective way to prevent pregnancy permanently. It is not always reversible.
Anyone considering sterilization should discuss the risks and benefits with their doctor and ensure that the doctor has answered all of their questions before the procedure.