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, such as Essure, 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.

Why It Is Done

A tubal ligation or tubal implant placement is a permanent method of birth control. Only consider this method when you are sure that you will not want to become pregnant in the future.

Permanent birth control is a reasonable option when you:

  • Do not want to have children in the future, no matter how your life may change.
  • Have a partner who also does not want children in the future but does not want to have a vasectomy.
  • Have also considered other methods of birth control and do not want the side effects, risks, or costs of those methods.
  • Have health problems that would be made worse by pregnancy.
  • Have a hereditary condition that you do not want to pass on.
  • Do not have any medical conditions that would make having surgery dangerous.

Tubal Implant Method

Implants, such as Essure, 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 doctor 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 doctor 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 cramps afterwards.
  • After the procedure, an X-ray is taken to make sure the implants are in place and the tubes are closed.

In some cases, 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.

What To Expect After Surgery

Tubal Ligation

After a tubal ligation, you will most likely go home the same day. Your surgeon will give you instructions on what to expect and when to call after the surgery.

  • You may have some slight vaginal bleeding caused by the movement of your uterus during the surgery.
  • If you had a laparoscopy, your stomach may be swollen (distended) from the gas that was used to lift your skin and muscles away from your abdominal organs so the surgeon could see them better. This should go away within a day or so but may last longer. You may also have some back or shoulder pain from the gas in your abdomen. This will go away as your body absorbs the gas.
  • You can shower 24 hours after the surgery, but avoid rubbing or pulling on your incision for at least a week.
  • You can have sexual intercourse as soon as you feel like it and it does not cause pain, which is usually 1 week after surgery.
  • Be sure to rest for a few days (or at least 24 hours) before beginning to resume your normal activities. You should be able to resume all activities within a week.
  • No backup method of birth control is needed after the surgery.
  • A follow-up exam in 2 weeks is usually scheduled.

Tubal Implants

  • Most women can return to normal activities the same day as the procedure.
  • Be sure to use another method of birth control for 3 months, until an X-ray confirms that the fallopian tubes are blocked.

How Well It Works

Tubal ligation and tubal implants are not 100% effective at preventing pregnancy.

Tubal Ligation

There is a slight risk of becoming pregnant after tubal ligation. This happens to about 5 out of 1,000 women after 1 year. After a total of 5 years following tubal ligation, about 13 out of 1,000 women will have become pregnant.

Pregnancy may occur if:

  • The tubes grow back together or a new passage forms (recanalization) that allows an egg to be fertilized by sperm. Your doctor can discuss which method of ligation is more effective for preventing tubes from growing back together.
  • The surgery was not done correctly.
  • You were pregnant at the time of surgery.

Tubal Implants

  • Sterilization implants are a newer birth control technology, so there are no long-term statistics. Studies so far show that over 2 years, fewer than 1 out of 100 women got pregnant with implants.
  • A tubal implant can be difficult to insert. Some women have to have a repeat procedure before both tubal implants are properly placed.
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