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Sterilization

by Laura Sech, Daniel R. Mishell, Jr., MD; Emily Silverstein

Sterilization involves making a person incapable of reproduction.

  • Disrupting the tubes that carry sperm or the egg ends the ability to reproduce.

  • Vasectomy is a short procedure for men, done in the doctor’s office.

  • The procedure for women (often called tubal ligation) is more complicated and may be done using a thin tube inserted through a very small incision in the abdomen, instruments inserted through the vagina, or an incision in the abdomen.

In the United States, about one third of all married couples who use family planning methods, particularly if the woman is over 30, choose sterilization. For men, the procedure is vasectomy. For women, sterilization can be done using a thin tube inserted through a very small incision in the abdomen (laparoscopy), instruments inserted through the vagina (hysteroscopy), or an incision in the abdomen (minilaparotomy—see below). Sterilization for women is often called tubal ligation, which also refers to a specific sterilization procedure, the so-called tying the tubes.

Sterilization should always be considered permanent. However, if couples change their minds, an operation that reconnects or opens the appropriate tubes (called reanastomosis) can be done to try to restore fertility. Its success depends in part on which procedure was used for sterilization. Reanastomosis is less likely to be effective in men than in women and cannot be done if certain procedures that block the tubes were used. For couples, pregnancy rates are 45 to 60% after reanastomosis in men and 50 to 80% after reanastomosis in women. If reanastomosis is unsuccessful, conception may be possible with in vitro (test tube) fertilization (see In vitro (test tube) fertilization (IVF)).

Vasectomy

Vasectomy is used to sterilize men. It involves cutting and sealing the vasa deferentia (the tubes that carry sperm from the testes). A vasectomy, which is done by a urologist in the office, takes about 20 minutes and requires only a local anesthetic. Through a small incision on each side of the scrotum, a section of each vas deferens is removed and the open ends of the tubes are sealed off. After a vasectomy, backup method of contraception should be used until sterility is confirmed. Usually, men do not become sterile until they have had about 20 ejaculations after the operation because many sperm are stored in the seminal vesicles. Sterility is confirmed when a laboratory test shows that semen from two ejaculations, usually obtained 3 months after the procedure, is free of sperm.

Complications of vasectomy include a blood clot in the scrotum (in fewer than 5% of men), an inflammatory response to sperm leakage, and spontaneous reanastomosis (in fewer than 1%). In spontaneous reanastomosis, the disrupted tubes become reconnected or unblocked on their own, thus restoring fertility). If reanastomosis occurs, it usually does so shortly after the procedure.

Sexual activity, with contraception until sterility is confirmed, may resume as soon after the procedure as men wish, but ejaculation should be avoided for the first few days because it can cause pain. About 0.15% of women become pregnant after their partner is sterilized.

Did You Know...

  • Sterilization, although considered permanent, can often be reversed.

  • Contraception should be continued for a while after a vasectomy, until tests confirm that semen is free of sperm.

Sterilization for women

One of several methods (such as laparoscopy, hysteroscopy, or minilaparotomy) may be used. Most often, these procedures are used to disrupt the fallopian tubes, which carry the egg from the ovaries to the uterus.

Women who have just delivered a child can be sterilized immediately after childbirth or on the following day. Sterilization may also be planned in advance and done as elective surgery

Laparoscopic sterilization is often done. Working through a thin tube (laparoscope) inserted through a very small incision in the woman’s abdomen, doctors disrupt and/or close off the fallopian tubes by doing one of the following:

  • Cutting and tying off the cut ends (tubal ligation)

  • Using electrocautery (a device that produces an electrical current to cut through tissue) to seal off about 1 inch of each tube

  • Applying devices, such as plastic bands or metal clips, to block the tubes or pinch and hold them closed

Tubal ligation (tying the tubes) is commonly done through a laparoscope. This procedure involves an incision just below the navel, done after women are given a general or regional (such as spinal) anesthetic. It is done in an operating room.

Success rates for reversal after tubal ligation vary by age:

  • For age 15 to 30: 73%

  • For age 30 to 33: 64%

  • For age 34 to 49: 46%

After laparoscopic sterilization, the woman usually goes home the same day. Up to 6% of women have minor complications, such as a skin infection or pain at the incision site or constipation. Fewer than 1% have major complications, such as bleeding or punctures of the bladder or intestine.

Disrupting the Tubes: Sterilization in Women

Both fallopian tubes (which carry the egg from the ovaries to the uterus) are cut, sealed, or blocked so that sperm cannot reach the egg to fertilize it.

Hysteroscopic sterilization may be done in a doctor's office or an operating room. No incisions are necessary. A local anesthetic is used, with or without drugs to make the woman drowsy (sedatives). For the procedure, doctors insert a flexible viewing tube (hysteroscope) through the vagina and uterus and into the fallopian tubes. Coils (microinserts) are then inserted into the fallopian tubes to block them. The coil irritates tissue in the tubes, causing scar tissue to form. The scar tissue blocks the tubes. Scar tissue takes up to 3 months to form, so women must use another method of contraception until doctors confirm that the tubes are blocked. Women can usually go home the same day as the procedure. About 3 months later, doctors confirm that the tubes are blocked by taking x-rays after a radiopaque dye is injected through the vagina into the uterus and fallopian tubes (called hysterosalpingography). If the dye does not come out the end of the fallopian tubes, doctors can confirm that the tubes are blocked. Usually, this type of sterilization cannot be reversed.

Minilaparotomy is sometimes used instead of laparoscopic sterilization, usually when women want to be sterilized soon after they have had a baby. A general, regional, or local anesthetic is used. Women do not have to stay in the hospital any longer than they would after having a baby. Doctors make a small incision (about 1 to 3 inches) in the abdomen. Then, they usually remove a section of each fallopian tube. Compared with laparoscopy, minilaparotomy causes more pain, and recovery takes a little longer.

After laparoscopic or minilaparotomy sterilization, doctors recommend that women do not place anything in the vagina (such as tampons or douches) and that they do not have sexual intercourse for about 2 weeks.

About 2% of women become pregnant during the first 10 years after they are sterilized. About one third of these pregnancies are mislocated (ectopic) pregnancies that develop in the fallopian tubes.

Surgical removal of the uterus (hysterectomy) also results in sterility. This procedure is usually done to treat a disorder rather than as a sterilization technique.

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