Thinking About Tying Your Tubes? 8 Things You Should Know First

Contraception is a wonderful thing. (If you've read about how excited I am to get a contraceptive arm implant, you'll know I'm a serious fan.) And for those women who intend to have precisely no babies ever, whether they've already reached their preferred number or would like a child-free existence altogether, a category of surgical procedures (known colloquially as "tying your tubes") exists to stop eggs getting anywhere near sperm — permanently. If getting your tubes tied is something you're considering, there are certain things to know about your options, the procedure itself, and how the whole enchilada works; I'm not trying to scare you off, and I respect your choice while also wanting you to be as informed about it as possible.

Unfortunately, if you're young, single, or haven't had any children yet, you may find that your doctor is unwilling to let you commit to the procedure. Slate ran an epic roundup in 2012 of young women who'd been thwarted by "well-meaning" doctors in their attempts to get tubal ligations or occlusions, in the belief that they were too young to make such a permanent decision about their reproductive futures and that they might regret it later. It is a serious procedure, but you have the absolute right to determine your reproductive future. So it may be wise to prepare for resistance. I'm not saying it's not infuriating and ridiculous; I'm saying I want you to be ready for it.

If this is something you're considering or may think about in the future, here are some basic facts about the procedures and surrounding issues to know about. Further information about them is available at Bedsider, Planned Parenthood, What To Expect, the Mayo Clinic, and elsewhere.

1. There Are Multiple Ways Of "Tying Your Tubes"

The phrase "tying your tubes" actually covers a bunch of different processes, some of which aren't strictly about ties at all. Tubal ligation and the other associated processes all involve interrupting the process of the fallopian tubes, the parts of the female reproductive system that delivers eggs from the ovaries to the uterus, but they can go about it in several different ways.

Tubal ligation is the procedure that "tying your tubes" technically references; it involves an operation in which the tubes are surgically closed. According to Planned Parenthood, they can also be sealed using an electrical current, closed with certain apparatus like clamps, or partially amputated. Sterilization of the fallopian tubes can also be done via tubal implant, or putting something like a small metal spring inside the tubes that will become covered in scar tissue and cause a blockage. That procedure is done via the cervix and won't cause any abdominal scarring.

The end result will be the same — fallopian tubes that can't deliver eggs — but the mechanisms differ, and what you're offered will depend on your specific needs and the care available. Implants, for instance, might not be effective for several months. And you can actually get your tubes tied just after you've had a baby, about 48 hours after a vaginal delivery.

2. The Procedure Itself Isn't As Terrifying As It Sounds

Whether you opt for a tubal ligation of some kind or a tubal implant, both are now outpatient procedures, which means you won't be a hospital patient overnight and will be allowed to go home the same day. SOGC, or the Society of Obstetricians & Gynecologists of Canada, has a good walk-through if you're nervous: basically, the key difference between the procedures is that ligation involves a laparoscopy, or a small incision blow the belly button, and implants are inserted through a dilated cervix, so no incision is made.

The difference between the two procedures also affects anesthetics and recovery time. Ligation, clamps, rings, or anything else involving a laparoscopy will likely be done under general anesthetic, while tubal implants may not involve any anesthetic at all, or just a local one. After a ligation, you'll be allowed to go home, but you can't do heavy lifting or have sex for at least a week, and will need to keep checking the incision for infection; post-implant, you may need painkillers but can basically go about life as before. Implants take about three months to create enough scar tissue to prevent pregnancy, and you'll do an X-ray at that point to confirm whether they've been blocked or not.

3. It's Highly Effective And Won't Interrupt Your Menstrual Cycle

The current statistics about tubal ligation or implantation indicate that it's highly effective — 99 percent effective, in fact. The National Health Service estimates that fewer than one woman in 200 will experience a pregnancy after having the surgery. It may be a particularly useful form of contraception if you're intent on not having kids and have had difficulties with hormonal birth control, as having your fallopian tubes taken out of action has no impact on your body's hormone levels; you'll continue to experience menstruation, and then menopause, naturally. There's also another benefit: according to the National Institute Of Health, a tubal ligation lowers your chances of developing ovarian cancer in the future.

4. It's Very, Very Tricky To Reverse

One of the main reasons that counseling and a lot of forethought are generally recommended before tubal ligation is that it is a very permanent surgery. Only 20 to 40 percent of women who have the procedure reversed go on to carry pregnancies successfully. Reconnecting the fallopian tubes once they've been severed or blocked is a delicate procedure and often very difficult, because the surgery has likely damaged them in ways that make them unlikely to function properly in the future. Insurance may also not cover the reversal procedure, which is an additional thing to think about.

5. It's Covered Under The Affordable Care Act

The Affordable Care Act introduced in 2010 has shifted the affordability of contraception choices considerably, but you may not know that tubal ligation is among those procedures whose cost is entirely covered. IUDs, the contraceptive implant, the birth control shot, and emergency contraception are on the list too, as are all other forms of "permanent" contraception methods. This only covers sterilizations if you're over the age of 21, though.

6. There Are Possible Side Effects

Any abdominal surgery or interference carries risks, from damage to organs to the need for a blood transfusion, but they're extremely rare in the case of tubal ligations. And despite the near-perfect permanence of the procedure, a tiny proportion of women do still manage to get pregnant, or to have an ectopic pregnancy, where the embryo is implanted outside your uterus. After all, the body doesn't stop producing eggs, you've just cut off their highway to their normal environment, and in a small fraction of cases, they somehow find some other way.

You'll likely be given a list of symptoms after the procedure that will require medical attention if they show up: Johns Hopkins Health Library includes pain, bleeding, redness, or fevers on the list. And here's something to note: Essure, the device that's most often used for tubal implants in the US, Canada, and the UK, has been linked to some serious health concerns, including a possible 303 fetal deaths since its approval in 2002. In June 2016, Health Canada warned that women planning on using it should be warned of possible serious side effects, including violent abdominal pain. If you're planning on tubal occlusion, as the process of getting a tubal implant is known, it's worth discussing the evidence of side effects with your health provider and whether you should consider other options.

7. It Doesn't Protect You From STDs

A blockage in the fallopian tubes don't provide any protection from the spread of sexually transmitted diseases, and protection still needs to be used with partners. This should be fairly logical: just because a small section of the internal gynecology of a woman is "shut off" from making babies doesn't mean she's protected from nasties introduced from outside.

8. Your Care Provider Might Refuse To Perform The Procedure

This is an interesting one: as a permanent procedure which is very difficult to reverse, doctors and health care professionals often have scruples prescribing tubal ligations to young women without significant hurdle-jumping about the decision first. To make sure that you won't regret the decision and understand the implications, the Mayo Clinic explains, you and your health care provider (or a recommended counselor) will likely have long and involved conversations about your medical history, why you want permanent contraception rather than temporary methods, and whether your relationship's stability may have an impact on the decision. Your doctor may also enforce a 30-day waiting period between your decision and the date of the surgery, to allow you to change your mind if necessary. Basically, things are going to get personal and you may feel dissuaded.

If you're in a position where a doctor refuses to give you the procedure, you may be stuck; even if you can argue that they're being unnecessarily paternalistic, that your decision is your own and your regrets are your responsibility, your only option may be to keep changing doctors until you find one that listens to you. Legally, it's not possible to force your doctor to perform a surgery he or she doesn't believe is necessary. It sucks. I'm sorry.

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