Failure Rate: 0.4%
Surgical sterilization is a very effective way to achieve permanent infertility and has a failure rate of only 0.4% per year. In women, the process is often referred to as "tying the tubes," but in actuality the fallopian tubes may be tied, cut, clamped, or blocked. This serves to prevent sperm from joining the unfertilized egg.
Although sterilization may seem an attractive alternative to reversible methods, as it dispenses with the need for forethought and planning before sex, it has its own set of drawbacks. It is comparatively expensive, costing between $1,000 and $3,000, though often the cost is covered by insurance. Sterilization requires exacting abdominal surgery and anesthesia, both of which carry health risks. Surgical complications include infection and uterine perforation. The medical risks multiply if a hysterectomy (surgical removal of the uterus) is performed for sterilization (as opposed to simply treating the fallopian tubes); hysterectomy should never be used for this purpose.
Long term health risks of sterilization include ectopic pregnancy, cervical cancer, menstrual cycle disturbances (increased bleeding and pain), and gynecological problems necessitating hysterectomy. In fact, for reasons that are not yet clear, women who undergo tubal sterilization are 4 to 5 times more likely to require a hysterectomy than those whose partners underwent vasectomy.
Sterilization should be considered permanent. Women are sometimes pressured into getting sterilized by well-meaning medical professionals or social workers. Women are especially susceptible to this sort of pressure right after a trying pregnancy or abortion. Many are under the mistaken impression that sterilization is easily undone.
One in three sterilized women regret their decision at some point in their lives, and many seek to have the procedure reversed. Reversals are very expensive — costing $10,000 or more, and results are iffy. Common reasons women seek reversal are because of a change in marital status, the death of a child, or just because they want more children. For this reason, sterilization is not recommended unless you have a medical condition that would make pregnancy difficult or dangerous. Male sterilization, or vasectomy, is medically safer but should also be considered permanent.
In-vitro fertilization (IVF) or microsurgical tubal reversal can be considered for women who want more children. Success is not guaranteed with either approach, and the options must be weighed carefully in consultation with a medical specialist. Surgery, especially major abdominal surgery, carries health risks, including risks due to anesthesia. Ectopic (tubal) pregnancy is very dangerous and is more common among pregnancies occurring after surgical reversal of female sterilization (ectopic pregnancy rates range from 1% to 7% or higher). Both IVF and reversal surgery are expensive and are often not covered by health insurance.
Image Credits: R. A. Hatcher et al., "Contraceptive Technology," 16th Revised Ed., Irvington Publishers, 1994. p. 386.
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