No More Kids

By J. Ron Eaker, M.D.

Roald Dahl once said, “It’s a funny thing about mothers and fathers. Even when their own child is the most disgusting little blister you could ever imagine, they still think that he or she is wonderful.” Blisters and all, there comes a point in many couples lives that they make a decision that they don’t want any more children. Granted there may be single folks who also make this decision, yet the vast majority of those who want to do something permanent surrounding birth control do it in the auspices of the family.

Putting aside any moral or religious grounds for or against sterilization (that is a debate for another day) I want to explore the various options for permanent contraception.  

For Her

Surgical sterilization, or having one’s “tubes tied,” generally refers to a procedure that permanently blocks, removes or destroys both fallopian tubes. Many of you remember from high school anatomy that the fallopian tubes are the meeting place of the egg and the sperm as they begin their courtship. There are a variety of techniques for accomplishing sterilization and each has its unique advantages and disadvantages.

Two ways of surgically altering the tubes are associated with the immediate postpartum period. If a woman has a caesarean section the tubes are prominently displayed at the time of the surgery. It is a relatively simple matter to perform a sterilization procedure at this time. There are various ways of accomplishing this but they all involve either cutting, tying or removing a portion of the tubes.

Recently there has been a move to actually remove the ends of the tubes, or even the entire tube itself, instead of just a small portion. Recent studies suggest there is a higher incidence of ovarian cancer in women with intact tubes as opposed to those who have had their tubes removed. Understand this doesn’t mean in any way there is an association with having a tubal ligation and ovarian cancer. It means just the opposite, that is, removing the tubes may lower the risk of cancer of the ovaries. There are even clips that can be placed across the tubes at the time of surgery.  

If a woman delivers vaginally, she may also easily undergo a surgical procedure shortly thereafter to tie her tubes. This involves a small cut below the belly button (with anesthesia of course) and again, there are a variety of techniques for accomplishing the procedure. It is feasible at this time because the uterus is still quite large and easily accessed from this small incision. In general, having a sterilization procedure after having a baby doesn’t prolong or intensify your recovery.

Another common approach for permanent sterilization is accomplished as an outpatient by means of laparoscopy. This is a procedure that involves one or two very small cuts on the abdomen in which an instrument is inserted and the tubes are visualized. Again, clips can be placed across the tubes or, more commonly, the tubes are cauterized, destroying their lumen (inside) and blocking anything from passage. A surgeon can still remove a portion or all of the tube by this technique. It is an outpatient procedure and the recovery time is brief.

What To Expect

Many women express concerns about possible changes after a tubal. They have heard from family, neighbors and that trusted medical text, the Internet, that having a tubal will cause a woman to have irregular, heavy, painful cycles. This is largely a myth. Many women are on hormonal contraception (the pill, patch, etc.) prior to getting their tubes tied. Naturally, once they have had the procedure there is no reason to continue the hormones, so they stop. The pill and other hormonal contraceptives are powerful medicines and very effective at regulating cycles and reducing both period amounts and associated cramping. Coming off these pills often results in a resumption of bothersome cycles, so it is stopping the pills, not having the tubal, that is responsible for most menstrual difficulties after the procedure.  

A newer technique called Essure is an outpatient (and sometimes office) procedure that involves placing a scope vaginally through the cervix into the uterine canal. Using a specialized instrument, a small metal coil is placed in each tube occluding their openings. It has the advantage of not requiring any abdominal cuts, but does require proving the tubes are blocked by doing an X-ray a few weeks later.

For Him

Not to be left out, the male can also do his part to stamp out fertility by getting a vasectomy. This is a procedure that blocks the Vas Deferens, the tube traversed by sperm from the testes. The testicles continue to produce sperm, but the sperm are reabsorbed by the body. Like the tubal, there are various techniques for accomplishing this, all with similar efficacy.

The decision not to have any additional children involves many facets. Each person should approach it with the intent of it being permanent, as reversals of these procedures are difficult and not always effective.