Sterilization – The Conscious Choice To End Fertility
To finish up our series on modern contraceptive options, I want to talk about sterilization, since it is one of the most widely used options among mature women who have had children.
The various methods of sterilization are meant to permanently render you sterile. These methods are not appropriate for teens or women who may want to have children.
Doctors will often refuse to sterilize young women for fear that she might change her mind in the future and wish to have children. The younger a woman is when she gets sterilized, the more likely she will be to have regrets in the future regarding her decision. While it is possible to reverse some of these procedures, doing so is costly and doesn’t guarantee success.
So with that in mind, let’s start with the options available for women, including a look at the latest non-surgical methods of sterilization for women. Then we’ll finish up with a look at what’s available for men.
Approximately half of the 10.3 million American women who use tubal ligation to prevent pregnancy had the procedure done immediately after delivering a baby. It’s an extremely effective method of preventing pregnancy. However, if a pregnancy should occur after the procedure (very rare), there’s a much greater risk of it being an ectopic pregnancy.
An ectopic pregnancy occurs when the egg implants outside the uterus, either in the abdominal cavity or most often, in the fallopian tube. When the embryo grows too large for the slender fallopian tube, it can rupture and cause fatal hemorrhaging. If an ectopic pregnancy is suspected it should be addressed immediately with the help of your physician, local clinic or emergency room.
There are many ways to “get your tubes tied”. They include tying, clamping, cutting, cutting and tying, burning (cauterization), and physically removing sections of the fallopian tube. Tubal ligation costs somewhere between $1500 and $6000 and according to Planned Parenthood you may be able to use your health insurance to help cover the costs. It may also pay to shop around; different facilities may have different costs for the procedure. Just be sure to find a good surgeon, as they are cutting you open after all!
Essure is a non-surgical method of sterilization for women that has been available since 2002. It doesn’t contain hormones and there is no scar left behind after placement. You can have it done in the doctor’s office and go home right after.
They insert the device into the fallopian tube by entering the uterus through the cervix, much like when placing an IUD. Essure is a small coiled spring that will remain in your fallopian tube as scar tissue forms around it.
Essure works by causing irritation and inflammation in the fallopian tubes, provoking an immune response. Scar tissue forms around the device, blocking the fallopian tube so sperm can’t reach the egg. After ovulation, the egg remains trapped on the ovary side of the fallopian tube and can’t reach the sperm.
It takes time for the scar tissue to form so an alternative method of contraception is used for the following three months until you receive the “OK” from your doctor.
When you return for your follow-up appointment they’ll conduct a test to ensure the device successfully caused the blockage of your fallopian tubes. The test consists of injecting contrast dye into the uterine cavity through the cervix and using a special x-ray for confirmation.
If for some reason pregnancy should occur with Essure in place, it’s likely to be an ectopic pregnancy due to all the scarring in the fallopian tube. As previously mentioned this is a life-threatening emergency that must be addressed right away.
The cost to have Essure inserted is around $2000. If you have health insurance, this option may be available to you at no cost under your contraceptive health benefits.
One thing to know about this method of sterilization is that the device contains nickel. You’ll want to make sure nickel isn’t a problem for you before Essure is inserted. There can be unexpected consequences too: some women have reported chronic pelvic pain after Essure was inserted.
One of the issues with Essure is that if it’s not working out, once the scar tissue has formed you can’t remove the device. The only way to get rid of it would be a hysterectomy, which means removing your uterus.
In rare cases, the device can migrate from where it’s supposed to be into the abdominal cavity. This is a medical emergency and requires surgery to locate and retrieve.
Adiana Permanent Contraception
Adiana is the newest method of sterilization available for women, introduced to the public in 2009. It uses a two step approach: first the fallopian tube is damaged by using radiofrequency waves to create a small and precise thermal injury. Then a tiny plug about the size of a piece of rice is inserted through the cervix into the injured area. As the injury heals, the tissue grows into the special silicone matrix and seals off the fallopian tube, preventing future pregnancies. This particular method of sterilization may take as long as 6 months to become fully effective. The FDA requires a hysterosalpingography (HSG), with contrast dye to be preformed afterwards. This is the medical term for the special x-ray test I mentioned earlier and would be translated as followed: hyster– refers to the uterus; salping– refers to the fallopian tube; and –graphy refers to the record or recording that will be made while the test is performed. This test is required to make certain the fallopian tubes are blocked.
Men really only get three choices when it comes to preventing pregnancy. The first is to use a condom, the second to practice withdrawal, and the third is permanent sterilization by vasectomy.
Have you ever wondered about the word vasectomy? It’s a medical term. Vas– refers to the vas deferens, a tube through which the sperm travels when ejaculation occurs. –ectomy means that part of the body is removed surgically. So vasectomy means that a portion of the vas deferens is surgically removed to prevent sperm from leaving the testicles. This causes permanent sterility.
As far as the actual surgery goes, it’s just a tiny incision or a small puncture wound made through the skin of the scrotum. The methods used for vasectomy are similar in many ways to tubal ligation. The vas deferens may be cut and cauterized or a portion may be removed.
After the vasectomy, a man can go home right away but needs to use an alternative form of birth control until a semen analysis comes back showing no sperm.
Vasectomies can range in cost from $300 to $1000 and sometimes will be covered under health insurance policies.
Deciding to get sterilized is a big decision. It’s not reversible, (at least not easily or cheaply) and there is no guarantee of success if you try to get it reversed.
In the past, the cost of sterilization has been prohibitive for many who would choose this option. With the introduction of the Affordable Care Act (Obamacare), these procedures may be covered under your birth control benefits, if you have health insurance.
Some people worry about possible consequences when forcing the body to retain sperm, while others have concerns about disrupting energetic meridians of the body by severing fallopian tubes or vas deferens. Others worry about arterial blood flow to the ovaries being damaged during tubal ligation or unforeseen problems from surgery. Some may feel uncomfortable with the idea of a foreign object in the body, as with Essure and Adiana, and worry about possible unexpected long-term consequences such as chronic pelvic pain.
Only you can decide what is best for you. I encourage my clients to learn about all the options and do their own research and ask lots of questions so that they can make an informed decision about what is best for them.
If you’re baby-making years are behind you, sterilization can be a great solution for worry free sex (don’t forget about STDs).
Sterilization Not For You?
For those of us who are young, who still want children, or who choose not to get sterilized for any number of reasons, fortunately, we have many options to choose from.
Over the last few blog posts we’ve been talking about the different types of modern birth control available, and by now, you know the advantages and disadvantages of each.
Coming up next time we’re going to cover one of my favorite topics – what to do if you are sick of condoms or worried about relying on withdrawal and you’d like a better option.