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Family Planning – Sterilization

January 3, 2011
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.
  • Tubal ligation, the procedure for women, is more complicated, requiring an abdominal incision and an anesthetic.

In the United States, about one third of all married couples who use family planning methods choose sterilization (vasectomy or tubal ligation). Sterilization should always be considered permanent. However, if couples change their minds, an operation that reconnects the appropriate tubes (reanastomosis) can be done to try to restore fertility, or conception may be possible with in vitro fertilization. Reanastomosis is less likely to be effective in men than in women. For couples, pregnancy rates are 45 to 60% after reanastomosis in men and 50 to 80% after reanastomosis in women.

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, contraception should be continued for a while. Usually, men do not become sterile until they have had about 15 to 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 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%). Reanastomosis, which restores fertility, usually occurs shortly after the procedure.

Sexual activity, with contraception until sterility is confirmed, may resume as soon after the procedure as men wish. Fewer than 1% of women become pregnant after their partner is sterilized.

Tubal Ligation: Tubal ligation is used to sterilize women. It involves cutting and tying or blocking the fallopian tubes, which carry the egg from the ovaries to the uterus. More complicated than vasectomy, tubal ligation usually requires an abdominal incision and a general or regional anesthetic. Women who have just delivered a child can be sterilized immediately after childbirth or on the following day, without staying in the hospital any longer than usual. Sterilization may also be planned in advance and done as elective surgery.

Tubal ligation is often done using laparoscopy. Working through a thin tube inserted through a small incision in the woman’s abdomen, a doctor may cut the fallopian tubes and tie off the cut ends. Or a doctor may use electrocautery (a device that produces an electrical current to cut through tissue) to seal off about 1 inch of each tube. The woman usually goes home the same day. After laparoscopy, up to 6% of women have minor complications, such as a skin infection 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.

Various mechanical devices, such as plastic bands and spring-loaded clips, can be used to block the fallopian tubes instead of cutting or sealing them. Sterilization is easier to reverse when these devices are used because they cause less tissue damage. However, reversal is successful in only about three fourths of the women.

Instead of laparoscopy, a doctor may use hysteroscopy, which involves inserting a flexible viewing tube through the vagina and uterus and into the fallopian tubes. Coils (microinserts) can be inserted into the fallopian tubes to seal them. No incisions are necessary. A local anesthetic is used, with or without drugs to make the woman drowsy (sedatives). About 3 months later, sterility is confirmed by x-rays taken after a radiopaque dye is injected through the vagina into the uterus and fallopian tubes (hysterosalpingography).

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.

Very rarely, tubal ligation causes complications, such as bleeding and injury of the intestine.

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.

Source: Merck Manual
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