Tubal ligation, or getting your “tubes tied,” is a common surgical procedure that women have done for a variety of reasons.
Dr. Elin Raymond, staff obstetrician and gynecologist at Michael Garron Hospital in Toronto, told Global News the procedure is done under a general anesthetic and is a laparoscopic procedure, meaning an incision is made in the abdominal area.
What does the procedure entail?
Doctors take a look at the fallopian tubes and assess which method is the best way to close the tubes. Raymond said one method involves clipping them, while another involves cutting the tube and burning it and still another method involves removing the tube altogether.
Dr. Jonathon Solnik, site chief of obstetrics and gynecology at Women’s College Hospital in Toronto, said that currently, the most common method used is to completely remove the tube.
“In recent years, we have learned that a percentage of ovarian cancers may actually begin within the fallopian tube so choosing to remove them to prevent pregnancy may, theoretically, have some additional benefit,” he said.
HealthLink BC notes that, sometimes, the procedure is also done after women give birth.
“The fallopian tubes are higher in the abdomen right after pregnancy so the incision is made below the belly button (navel). The procedure is often done within 24 to 36 hours after the baby is delivered,” says the non-emergency health information service.
There is also an implant option, which is done at a doctor’s office without surgery or anesthesia.
Why women do the procedure
Women can have the procedure for several reasons — such as not wanting children anymore (or at all) or due to a medical condition — but Raymond added that it often comes down to contraception.
The procedure itself is covered in Canada, and most women will return to daily activities and work within a week, Solnik added.
“Only women and couples who are very certain of their decision to not conceive should consider tubal ligation. Notwithstanding, a very small percentage of women will conceive after this procedure — meaning, it is not 100 per cent effective in every situation,” Solnik explained.
“While pregnancy following tubal ligation is very rare, those who do conceive have a much higher probability of experiencing an ectopic pregnancy — or a pregnancy outside of the uterus. If a woman suspects she may be pregnant, such as a missed period, which should not happen after a tubal ligation, then she should seek immediate medical advice.”
Barriers some women face
In a recent post for Today.com, writer Meghan Holohan talked about wanting the procedure for years after she knew she didn’t want children. The 27-year-old first asked her OB-GYN for the surgery when she was 18.
“She said I was too young and it was a procedure reserved for women in their 30s or 40s who had at least two children and knew they were done having children,” she wrote. “I realize I was ambitious in approaching my doctor at only 18 but I was certain that I did not want to have any children.”
Years later, in Nashville, Holohan found a doctor who would perform the procedure — but not before asking her husband for “permission” first.
“After securing my husband’s permission, sharing my list of pros and cons and agreeing to adoption, I underwent the outpatient, minimally invasive procedure, where my doctor clipped my tubes to permanently prevent pregnancy,” she wrote.
Stories like these have also been seen in Canada. In 2017, an article published in the Journal of Obstetrics and Gynaecology Canada found doctors were hesitant to provide the procedure to women under 30, the National Post reported.
The reported noted that Canadian guidelines suggest any woman who understands how permanent the option can be is eligible for the procedure.
“Often, these women have other role models in their life who are also child-free,” Dr. Dustin Costescu, a professor at McMaster University in Hamilton, Ont., told the paper.
“They may be aunts or people in senior positions in their workplace — role models who demonstrate they can meet all of their other life goals without having children.”
Solnik added the scenario is not uncommon for women under 30.
“Earlier research showed that women under the age of 30 years had a much higher chance of regretting undergoing the procedure,” he said.
“This is because it is irreversible, and since life events sometimes change, wanting to have children in the future may be of interest to some patients. Having said that, if a woman is certain she does not want to have children and is younger than 30 years, tubal ligation should be an option.”
Can you reverse it?
According to the Mayo Clinic, there is a reversal procedure for tubal ligation, but only if the tube wasn’t fully removed. During the reversal procedure, blocked tubes are reconnected to the remainder of the tube.
“This may allow eggs to again move through the tubes and sperm to travel up the fallopian tubes to join an egg,” the site noted.
However, this doesn’t mean there is a guarantee that women can get pregnant after the reversal procedure.
“Pregnancy rates following reversal of tubal ligation vary greatly depending on a woman’s age and other factors,” the Mayo Clinic added.
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MyHealth Alberta noted the reversal surgery can cost more than $10,000 and is not covered by major plans across the country,
Doctors can also refuse to do the procedure if they believe there is a low chance of it being successful.
arti.patel@globalnews.ca