In the US, one third of couples attempting to prevent pregnancy, particularly if the woman is > 30, choose sterilization with vasectomy or tubal ligation. Sterilization should be assumed to be permanent. However, if pregnancy is desired, reanastomosis may restore fertility in 45 to 60% of men after vasectomy and in 50 to 80% of women after tubal ligation. Also, in vitro fertilization may be used successfully.

Vasectomy

The vasa deferentia are cut, and the cut ends are ligated or fulgurated. Vasectomy can be done in about 20 min; a local anesthetic is used. Sterility requires about 15 to 20 ejaculations after the operation and should be documented by 2 sperm-free ejaculates. Complications of vasectomy include hematoma (≤ 5%), sperm granulomas (inflammatory responses to sperm leakage), and spontaneous reanastomosis, which usually occurs shortly after the procedure.

Tubal ligation

The fallopian tubes are cut and a segment is excised, or the tubes are closed by ligation, fulguration, or various mechanical devices (plastic bands, spring-loaded clips). Sterilization using mechanical devices causes less tissue damage and thus may be more reversible. Via laparoscopy, tubal ligation can be done using a small periumbilical incision and a general or local anesthetic. Tubal ligation is often done immediately after or the day after delivery.

Another method is to occlude the lumen of the tubes by inserting microinserts with inner coils via hysteroscopy. This procedure does not require incisions or cutting, clipping, or burning of the tubes. After microinserts are placed, tubal occlusion (and thus sterility) is confirmed by hysterosalpingography done about 3 mo after the procedure.

Pregnancy rates after tubal ligation are < 0.5% during the 1st yr and 1.5 to 2% after 10 yr. Rates are lower if the tube has been partly excised.

Adverse effects are uncommon: death in a few patients per 100,000, hemorrhage or intestinal injuries in about 0.5%, and other complications (eg, infarction, failure of occlusion) in up to about 5%. About 30% of pregnancies that occur after tubal ligation are ectopic.

Last full review/revision August 2007 by Daniel R. Mishell, Jr., MD; Megan A. Economidis, MD