Dear Doctor,

I am pregnant with my third child and I was thinking this might be the last.  I want to have my tubes tied after birth. Is it a complicated procedure?  What should I expect and in the event that I change I mind, is it reversible?

Diana

Dear Diana

 Tuballigation or tubectomy as it known popularly, is one of the most commonly adopted procedures for permanent contraception. It is adopted by 33 per cent of women worldwide. Here, the fallopian tubes (that carry the fertilised ovum to the uterus are blocked to prevent implantation of the fertilised egg in the uterus.

It is a surgical procedure, which is done by using a spinal anaesthesia or if necessary, general anaesthesia. It is carried out if the woman has no medical condition preventing use of anaesthesia. The woman in question has to be "fit” for a surgical procedure. Uncontrolled diabetes, high blood pressure, bleeding disorders, severe anaemia, are some of the conditions, where the surgeon may defer doing tubectomy till the woman becomes stable and medically fit.

A nick is made on either side in area around the groin. The tubes are either cut, ligated, blocked by rings or cauterised. The procedure is associated with the same risks as any other surgical procedure. If there is lapse in following proper hygienic procedures, there can be post-operative infection. If a blood vessel is cut inadvertently, there can be bleeding. A tubectomy done with a caesarean section is highly desirable as the lower abdomen is already open, giving easy access to the parts of the uterus, including tubes. Tubal ligation not only prevents an unwanted pregnancy, it also reduces risk of ovarian cancer. 

Tubectomy is very effective in preventing pregnancy. However, rarely, one may conceive even after this procedure. The risk is more after one year, particularly with use of rings to block the tubes. This happens as the rings may slip. Ectopic pregnancy (where the fertilised ovum is implanted elsewhere instead of the inner lining of the uterus, is a risk after tubectomy or tubal ligation. Diagnosis is made on grounds of high suspicion and confirmed by ultrasound examination.  It is a surgical emergency, needing urgent surgery to remove the ectopic pregnancy.

If one desires to have a baby, after sterilisation procedure, a procedure known as recanalisation is carried out. Here, the blockade is removed or cut and the ends of the tube joined again.

Dr. Rachna Pande is a specialist in internal medicine.

rachna212002@yahoo.