What is ‘Tube Tying’?

Each year in the United States, approximately 600,000 women undergo a tubal occlusion or ligation procedure to prevent pregnancies.

Franziska Haydanek, DO, is an OBGYN specialist and explains the procedure, different methods used, and some alternatives for patients to consider.

What is a tubal ligation?

Surgeons perform a tubal ligation to remove or block the fallopian tubes in a woman’s body. This procedure is done with the purpose of preventing pregnancy.

The term ‘tube tying’ comes from the idea of tying off the fallopian tube to prevent eggs from traveling from the ovaries to the uterus and becoming fertilized along the way.

During a tubal ligation, surgeons will cut or block the fallopian tubes.

Types of tubal ligation

There are several ways that a surgical team can perform the procedure.

Bilateral salpingectomy

Currently the most common technique used to conduct a tubal ligation, this minimally-invasive procedure allows a surgeon to create a small incision in a patient’s abdomen and remove both fallopian tubes.

Of all tubal ligation methods, this method has the highest success rate of preventing future pregnancies.

“Undergoing a bilateral salpingectomy has a success rate of nearly 100 percent, in terms of preventing future pregnancies,” Dr. Haydanek said. “If you are currently considering getting your tubes tied, you should also consider that a full bilateral salpingectomy is not reversible.”

Partial bilateral salpingectomy

This procedure is similar to a standard bilateral salpingectomy, but instead of removing both tubes completely, a surgeon will remove only part of each tube – allowing some of it to remain intact.

Patients who undergo this procedure may be able to undergo a tubal ligation reversal if desired but a successful reversal is not guaranteed. The decision to move forward with this surgery should be considered permanent and should be made under consultation with the patient’s OBGYN doctor and an OBGYN surgeon.

Occlusive tubal ligation

In this procedure, a laparoscopic incision is made in the abdomen. A surgeon will place clips onto the patient’s fallopian tubes to prevent eggs from traveling to the uterus and sperm from traveling into the tubes to fertilize any eggs.

If desired by the patient, this surgery may be reversible. However, a successful reversal is not guaranteed.

Eligible patients

The first step in this decision-making process should be having a conversation with an OBGYN doctor. Schedule a consultation to ask if you are a good candidate for the procedure, if you might be interested in another option for preventing pregnancy, or if you want to move forward with a tubal ligation.

Women who are eligible for these surgeries:

• do not desire any or additional pregnancies
• over the age of 21 if on Medicaid

Alternatives to tubal ligation

For women considering non-surgical options to tubal ligation, several types of LARCs, or long-acting reversible contraceptives, are available.

These include an intrauterine device (IUD), which is inserted in the uterus. A copper IUD emits copper ions that make the fallopian tubes and uterus inhospitable for sperm, while levonorgestrel IUDs release the hormone levonorgestrel – making a woman’s cervical mucus impenetrable to sperm.

Nexplanon is a single-rod progestin implant that is inserted under the skin. Once in place, it continuously releases a hormone called etonogestrel that prevents an egg from being released from the ovaries and prevents sperm from fertilizing the egg.

All of these devices are more than 99 percent effective at preventing pregnancy and can be placed in an office setting. Once placed, they are effective in the long term and allow for the rapid return of fertility once removed, according to the American College of Obstetricians and Gynecologists.

“These are great options for individuals who may not currently want to have a pregnancy, but may want to have one in the future,” Dr. Haydanek said.