After the Supreme Court overturned Roe v. Wade in June, gynecologists across the country have reported seeing an increase in patients who want to get their fallopian tubes tied. But it isn’t always easy to get the procedure. The Washington Post asked doctors about tubal sterilizations; here’s what they said.
1. What is tubal sterilization?
Tubal sterilization, also known as tubal ligation or “getting your tubes tied,” is a form of permanent sterilization involving closing the fallopian tubes, or removing them entirely (which is known as a bilateral salpingectomy). The fallopian tubes carry eggs from the ovaries to the uterus and are the site of fertilization with sperm, allowing for a pregnancy. Once closed or removed, the tubes can no longer allow for fertilization, preventing pregnancies with more than a 99.5 percent success rate.
2. How old do I have to be to get my tubes tied?
There is no set legal age requirement for getting your tubes tied, and the age minimum can vary by state, insurance company and physician. Many younger patients have faced, and continue to face, doubt and pushback from doctors, and some are denied the procedure entirely. If you are younger than 21, Medicaid will not cover the procedure.
3. Will my insurance cover the procedure?
Under the Affordable Care Act, private insurance companies are required to cover tubal sterilizations, but patients may still have to pay some of the cost. Patients using Medicaid to cover sterilization must wait at least 30 days to receive the procedure after giving consent — another requirement that some say is a barrier. “For people who are pregnant and desiring a tubal at the time of their delivery, or immediately postpartum, [the Medicaid waiting period] has become an issue,” said Amy Lasky, an OB/GYN in Stony Brook, N.Y. Out-of-pocket costs for the procedure can range from zero dollars with insurance to $6,000 without it — many times the cost of a vasectomy, a form of sterilization that prevents sperm from flowing through the sperm duct and combining with semen.
4. Is tubal sterilization reversible?
It depends. Most types of tubal sterilization cannot be reversed, but some procedures are technically reversible through major surgery that is not always effective and can be costly. However, physicians encourage patients to be certain they want their tubes tied, because the procedure is not meant to be reversible. “It’s meant to be considered permanent,” Lasky said. “I think that’s a common misconception that people have when talking about tying your tubes, that it’s like a tie that you can then untie. I’ve heard that before, but it is not that. It’s considered sterilization [that is] permanent.” Bilateral salpingectomies, which are increasingly common, are not reversible because they involve entirely removing the fallopian tubes, said Franziska Haydanek, an OB/GYN in Rochester, N.Y., who makes TikTok videos informing patients about tubal sterilizations.
5. What can I expect at my initial consultation for a tubal sterilization?
According to recommendations from the American College of Obstetricians and Gynecologists, physicians are advised to emphasize to patients the permanence of the procedure, discuss with patients other reversible contraceptive options and, “in appropriate cases,” discuss the sterilization of male partners “as an option with fewer risks and greater efficacy than female sterilization.” You may be asked how certain you are about being sterilized, especially if you are younger, and be informed about the risk of regret. Many younger patients have reported facing resistance from physicians during consultations.
6. How difficult is it to get a tubal sterilization performed?
In addition to the barriers some patients report about getting the procedure performed, it is important to note the procedure itself is a surgical procedure, unlike a vasectomy, which is an office procedure. “It takes around under 30 minutes,” Lasky said. “But compared to vasectomy, it’s far more invasive.” Although it is a minor surgery with generally three incisions, she said it has surgical limitations: no heavy lifting for at least four weeks, no exercise, waiting to go back to work until you feel ready. “Although for a minor surgery, I have plenty of people who go back to work the next week,” Lasky said, adding that pain and recovery is also “different for everybody.”
7. Can I still get pregnant after a tubal sterilization?
Tubal ligations are more than 99.5 percent effective in preventing pregnancy, Lasky said. But if you decide to have children post-tubal sterilization, you can still pursue a planned pregnancy through in vitro fertilization (IVF) or surrogacy. IVF is an expensive procedure, however, and typically costs $15,000, according to Haydanek. And there are concerns that the IVF procedure could become more complicated and costly after the Dobbs decision.
8. Where can I schedule a tubal sterilization and find resources?
In addition to making informative TikTok videos, Haydanek has put together a list of gynecologists she describes as “willing to perform a tubal ligation on any patient, 18-21+, no matter their marital status or number of children.” Lasky has created a Twitter thread with resources. And r/childfree on Reddit offers resources for patients seeking tubal sterilizations. Patients have also reported bringing sterilization binders to appointments assembled from online how-to guides to answer their physicians’ questions.