Search for tag: "tubal ligation"

Interviewer: You've had all the children you and your partner want. Your family is complete, and now you're considering permanent birth control. But how do you decide who gets it done? Is it the dad, and he gets a vasectomy, or is it the mom, and she gets tubal ligation?

Dr. Alex Pastuszak is a urologist and a fertility expert at University of Utah Health. What is your take on this question, tubal ligation or a vasectomy?

Dr. Pastuszak: So, Scott, I'm going to come right out and say that I would be strongly in favor of the vasectomy.

Interviewer: All right. But that's what you do, so I would expect that. Do you have some more support for it?

Dr. Pastuszak: Right, yeah. So, no, this has nothing to do with my pocket.

Interviewer: Okay.

Dr. Pastuszak: But it has everything to do with the safety and the cost of the two procedures relative to one another.

Interviewer: All right. Break that down.

Dr. Pastuszak: So I would tell you that vasectomy is the safer and cheaper option compared to tubal ligation. So let's go ahead and, just like you said, break that down.

So what are the risks of tubal ligation? So we know that, just like a vasectomy, it can include bleeding and infection. Unlike vasectomy really, though, it can include injury to other organs because you're dealing with the tubes that are inside a woman's pelvis, which are really close to a lot of other sensitive structures.

Tubal ligation requires general anesthetic or strong regional, so the anesthesia is already more significant, and the side effects from that can be more significant than that for a vasectomy. And then just in terms of pregnancy itself. So while tubal ligation is just as effective, effectively, as vasectomy, so more than 99 percent, you can still run the risk of an ectopic pregnancy or incomplete closure of fallopian tube which results in pregnancy.

Now, if you counterpoint those against the risks of a vasectomy, then you're really just talking about bleeding, infection, some pain, and maybe failure of that vasectomy as the main risks. Very few.

Interviewer: And recovery is also much quicker for a vasectomy versus tubal ligation.

Dr. Pastuszak: Right. Because tubal ligation, again, you need to make an actual hole in the abdomen, which by surgical standards in this case, it's a minor surgery, but it's still much more major than a vasectomy.

Interviewer: Gotcha. What about the cost? I think this'll be a short conversation because vasectomy is cheaper.

Dr. Pastuszak: Well, it's cheaper, and the reason it's cheaper is just because you can do it in the office under local anesthesia.

Interviewer: Gotcha, gotcha. Is there a reason why a couple might actually want to get a tubal ligation versus a vasectomy in spite of the reasons that you just gave? Is there anything that you're aware of?

Dr. Pastuszak: So unless there's an actual reason that a man cannot physically get a vasectomy, and I can't think of one off the top of my head, they may exist, or the woman is already undergoing another surgical procedure, like a Caesarian section, and at the time of that procedure wants to go ahead and have that tubal ligation, I don't see any reason why a tubal ligation would be or should be preferred over a vasectomy.

Interviewer: The difference is, though, a tubal ligation, a pregnancy could still occur that could be . . .

Dr. Pastuszak: That could be damaging to the woman.

Interviewer: Yes, exactly.

Dr. Pastuszak: In the setting of, say, an ectopic pregnancy.

Interviewer: Which means?

Dr. Pastuszak: Which means that the pregnancy actually starts in the fallopian tube, and since that fallopian tube is now closed, that fertilized egg can't get to the uterus, and so it starts growing in the fallopian tube, which becomes an urgent or emergent surgical situation for the woman.

Interviewer: And, as of right now, there are more tubal ligations than vasectomies in the United States, isn't there?

Dr. Pastuszak: That's right.

Interviewer: Yeah. Even though the other one is the clear winner, it sounds like, to me.

Dr. Pastuszak: Yes.

Interviewer: So, in this conversation, is there anything else that you would recommend for a couple to consider while having it, other than just kind of the facts that you laid out?

Dr. Pastuszak: So I think the couple really does need to have the facts because, you know, guys are (a) afraid. I shouldn't say afraid, but guys do not tend to seek medical care, right. In the US, women are often the driver of their own and their partner's and family's medical care. So that is one barrier to more men having vasectomies. In fact, maybe not most, but a lot of the men I see in my office come because their partner, their female partner asked them to come, not because they have taken the responsibility.

You know, and I would kind of put this back in the men's court just to sort of say, well, how sexy do you think your woman thinks you are, you know, if you're sitting there and pushing back against this vasectomy? What do you think she would think if you said, "Honey, I'm going to go ahead and get this vasectomy, and I'm going to do this for us and for our family"?

Interviewer: Yes, because it's a safer and a more economically cheaper option. That's pretty sexy.

Dr. Pastuszak: I think so.

Interviewer: So I think, finally, if in spite of all this information, a guy still has it in about getting that vasectomy, what would you say at that point? Because, to me, the course of action seems obvious, but men can still be hesitant. What would you say at that point?

Dr. Pastuszak: So I really do think information is power, and I know that men are hesitant. You know, at the very least, go get the facts. Go see somebody who knows what they're talking about this. Go see your local urologist. Just talk to him about it. He's not going to commit you to having a vasectomy in the office that day. It's your decision, but at least know objectively what you're walking into. And I will tell you, most of you will go with the vasectomy after you talk to him.

Interviewer: Six reasons women love men that get a vasectomy. Dr. Alex Pastuszak is a urologist and reproductive expert at University of Utah Health, and he's counseled thousands of patients through this decision. And today we're going to find out the top six reasons that women love men that get a vasectomy. Let's just start with number one.

Dr. Pastuszak: Reason number one, they don't have to think about birth control anymore. I mean, it's one thing less on your to-do list. Instead of having to go get your birth control every month, either from the pharmacy or from your doctor, you've got your guy who's already taken care of it. Once a vasectomy is done and the lab results come back and there's no more sperm, you're good to go.

Interviewer: All right. Yeah, that's awesome, because so often the woman is responsible for birth control, and, you know, even with other long-term options, in three years you've got to go back or whatever. So it's one and done as they say.

Dr. Pastuszak: One and done.

Interviewer: Okay. Six reasons women love men that get a vasectomy, number two.

Dr. Pastuszak: All right. So a vasectomy is really reliable. I mean, just think about the financial and emotional burden that an unplanned pregnancy can have on someone's life. A vasectomy is more than 99 percent effective. It's really only secondary to abstinence, which most couples, once they're in a partner relationship, don't really want to have. You can test to see that it's been effective, and it's going to prevent you from having a pregnancy down the road.

Interviewer: So that reliability, yeah, I mean a financial hardship or a really tough decision could come if you've decided, you know, we're done having children, and then you have to deal with that. So a vasectomy, very reliable. I like that. What about number three on the top six reasons women love men that get vasectomies?

Dr. Pastuszak: Another great reason is that there are no side effects for the woman, and quite honestly there are almost no side effects for the men either. Remember, the risks of side effects are really about in the 1–2 percent range. So other forms of birth control can have significant side effects for women.

Just think about all the hormonal manipulation that all of these birth control options, except tubal ligation, have. And this can leave women feeling awful, gaining weight, and just in general not wanting to continue with that birth control. Why not just one and done it and get that vasectomy?

Interviewer: All right. Six reasons women love men that get a vasectomy, number four.

Dr. Pastuszak: All right. So this kind of following on what I just said about tubal ligation, you don't need a tubal ligation as the female partner if your male partner has gotten a vasectomy. Why is that important? Because vasectomy is just as effective, safer, and cheaper. So why would a woman need to put herself through a more invasive, riskier, and more expensive procedure when a guy can just go ahead and get his done?

Interviewer: All right. And number five on the top six reasons women love men that get a vasectomy?

Dr. Pastuszak: It's a one-time cost. That's it. And it's usually extraordinarily well covered by insurance. Insurance companies don't want people to have babies. They want them to not have babies. So they'll cover this the vast majority of the time. So pay for it once, and that's it, no more ongoing expenses.

Interviewer: All right. And number six and the final reason that women love men that get vasectomies?

Dr. Pastuszak: It makes a man sexier, Scott.

Interviewer: How's that?

Dr. Pastuszak: What is sexier than a man taking responsibility for the family's birth control? I mean, think about it. Women do so much. A woman, in today's day and age, is still very often both a career person as well somebody who takes care of the kids, raises the kids, and runs the household. A guy can step up and do his part. In no way, any evidence that a vasectomy is going to affect a man's masculinity.

You know, there's

• no impact on testosterone,
• no impact on sexual function,
• no impact on an ejaculatory function,
• no impact on cancer risk,
• etc., etc.

There is absolutely zero reason why a man shouldn't get a vasectomy and be rewarded by being that guy who steps up.

Interviewer: How should a woman bring this topic up in a way that a man might be more open to it if he initially is not? Like if there's a woman listening, that's like, "I don't know if my husband is going to buy into this," and she's already laid out it's going to make you sexier, is there anything else that you would recommend?

Dr. Pastuszak: So I would find that a very compelling reason, but . . .

Interviewer: Yeah, I would think so. I think we should be done really, but, you know, maybe there's that one stubborn guy out there, because, you know, we do exist.

Dr. Pastuszak: You know, it may be a process. You know, but ultimately knowledge is power. I think the facts speak for themselves, and, you know, quite honestly, like getting a man in front of somebody who can actually tell him what the experience is going to be like, either somebody who's had a vasectomy or a urologist who does these day in and day out, is a start.

Interviewer: Got you. What's the next step after you get that buy-in from your man?

Dr. Pastuszak: Go see your urologist. Go see somebody who can give you the facts.

Are you happy with your family size? Have you had all the kids that you planned or a few more? Are you considering having your tubes tied? Let's talk about that.

Prior to the development of effective hormonal contraception, women choosing to end their childbearing through sterilization procedures had major operations to remove their fallopian tubes or had hysterectomies. Although the history of female sterilization is clouded with cases where women may not have given informed consent, since 1960, about the same time that birth control pills came on the market, techniques for female sterilization became less invasive and easier to do with less risk. The term used for these easier techniques is tubal ligation.

Now, there are many techniques and the timing for this procedure, and about 30% of American women have had a tubal ligation. Techniques include taking a suture and tying it around a loop of tube and then cutting the tied-off loop of the tube out. And then there are a number of techniques like this to remove the middle segment of the fallopian tube so sperm cannot get to eggs and fertilize them. Other techniques include putting a clip to close the tube permanently, or cauterize or burning the tube in the middle to close it.

The timing could be shortly after a baby is born, within a day or so, while the woman is still in the hospital, or at the time of Caesarian section when the tube is right there, or anytime between children, when the procedure can be done by laparoscopy. But half of tubal sterilizations occur right after the baby is delivered vaginally or by Caesarian, and that comes to about 350,000 tubal sterilizations a year.

The word "ligation" in the term "tubal ligation" means to tie. This unfortunate term translates into tying your tubes. This has led some women to assume if you had your tubes tied, it would be simple to untie your tubes, like untying your shoelaces. Tubal ligation can be reversed surgically for women who regret having had a tubal sterilization, but it's expensive and it doesn't always work.

For years, it has been noted that tubal sterilization decreased the risk of some types of ovarian cancer by 30% to 50%. Now, that's significant. Now, we're getting to the main topic of this little podcast. The lifetime risk of ovarian cancer in the U.S. is about 1.3 out of 100 women. Ovarian cancer is particularly deadly because it spreads early, and we don't have any early detection methods the way we do with breast cancer, like a mammogram, or cervical cancer with a Pap smear. Ovarian cancer comes in different types, but one of the most common types, serous ovarian cancer, may often actually arise in the end of the fallopian tube near the ovary. For this reason, women who have genetically-linked risks of ovarian cancer, such as the BRCA1 and 2 mutations with familial breast and ovarian cancer, are recommended to have their ovaries and their fallopian tubes removed when they finished having their families.

Recent studies have suggested that women who are planning a tubal sterilization who have their tubes completely removed have about a 60% reduction in the risk of these serous ovarian cancers compared to women who didn't have a tubal sterilization or women who just had part of their tubes removed at tubal ligation.

Now, there are other advantages to having the entire tube removed if a woman is planning a tubal sterilization. Tubal ligations have a known failure rate, a pregnancy after the procedure of as much as 3 to 5 pregnancies per 100 women over 10 years who had their tubal sterilization at the time other than when the baby was delivered, with laparoscopy. Women who had their tubes completely removed have a much lower failure rate, almost zero. Women who have a tubal ligation also have an increased risk of ectopic pregnancy or tubal pregnancy if they do become pregnant compared to women who've had their tubes removed completely.

Now, we know that putting a little clip on the tube, burning the tube, or cutting a loop of tube is quite simple and takes a very short time. Anybody could do it. Removing the whole tube takes a little longer. Studies recently published looked at women who were randomized to removing the whole tube at the time of tubal sterilization or cutting a loop out at the time of Caesarian section an easy time to do it as the tube is right there to look at and operate on.

One study used an advanced technique to take out the tube completely and found that time was only about five minutes longer compared to the standard procedure of taking out just a part of the tube. Another study using older techniques suggested took about 10 to 15 minutes longer. There was not significantly more blood loss with taking the whole tube out compared to just part of the tube.

The other issue is that if the entire tube is removed, you cannot come back and have your tubes untied or put back together again the way you might if only a part of the tube is removed. Of course, these days, many women who choose to have more children after tubal sterilization will use in vitro fertilization and it doesn't matter if you have part of a tube or no tube. Although IVF is expensive, so is surgically putting the tube back together again. And in some cases, IVF may be more successful.

So if you're planning a tubal sterilization, your tubes, not your husband's tubes, that would be a vasectomy, consider the following. If you have a BRCA1 or 2 mutation or have a strong family history of ovarian cancer, you should have your entire tubes removed when you have your tubal sterilization, whether it's right after the baby is delivered or sometime later. And often, women also had their ovaries removed.

If you have concerns about ovarian cancer, and you're planning a tubal sterilization, talk with your OB-GYN about taking the whole tube out. If you don't have a family history of ovarian cancer and the concern of the risk of ovarian cancer isn't high on your worry list, think about the benefits and risks that were just mentioned and discuss your options with your OB-GYN. Many OB-GYNs are discussing tubal removal as an alternative to tubal ligation when women are planning a tubal sterilization. Whatever you choose, we're glad you are informed about new options and old options in planning your family, and thanks for joining us on The Scope.

updated: September 10, 2020
originally published: August 9, 2018