Tubal ligation (or "tying the tubes") is surgery to close a woman's fallopian tubes. These tubes connect the ovaries to the uterus. A woman who has this surgery can no longer get pregnant (sterile).

Tubal ligation is done in a hospital or outpatient clinic. You may receive general anesthesia. This will make you unconscious and unable to feel pain. Or, you may have local anesthesia (awake and unable to feel pain) or spinal anesthesia (awake but unable feel pain). The procedure takes about 30 minutes.

• Your surgeon will make 1 or 2 small incisions (cuts) in your belly, usually around the belly button. Gas may be pumped into your belly to expand it. This helps your surgeon see your uterus and fallopian tubes.
• Your surgeon will insert a laparoscope, a narrow tube with a tiny camera on the end into your pelvic area. Instruments to tie your tubes will be sent through the laparoscope.
• The tubes are either cauterized (burned shut) or clamped off with a small clip, a ring, or rubber bands.

Tubal ligation can also be done right after you have a baby through the vagina or during a cesarean section.

Tubal ligation may be recommended for adult women who know for sure they do not want to get pregnant in the future.

Even though many women choose to have tubal ligation, some are sorry later that they did. The younger the woman is, the more likely it is she will regret having her tubes tied as she gets older.

Tubal ligation is considered a permanent form of birth control. It is NOT recommended as a short-term method or one that can be reversed. Even so, major surgery can sometimes reverse it. About 50 to 80 women out of 100 who have their tubal ligation reversed are able to become pregnant.

Risks for any surgery are:

• Bleeding
• Infection

Risks for any anesthesia are:

• Allergic reactions to medicines
• Breathing problems or pneumonia
• Heart problems

Risks for tubal ligation are:

• Incomplete closing of the tubes, which could make pregnancy still possible. About 1 out of 200 women who have had tubal ligation get pregnant later.
• Increased risk of a tubal (ectopic) pregnancy if pregnancy occurs after a tubal ligation
• Injury to nearby organs or tissues from surgical instruments

Always tell your doctor or nurse:

• If you are or could be pregnant
• What drugs you are taking, even drugs, herbs, or supplements you bought without a prescription

During the days before your surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

• You will usually be asked not to drink or eat anything after midnight the night before your surgery, or 8 hours before the time of your surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital or clinic.

You will probably go home the same day you have the procedure. Some women may need to stay in the hospital overnight.

You will have some tenderness and pain. Your doctor will give you a prescription for pain medicine or tell you what over-the-counter pain medicine (medicine you can buy without a prescription) you can take.

Most women will have no problems. Tubal ligation is an effective form of birth control for women. You will NOT need to have any tests to make sure you can not get pregnant in the future.

Mishell DR Jr. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 14.

American College of Obstetricians and Gynecologists. Sterilization by laparoscopy. ACOG Education Pamphlet AP035. February 2003. Accessed February 19, 2009.