Tubal ligation

Tubal ligation is very reliable and in most cases will prevent pregnancy, but it is not 100% effective. About 1 in 200 women who have a tubal ligation may become pregnant. This may happen if:

• the fallopian tubes are not cut or blocked properly
• the cut ends grow back together
• the clips used to block the tubes migrate (move).

If pregnancy does occur after a tubal ligation, there is a higher chance that it will be ectopic. This means that the pregnancy happens outside your uterus (womb), usually in your fallopian tubes, where the foetus cannot survive.

Advantages

• You do not have to remember to take a pill every day.
• You would usually be asleep (under general anaesthetic) during the procedure.
• After the procedure is complete, it is a private method of avoiding pregnancy as you don't have to take contraceptives.
• Tubal ligation does not interfere with sex.
• There are no significant long-term side effects.

Disadvantages

• As tubal ligation is permanent, and difficult to reverse, some people regret having it – especially if their circumstances change. 
• Tubal ligation does not protect against STIs. Using condoms is the best way to prevent STIs. 
• There are possible surgery-related complications.
• Public funding may not be available for everyone who requests tubal ligation. Services may be prioritised based on clinical need. 

During tubal ligation, the fallopian tubes are closed either by:

• cutting and tying the tubes, or
• placing a clip, ring or band around the tubes.

There are 2 types of tubal ligation surgery – laparoscopic tubal ligation and mini-laparotomy. Your doctor will discuss the options with you.

Laparoscopic tubal ligation

This is the most common procedure by which tubal ligation is performed. The following steps are taken with this approach:

• Two small incisions (cuts) are made in your abdomen (tummy). A laparoscope (a long thin tube with a camera and light source at its tip) is inserted through one incision and surgical instruments are inserted through the other incision.
• The fallopian tubes are then able to be located and the tubal ligation performed.
• The incisions in the abdomen are closed with steristrips (small paper tapes) or small stitches.

Laparoscopic tubal ligation is usually performed under a general anaesthetic. The procedure takes about 30 minutes and you don't usually need to stay overnight in hospital.

Mini-laparotomy

Sometimes an ‘open’ surgical approach known as mini-laparotomy may be needed if the laparoscopic approach is unsuitable such as if you have:

• scarring in your pelvis from previous surgery
• health conditions such as endometriosis.

The following steps are taken with this approach:

• A single incision of about 4–5 cm long is made, just above your pubic hair line.
• Your fallopian tubes are located and the tubal ligation performed.
• The incision is closed with dissolvable stitches.

This type of tubal ligation usually requires you to stay in hospital for a day or two. 

Generally, tubal ligation is a safe procedure with very few complications. Most women have no problems after a tubal ligation.

However, there is a small risk of:

• infection, bruising or bleeding at the operation site
• pelvic pain or pain in your abdomen (tummy)
• a possible reaction to the anaesthetic
• rarely, damage to organs, including your bowel, bladder, uterus, ovaries, blood vessels and nerves.