Tubal ligation

Tubal ligation is a permanent form of contraception, to prevent pregnancy. It is also sometimes called 'female sterilisation'.

Key points about tubal ligation

  1. Tubal ligation is a permanent form of contraception that should only be considered when you are sure you do not want to have a child in the future.
  2. It involves a small operation in which your fallopian tubes are cut or blocked. This stops sperm from reaching an egg to fertilise it.
  3. It is a very reliable and in most cases will prevent pregnancy but it is not 100% effective.
  4. However, tubal ligation does not protect against sexually transmitted infections (STIs).
  5. Tubal ligation is usually done under general anaesthetic with a simple laparoscopic procedure that takes about 30 minutes. You don't usually need to say in hospital overnight.

How well does tubal ligation prevent pregnancy?

Tubal ligation is very reliable and in most cases will prevent pregnancy, but it is not 100% effective. About 1 in 200 women who have a tubal ligation may become pregnant. This may happen if:

  • the fallopian tubes are not cut or blocked properly
  • the cut ends grow back together
  • the clips on the tubes slip.

If pregnancy does occur after a tubal ligation, there is a greater chance that it will be ectopic. This means that the pregnancy occurs outside your uterus, usually in the fallopian tubes, where the foetus cannot survive.

What are the advantages and disadvantages of tubal ligation?

Advantages

  • You do not have to remember to take a pill every day.
  • After the procedure is complete, it is a private form of birth control.
  • Tubal ligation does not interfere with sexual intercourse.
  • There are no significant long-term side effects.

Disadvantages

  • As tubal ligation is permanent, and difficult to reverse, some people regret having it – especially if their circumstances change. 
  • Tubal ligation does not protect against STIs, including infection with the human immunodeficiency virus (HIV). Condoms are the most effective method for preventing STIs. 
  • There are possible short-term surgery-related complications such as discomfort, infection, bruising or bleeding at the operation site, and possible reaction to anaesthesia.

How is tubal ligation done?

During tubal ligation, the fallopian tubes are closed either by:

  • cutting and tying the tubes, or
  • placing a clip, ring or band around the tubes.

There are 2 types of surgery by which tubal ligation may be performed: laparoscopic tubal ligation and mini-laparotomy. Your doctor will discuss the best option for you.

Laparoscopic tubal ligation

This is the most common procedure by which tubal ligation is performed. The following steps are taken with this approach:

  • Two small incisions (cuts) are made in your abdomen (tummy). A laparoscope (a long thin tube with a camera and light source at its tip) is inserted through one incision and surgical instruments are inserted through the other incision.
  • The fallopian tubes are then able to be located and the tubal ligation performed.
  • The incisions in the abdomen are closed with steristrips (small paper tapes) or small stitches.

Laparoscopic tubal ligation is usually performed under a general anaesthetic. The procedure takes about 30 minutes and you don't usually need to stay overnight in hospital.

Mini-laparotomy

Sometimes an ‘open’ surgical approach known as mini-laparotomy may be needed if the laparoscopic approach is unsuitable such as if you have:

  • scarring in your pelvis from previous surgery
  • health conditions such as endometriosis.

The following steps are taken with this approach:

  • A single incision of about 4–5 cm long is made, just above your pubic hair line.
  • Your fallopian tubes are located and the tubal ligation performed.
  • The incision is closed with dissolvable stitches.

This type of tubal ligation usually requires you to stay in hospital for a day or two. 

What are the possible complications of tubal ligation? 

Generally, tubal ligation is a safe procedure with very few complications. Most women have no problems after a tubal ligation.

However, there is a small risk of:

  • infection, bruising or bleeding at the operation site
  • pelvic pain or pain in your abdomen (tummy)
  • a possible reaction to the anaesthetic
  • rarely, damage to organs, including your bowel, bladder, uterus, ovaries, blood vessels and nerves.

Learn more

The following links provide further information about tubal ligation. Be aware that websites from other countries may have information that differs from New Zealand recommendations.   

Tubal ligation Family Planning, NZ

References

  1. New Zealand Aotearoa’s guidance on contraception Ministry of Health, NZ, 2020
  2. Contraception: which option for which patient? BPAC, NZ, 2019
Credits: Health Navigator Editorial Team.