Sterilization

Sterilization involves making a person incapable of reproduction.

About one third of all married couples in the United States who use family planning methods choose sterilization. Sterilization should always be considered permanent. However, an operation that reconnects the appropriate tubes (reanastomosis) can be performed to restore fertility. Reanastomosis is less likely to be effective in men than in women. For couples, pregnancy rates are 45 to 60% after reanastomosis in men and 50 to 80% after reanastomosis in women.

Vasectomy is performed to sterilize men. It involves cutting and sealing the vasa deferentia (the tubes that carry sperm from the testes). A vasectomy, which is performed by a urologist in the office, takes about 20 minutes and requires only a local anesthetic. Through a small incision on each side of the scrotum, a section of each vas deferens is removed and the open ends of the tubes are sealed off. A man who has had a vasectomy should continue contraception for a while. Usually, he does not become sterile until about 15 to 20 ejaculations after the operation, because many sperm are stored in the seminal vesicles. A laboratory test can be performed to be sure that ejaculates are free of sperm.

Complications of vasectomy include bleeding (in fewer than 5% of men), an inflammatory response to sperm leakage, and spontaneous reopening (in fewer than 1%), usually shortly after the procedure. Sexual activity, with contraception, may resume as soon after the procedure as the man desires. Fewer than 1% of women become pregnant after their partner is sterilized.

Tubal ligation is used to sterilize women. It involves cutting and tying or blocking the fallopian tubes, which carry the egg from the ovaries to the uterus. More complicated than vasectomy, tubal ligation requires an abdominal incision and a general or regional anesthetic. Women who have just delivered a child can be sterilized immediately after childbirth or on the following day, without staying in the hospital any longer than usual. Sterilization also may be planned in advance and performed as elective surgery.

Sterilization for women is often performed by laparoscopy. Working through a thin tube inserted through a small incision in the woman's abdomen, a doctor cuts the fallopian tubes and ties off the cut ends. Or a doctor may use electrocautery (a device that produces an electrical current to cut through tissue) to seal off about 1 inch of each tube. The woman usually goes home the same day. After laparoscopy, up to 6% of women have minor complications, such as a skin infection at the incision site or constipation. Fewer than 1% have major complications, such as bleeding or punctures of the bladder or intestine. About 2% of women become pregnant during the first 10 years after they are sterilized. About one third of these pregnancies are mislocated (ectopic) pregnancies that develop in the fallopian tubes.

See the figure Disrupting the Tubes: Sterilization in Women.

Various mechanical devices, such as plastic bands and spring-loaded clips, can be used to block the fallopian tubes instead of cutting or sealing them. Sterilization is easier to reverse when these devices are used because they cause less tissue damage. However, reversal is successful in only about three fourths of the women.

Surgical removal of the uterus (hysterectomy) results in sterility. This procedure is usually performed to treat a disorder rather than as a sterilization technique.