7 Things To Know About Getting Your "Tubes Tied"

Photographed by Megan Madden.
Sterilization may be one of the most common forms of birth control in the U.S., yet it's also one of the most misunderstood. Case in point: We still call it "getting your tubes tied." And, in a world with highly-effective reversible birth control options (hello, IUD), it often gets left out of the contraception conversation entirely. So what does it really mean to get your tubes tied?
First off, that's the last time we're going to call it that: "[Getting your tubes tied] is a bit of a misnomer because that never actually happens," says Paula M. Castano, MD, an obstetrician-gynecologist at NewYork-Presbyterian Hospital. Instead of "tying" your fallopian tubes, she explains, doctors block or interrupt the movement of the egg through the tubes in a variety of ways, none of which involve any kind of knot.
All of those techniques — referred to as types of "tubal ligation" or "tubal sterilization" — keep your eggs from making their way through your fallopian tubes and being fertilized.
Figuring out which procedure is right for you involves talking to your doctor about a bunch of different factors in your life (e.g. whether or not you've already had kids). But no matter which technique you go with, it's nice to know that sterilization is more than 99% effective at preventing pregnancy.
Ahead, we talk to Dr. Castano about what we get wrong about sterilization and what you need to know before pursuing the procedure.
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Doctors never call it "tying your tubes."

Again, tying doesn't really happen. Instead, there are three main techniques for tubal ligation and all of them require some level of surgery:

The first kind, referred to as "postpartum," can be done immediately after you give birth, Dr. Castano says, and involves removing a piece of each fallopian tube.

The other types are performed totally separate from the childbirth process and are, therefore, called "interval" tubal ligation. In these cases, you can have minimally invasive surgery through your belly button to have your fallopian tubes blocked (with little clips or rubber bands), a piece removed from each tube, or have the tubes burned to close them up.

You could also decide to have a hysteroscopic procedure, which requires your surgeon to go up through your vagina and cervix to reach your uterus. From there, your doctor will implant a device (such as the controversial Essure) to block your tubes.
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The procedure can (sometimes) be reversed.

All tubal ligation techniques are designed to be permanent. But, depending on the technique, they can be reversed to some extent, says Dr. Castano. "Something like a clip or even a burn would only affect a small portion [of the tube]," she says, "whereas removing a big chunk of the tube makes it harder to reattach."

That said, if a patient does have a change of heart about having biological kids, Dr. Castano explains that in vitro fertilization (IVF) is becoming a more popular option than reversing the sterilization. In both cases, your chances of getting the procedure covered via insurance are pretty slim. And, although IVF is certainly no cake walk, "doing in vitro is often easier and cheaper than undergoing surgical reversal," Dr. Castano says.

So, although you shouldn't count on being able to give birth after tubal ligation, all hope is not lost if your circumstances do change later on.
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The procedure lowers your risk for ovarian cancer.

It's true! In addition to having the security of knowing that your chosen method of birth control is over 99% effective — and permanent — Dr. Castano says that it can also reduce your risk for ovarian cancer. Granted, ovarian cancer is pretty rare (especially among women under the age of 40). But considering that it's the deadliest cancer of the female reproductive system, lowering your risk even more is a nice added benefit to the sterilization procedure.
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The procedure might increase your risk for other conditions.

In particular, tubal ligation increases your risk for ectopic pregnancy, a potentially dangerous condition in which a fertilized egg implants outside of the uterus. That egg can't survive in those conditions, so an ectopic pregnancy always requires medical attention.

Of course, for this to happen, sperm has to reach one of your eggs, which is highly unlikely if you've had a sterilization procedure. But in the extremely unlikely event that you do become pregnant, Dr. Castano says it's more likely for it to be ectopic than if you hadn't had a tubal ligation.

This is also another reason to consider IVF if you decide to try to become pregnant after sterilization. Dr. Castano explains that IVF may help overcome the risk for ectopic pregnancy because the fertilized egg is transferred directly into your uterus to facilitate implantation.
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You still get a period.

Yep, even if there's no egg making its way to your uterus, your endometrial lining still grows and sheds every month, giving you a period. That's because that process is governed by your hormones (not the egg), which aren't affected by the tubal ligation procedure, Dr. Castano explains.

Some sterilization patients also report that their periods are heavier than they were before the procedure. But Dr. Castano says there's no conclusive evidence that tubal ligation causes period problems. Instead, she says that many patients have been on hormonal birth control for years before undergoing tubal sterilization, and hormonal BC tends to make your periods lighter. So when patients finally go off that birth control because they've undergone a sterilization procedure and no longer need it, they're back to their normal periods, which are probably heavier than they're used to.
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You don't have to have kids to get one.

Whether or not you've already given birth is almost certainly a factor your doctor will bring up in discussions about sterilization, Dr. Castano says. "It's especially important for younger women to know that, even though they may feel like [they have enough kids or don't want them], life circumstances can really change in the next decade or two," she says. "And they could use [a] long-acting reversible contraceptive method, get the same effectiveness, avoid surgery, and have the possibility to change their mind down the road."

But at the same time, having children isn't a requirement for having the procedure. There are a million personal and medical reasons why you might want to avoid pregnancy. And, as Dr. Castano says, "Women shouldn’t have to provide a reason for why they don't want to have more or any children."
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But you might have to hunt for the right doctor.

Still, that doesn't mean that every medical provider will be on board with your decision immediately. So be prepared for a few discussions with your doctor about all the other long-term birth control options available (e.g. the copper IUD), which are on the same level of effectiveness as sterilization and have the benefit of not being permanent.

But if you still decide on tubal ligation and your doctor just isn't listening to you, don't be afraid to find another one. "I would encourage women in that situation to find another provider who can engage with them in a discussion about their desires and hear them out," Dr. Castano says, "and be aware that there are non-surgical, reversible options they can use while they're seeking out permanent options."