Why Tying Your Tubes Is Not Like Tying Your Shoelaces
It is easy to untie your shoelaces. Your tubes are more difficult. What we are talking about here are your fallopian tubes, which carry an egg for fertilization from the ovary toward your uterus (womb) for implantation. Tying them effectively puts up a block so the sperm coming from the other direction can not get to the egg. Pregnancy is prevented in this way, which is why a tubal ligation is performed surgically as a permanent contraceptive.
Tubal Ligation: Is it a permanent solution to a temporary problem?
“Permanent” is the important distinction here. Unfortunately, the simplistic description of merely “tying” them makes it sound so un-doable. Simply untie them if you change your mind, right? Sadly, this is a misconception some women discover only after the procedure.
Shoelaces are inanimate objects made of string, twine, or cloth. Your tubes are dynamic, living tissue with physiologic properties that allow them to heal, get infected, scar down, or even trap a fertilized egg on its way to your uterus (ectopic, or tubal, pregnancy—a surgical emergency). As living tissue goes, they are best when not tampered with. True, tying them will work well to prevent pregnancy, but the process is hardly just tying them. Depending on the doctor or technique, they are cut, burned, sectioned, removed (cut out), or buried into a dead end. After that, being living tissue, the remains do what they do best—seal off inflammation and try to heal, translated, “scar.”
The doctor who hopes to “untie” them often will be presented with a heap of scar tissue or not enough healthy tube to rejoin together. Even the greatest result in rejoining the burned or cut segments will result in some scarring, and if the tubes are then patent again, this spot of scarring is not great tube tissue like the rest of the path; the fertilized egg can get caught in it and grow there as an ectopic pregnancy. Since there is only one place suitable to grow an ever-enlarging baby (that is, in your uterus), it is only a matter of time before the tube will burst and present an internally bleeding emergency. Aside from that, sometimes a tubal reversal does not work at all in spite of successful rejoining of the segments. This is not to say reversals do not ever work. In the right hands, they can be successful, but the ectopic risk is still present.
All of this, of course, screams a warning:
Do not get a tubal ligation if you think there is any chance—any chance at all—you might want to get pregnant ever, ever again.
Other Options: Contraceptives and Interventions on Men
There are just too many reversible forms of pregnancy prevention you can do, from birth control pills to the highly successful “natural family planning.” (Even condoms, used correctly, are very effective. Their bad reputation for failure takes into account people who do not know how to use them.)
What if you do not share my confidence in these other methods? What if you need a guarantee?
What about Mr. Wonderful? - Vasectomy
Let us look at that trouble-maker—your partner. According to eMedicinei:
Vasectomy has a lower failure rate than tubal ligation.
It is much safer, as it does not involve general anesthesia.
It also is safer because it does not involve entering a major body cavity like with a tubal ligation, although your partner will argue tooth and nail that his scrotum is definitely “a major body cavity” to him.
It can be done in a doctor’s office, recovery is very shorter, is not a major surgery, and is cheaper.
But do not get confused. It should be considered just as permanent as a tubal ligation, because again, we are dealing with living tissue.
Tubal Ligation: The Good, The Bad, And The Worst
If you never, ever want to be pregnant again, a tubal ligation is good, although it may result in some irregular bleeding or heavy periods, which sometimes can get bad enough to make you want to stop them—either by using birth control pills (sounds like a wasted tubal ligation to me) or even hysterectomy or ablation. The reason for this is unclear. It could be that the tubal ligation also tied off some of the blood supply to your ovaries, making them “misread” your hormone levels; or, as others say, you had irregular periods before but they were masked by your using birth control pills, and now that you are off of them because of your tubal ligation, you are seeing what you would have seen without the pill. The statistics say that a tubal ligation has more women complaining of menstrual irregularities, called “postubal syndrome” than women without a ligationii. The worse may come with some of the “bigger” decisions in life, planning to fill the minivan with more children or starting a new family.
These are all things you will never think about as you are signing that consent to have your tubes tied. And even if reversal is feasible, insurance will not typically cover it. It is expensive. The alternative is in vitro fertilization (IVF), and that is an even more expensive crap shoot. According to the Institute for Family Studiesiii, the women who regret having had a tubal can reach as high as 25% of them.
What is the best strategy?
You can always have a tubal ligation later. You can not just un-have a tubal ligation, not without expense, risk, and drama. So the best strategy is to NOT choose a permanent solution to what may be a temporary situation. Many women who are flustered or exhausted throw up their hands and get sterilized when they have small children underfoot, which are very busy years—hectic years—that do not represent what their lives will be forever. Do not burn your bridges casually. Make it the important decision that it is. In the meantime, oral contraceptives (birth control pills) and other methods can keep you “un-pregnant” reliably. But if you must do something permanent, consider vasectomy for all of the above reasons, which make it a no-brainer. The only thing that tubal ligation has going for it is that it works, and sometimes is convenient (like with a C-section).
Are Contraceptives Risky?
Any medication has its risks, and birth control pills are no exception. But with today’s brands having the lowest amount of hormone content than ever before, any dangers have been reduced remarkably. And if you do not smoke, you can stay on them until you approach menopause. Additionally, as a bonus, you can use them to manipulate your periods—make them lighter, fewer, or even absent altogether if that is what you want.
This article is an invitation to consider various factors that come to play in permanent surgical procedures that may not be what you bargained for. Now you know. Choose wisely!
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