By Andrea KarrAug 04, 2020
Illustration: iStock/Olha Khorimarko
Let’s start with a quick physiology lesson so we’re all on the same page about reproduction:
The ovaries are each connected to the uterus by a fallopian tube. During typical ovulation, one of the ovaries releases a mature egg that travels through its adjacent fallopian tube and may become fertilized by sperm. Removing or blocking both fallopian tubes stops eggs from travelling each month—meaning no fertilization and no bun in the oven. Capiche?
In Canada, procedures that remove or block the fallopian tubes (a.k.a. having your tubes tied) are still fairly common, says Brigid Dineley, an OB-GYN at BC Women’s Hospital + Health Centre. However, there are plenty of factors to consider before undergoing this elective surgery. Here’s everything you need to know to make an informed decision.
There are two types of permanent female sterilization in Canada: salpingectomies (where the fallopian tubes are completely removed) and tubal interruption, also commonly known as tubal ligation (where a piece of each tube is removed or Filshie Clips are used to block the tubes). These procedures are covered by provincial healthcare. Essure, previously another option for permanent birth control, is no longer available in Canada.
Although there is no recommended age, women under 30 may face some resistance from their practitioner. “I hope that’s changing,” says Dineley, “because reproductive autonomy and bodily autonomy are very important.” It’s essential to note that most women do not experience regret after tubal surgery, but one study notes there’s a slightly higher risk of remorse for women under 30. “But that obviously that doesn’t apply to everybody and people know their bodies better than we do, so they should be able to make that decision,” Dineley says.
If you’ve decided that you want to undergo tubal surgery, you’ll need to meet with your family doctor or visit a walk-in clinic to get a referral to a gynecologist. At your gyno appointment, you’ll learn about the procedure and what it means for you, then you’ll be booked for surgery weeks or months into the future. Almost all tubal surgeries are performed laparoscopically, which means you will receive three small incisions in your abdomen—one in the belly button and two more incisions lower down. You’ll take a pregnancy test before the procedure to make sure you’re not pregnant, your surgery will take 45 minutes to an hour, and then you’ll usually go home later that day.
There are no specific risks for tubal interruption or salpingectomies, but all surgeries have standard risks such as infection, bleeding and damage to the organs around the surgery area (in this case, the bowel or bladder.)
Since these procedures affect the fallopian tubes, not the ovaries, there are no hormonal repercussions. Instead, you will experience the standard side effects for minimally invasive laparoscopic surgery: some pain and discomfort. Your recovery will likely last up to two weeks and you may need to take time off work and avoid heavy lifting, strenuous exercise and driving—depending on your painkillers. “Unlike a vasectomy, where you need a three-month waiting period and then a test to ensure that the procedure actually worked, a salpingectomy interruption> will work immediately,” says Dineley. However, if you ovulated a few days before your surgery and an egg was still in your uterus, you are at risk for becoming pregnant during that first week. So it’s recommended couples use back-up protection during intercourse for seven days after your procedure.
Can you reverse a tubal ligation or salpingectomy?
You may be eligible to have your tubal ligation reversed, but there are a limited number of gynecologists that perform this complicated type of surgery, and it’s not covered by healthcare. A salpingectomy, on the other hand, is irreversible, but you might still be able to become pregnant through IVF.
Salpingectomies and the reduced risk of ovarian cancer
Salpingectomies are irreversible, but they have an added benefit: the ability to reduce the lifelong risk of ovarian cancer. “We think a lot of ovarian cancers actually start in the tube and travel to the ovary,” says Dineley. In BC, most doctors offer salpingectomies instead of tubal interruption. Tubal interruption also reduces risk, but salpingectomies have a higher reduction rate.
Can you get pregnant if you have your tubes tied?
No method of birth control is completely, 100-percent foolproof for preventing pregnancy. All types of tubal surgery—whether you have your fallopian tubes removed completely or simply have part of the tube snipped or clipped—are over 99 percent effective. IUDs also have a less than one-percent fail rate.
Does getting your tubes tied stop periods?
The removal or blockage of your fallopian tubes will not affect your hormones or the ability of your uterus to build a monthly lining, which means you will continue to have normal periods (whatever normal is to you!) even after a tubal ligation or salpingectomy.
Why would a woman choose to have her tubes tied instead of getting an IUD?
As an effective birth control method, tubal surgeries and IUDs are pretty much on par. So why would someone take the permanent route over a method that’s easily reversible? “I think there are a lot of reasons,” says Dineley. “[Some] don’t like the idea of having something inside their bodies. There are two types of IUD. One has copper and tends to make your periods heavier. Then there’s another that has progesterone in it, which is a hormone, and they could have had a bad reaction.” She also notes that some women simply want the comfort and ease of never thinking about birth control again—and that’s a choice that every woman should have the right to make.