Tubal Ligations

Since the Supreme Court overturned Roe v. Wade, ruling that states can ban abortion, there has been a marked increase in permanent sterilization procedures. In fact, the ”number of tubal ligations doubled between June 2022 and September of last year.”

There are numerous surgical procedures to perform sterilization on women. Tubal ligation is a procedure that clamps the fallopian tube, whereas during a salpingectomy the doctor removes the fallopian tubes. Tubal ligation and salpingectomy have similar results, based on a metanalysis. For the purposes of this piece, I’ll call both “tubals”. And, for what it’s worth, they are required to be paid for by insurance under the women’s health provisions of the Affordable Care Act. 

However, a new study stood out to me – it showed a shockingly high failure rate for tubals. This study, showing the inferiority of tubal ligation to IUDs, was concerning. The study showed that “3 to 5% of women in the United States who had their tubes tied later reported an unplanned pregnancy.” In what absolutely gobsmacked me is that apparently fallopian tubes can grow back (maybe?)! A 2014 study reported that of 140 cases of sterilization failure, there “were 25 cases (17.86%) of spontaneous recanalization.” Recanalization apparently refers to the process by which a blockage is removed, and is done surgically to address infertility.

Salpingectomies take a few more minutes to perform, surgically, but significantly reduce the risk of ovarian cancer - deadly disease for which there is no screening test. That is why ACOG recommends the salpingectomy. So, for what it’s worth, if you’re considering permanent birth control, salpingectomy and IUDs (which are reversible) are the most reliable options.