
TUBAL LIGATION
What is tubal ligation?
Tubal ligation is one of the most common surgeries for permanent birth control in women. You will no longer need any other type of birth control method. However, it does not protect against sexually transmitted diseases.
Tubal ligation is not a temporary birth control method. Therefore, you must ask your doctor about the other options. An intrauterine device (IUD) can be placed in the uterus and it can serve as a temporary method for long-term option. A small hormonal implant can be placed under the skin for the same purpose.
Methods for tubal ligation
Tubal ligation cuts the tubes where sperm and oocyte meet to form an embryo. This cut can be achieved using several techniques. Using a rubber band to bind the tubes or cutting and suturing or cauterizing the edges can serve the same purpose. Since the tubes and uterus are inside the abdominal cavity and not easily reached, we use different techniques to expose the tubes. It can be done laparoscopically, or through a small incision in the lower abdomen. Sometimes it is done during cesarean section or around the belly button right after a vaginal delivery when the uterus is still large.
We use mostly the laparoscopic method. This requires general anesthesia and two 5 mm tiny holes at the belly button and lower abdominal area. The surgery takes about 15 minutes and patients can go home in 1-2 hours and resume normal daily activities right away.
Laparoscopy risks:
Although the risks are very rare in good hands,
Damage to the bowel, bladder or major blood vessels.
Reaction to anesthesia.
Infection at the operation site.
Pain at the puncture sites
Bleeding at the incisions or cut fallopian tubes
An unwanted pregnancy if the surgery is not successful
Laparoscopy is more difficult and the complications can occur more often if there is a past abdominal surgery, or endometriosis. Obesity can also make the procedure more difficult.
If you are already pregnant, the best time to do the ligation is right after the delivery whether you have a Cesarean or a vaginal delivery.
Your surgeon does a small cut under your belly button if you have a vaginal birth. This can be done with local anesthesia or sedation. The tubes are cut through a small opening.
If you have a C-section, your uterus and the tubes are already visible and the tubes can be severed easily in 2-3 min in addition to the C-Section surgery.
If you are not pregnant, the best time is right after the cessation of your menstruation when you are sure there is no pregnancy.
In that case, laparoscopy is the preferred method although a small (3 cm) incision at the lower abdomen can be used to sever the tubes in non-obese women. Laparoscopy can give the surgeon a better view than the mini-laparotomy.
After the procedure, what to expect
If you had laparoscopy for tubal ligation, CO2 gas is used to expand the abdominal cavity. Some gas can be trapped inside and cause shoulder pain after the surgery. Simple painkiller pills can fix this easily.
You can shower 4-5 hours after the surgery if your incision sites are covered with waterproof drapes. Otherwise, wait for 24 hours. Do not have a bath or swim for a week.
There is no contradiction to having intercourse right after the surgery if you feel up to it. If your tubal ligation is done after giving birth, you must not have sex for 4-5 weeks but this requirement is due to birth. Tubal ligation does not change this period.
When you must contact the clinic and your doctor
You must contact your doctor if you have fewer, pain in the stomach area, bleeding from your wounds, or foul odor discharge from the incision sites which may be a sign of infection.
Can the tubal ligation be reversed?
A tubal ligation can be reversed if a big part of the tube is not removed or cauterized. When both sides of the cut tubes are the same size, anastomosis of the healthy parts of the tubes can be attached by fine sutures more successfully. The reversal procedure is complex and costly and it might not work. When the tubes are totally removed, reversal is not possible.
Can I get pregnant if reversal is not possible?
If you are not eligible for a reversal or if the surgery is not successful, you can still get pregnant through IVF (in vitro fertilization). In this method, your eggs can be fertilized inside an artificial womb and the resulting embryo can be placed in the uterus bypassing the tubes.
Can I get pregnant if reversal is not possible?
If you are not eligible for a reversal or if the surgery is not successful, you can still get pregnant through IVF (in vitro fertilization). In this method, your eggs can be fertilized inside an artificial womb and the resulting embryo can be placed in the uterus bypassing the tubes.
The cost of tubal ligation
The cost may be slightly different according to the method such as laparoscopy or mini laparotomy. The laparoscopic approach may be slightly more expensive. You must expect to spend 1500-2000 Euros.