Facts About Tubal Ligation

"Tubal ligation," "bilateral tubal ligation," "BTL," and "tubal" are all terms used to describe the variety of procedures surgeons employ to block the fallopian tubes, resulting in female sterilization. With approximately 30 percent of all married women in the United States using female sterilization, tubals are the most common contraceptive method in the U.S.

Tubals should be considered permanent; they are not usually considered reversible. Therefore, women should know all of their tubal options, as well as all their risks and benefits, before making the decision to proceed with this form of sterilization.

Types of Tubals Available

Surgeons can access the fallopian tubes through one of two routes: through the abdomen or through the vagina. Once inside the woman's body, several methods of performing the tubals then become available.

Entry into the abdomen can be performed through

  • a laparoscopy, in which a tiny camera is inserted through small holes in the abdomen
  • a mini laparotomy, in which a small incision is made in the abdomen that's just large enough to reach the tubes
  • a laparotomy, where an open incision is made in the abdomen—such as during a Caesarean section

Once inside the abdoman, the surgeon has several options. He or she might remove part or all of the tubes, might burn them with an electric current, or might simply attach clips or bands to block the tubes.

Entry through the vagina is accomplished by introducing a camera through the vagina and into the uterus. When the surgeon then locates the tubal openings, he or she can either

  • inject blocking material into the tubes
  • place a metal coil inside the tube that is coated with a material that causes scar tissue to grow all around it
  • or, introduce a special plug that induces scarring as well

These last two methods, which rely on making scar tissue to block the tubes, require the woman to use another method of birth control for three months until the scar tissue grows and blocks the tubes. Last, a follow-up radiology study is required to ensure that the tubes are blocked.

Pros and Cons

Tubal ligation carries with it several benefits and risks. The obvious benefit is birth control. The obvious drawback is that both these operations are invasive surgical procedures, with all the possible immediate risks of anesthesia, infection, and surgical complications.

The cost of a tubal is also much higher than other birth-control methods--initially. However, long-term avoidance of future undesired pregnancies, coupled with not having to pay for the prolonged use of other methods, can make a tubal more cost efficient over time.

Even though I said above that a tubal should be considered permanent--and it should be!--there is a fairly good success rate with tubal reversal. Most facilities, however, simply recommend in vitro fertilization (IVF) if a patient should decide that she wants to get pregnant later. Research suggests that the highest regret rates occur in those patients who chose tubals at younger ages. Women in their 40s tend to regret tubals the least.

Women with blocked tubes should also have a lower rate of pelvic inflammatory disease, since bacteria can no longer travel from the uterus into the pelvis. And, finally, recent research indicates that blockage of the tubes might actually decrease the risk of ovarian cancer, since many ovarian cancers possibly arise from cells originating in the tubes or in the uterus.

Now you know

Now that you know all of the tubal options, as well as the associated pros and the cons, you can make an informed choice about female sterilization. If you think a tubal might be a good choice for you, see your provider to discuss the options available. Together with your provider, you can decide on the choice that best meets your needs.

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