Female sterilisation - Medical Experts

In tubal sterilisation (tubal ligation), the fallopian tubes are sealed. This prevents the egg from travelling through the fallopian tube to the womb. The egg and sperm are prevented from meeting; however, fertilisation cannot be completely ruled out.

Sterilisation is intended for women who no longer wish to have children. Anyone considering sterilisation should understand the procedure as a form of permanent contraception. The resulting infertility is the intended outcome.

Any potential future desire to have children should therefore be discussed during the consultation. Younger women are more likely to regret the decision later on. Before the operation, personal life plans, the relationship and any possible changes in one’s own wishes should be discussed openly.

The ovaries are left intact. The procedure is not intended to affect their hormone production or to bring about the onset of the menopause. Nor is the womb removed during tubal sterilisation.

Tubal sterilisation is one of the very safe methods of contraception, but it does not offer complete protection. In the studies evaluated by a Cochrane review, fewer than 5 pregnancies per 1,000 procedures occurred within one year.

You should continue to use another form of contraception until the day of the operation. Condoms can also provide additional protection against sexually transmitted infections.

Before the sterilisation, your decision and the medical preparations will be discussed. The operation is usually scheduled before ovulation to minimise the risk of an existing pregnancy.

• Lower abdomen: Preparation includes a physical examination of this area.
• Blood pressure: Your blood pressure will be measured before the operation.
• Fasting: You must not eat anything for 8 hours; clear liquids are permitted up to 2 hours before the procedure.
• Journey home: If possible, arrange for someone to accompany you on the journey home.

During the consultation, it should also be clarified whether a long-term but reversible method of contraception might be a better fit for your life plans. In addition to your current decision, it is important to consider whether your desire to have children might change in the future.

The fallopian tubes are usually blocked during a laparoscopy, i.e. keyhole surgery. In Germany, the procedure is usually carried out under general anaesthesia. You will therefore feel nothing during the operation.

1. Once the anaesthesia has taken effect, the doctor makes small incisions to insert the surgical instruments.
2. The fallopian tubes are exposed via the laparoscopy.
3. The fallopian tubes are cauterised or closed off individually with a clip. It is not necessary to cut them completely.
4. The instruments are then removed and the small incisions are closed.

The actual operation takes about 15 to 30 minutes. Following an outpatient laparoscopic sterilisation, you can usually go home on the same day as the procedure.

Complications are rare overall, but the usual risks associated with surgery and anaesthesia do apply. In a prospective study from the United States, the overall rate, depending on the definition used, was 1.6 or 0.9 complications per 100 procedures.

• Bleeding: This can occur in the surgical area or at an incision site.
• Infection: A wound or the surgical site may become infected.
• Failure of the procedure: Despite the fallopian tubes being blocked, pregnancy may occur later on.
• Subsequent regret: A change in one’s desire to have children may weigh heavily on this permanent decision.

If pregnancy occurs despite the procedure, an ectopic pregnancy is also possible. In an Australian population-based study, the cumulative incidence of ectopic pregnancy was 2.4 per 1,000 procedures after 10 years and 2.9 per 1,000 after 15 years.

After discharge, your body will initially need rest. A family planning guideline recommends taking it easy for 2 days following the operation.

You should avoid heavy physical work and heavy lifting for one week. It is advisable to have someone accompany you on the journey home, particularly because of the anaesthesia you have just had.

Before making a permanent decision, you should consider reversible methods of contraception. These include the pill, condoms, an IUD and natural family planning. Long-acting reversible methods are an option if you wish to use contraception in the long term but do not yet want to make a final commitment.

Surgical restoration of the fallopian tubes is known as refertilisation and is possible. However, sterilisation should not be chosen in the expectation that it can be reliably reversed at a later date.

A vasectomy involves the man’s vas deferens and is therefore different from tubal sterilisation.

The cost of a standard procedure paid for out of pocket ranges from 600 to 1,000 euros. The exact bill may depend on the method used and the medical circumstances.

Statutory health insurance covers the costs if sterilisation is necessary due to an illness. If the procedure is carried out solely for the purpose of contraception, the woman must pay for it herself.

Tubal sterilisation is a gynaecological surgical procedure. It is carried out by gynaecologists with experience in laparoscopic procedures. The doctor should be specifically trained in this procedure.

During your initial consultation, you can enquire about the planned method, the doctor’s experience with the procedure and the aftercare:

• What method do you use to block the fallopian tubes?
• What experience do you have with laparoscopic tubal sterilisation?
• What is my personal risk of bleeding, infection or other complications?
• What options would I have if I wished to have children in the future, and what role might assisted reproduction play?

You will find specialists in female sterilisation at the end of this text.