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There are two primary methods of sterilization to render an
individual infertile, tubal ligation and vasectomy. Both are highly effective
methods, and both should be considered permanent. Occasionally, with
considerable surgical effort and good fortune, they can be reversed, but this
is by no means an assured outcome. Sterilization should not be chosen if the
patient has any intention of seeking a pregnancy at a later time.
Tubal ligations can be performed in a number of different
ways, including outpatient laparoscopic surgery, post partum surgery, or
during a cesarean section. All involve blocking the fallopian tubes, keeping
sperm from reaching the egg. The tube may be crushed, cut, burned, ligated,
clipped, or removed. All are approximately 99% effective (failure rate of about 1%).
All have potential complications, but they are, for the most part, limited to
the usual surgical complications of bleeding, infection, anesthesia problems
and injury to adjacent structures. Other than pregnancy, long-term
complications are exceedingly rare.
 The advantages to tubal ligation are reliable, permanent sterilization, with no need for hormones, mechanical or
chemical methods to prevent further pregnancy. The disadvantages relate primarily to the surgical procedure itself:.
The cost of tubal ligation varies, depending on the setting. Performed
during a repeat cesarean section, it adds little to the cost of the procedure.
Performed as a separate procedure, the cost is typically that of a major
abdominal surgery. Health insurance coverage varies.
Vasectomy is a highly effective method of permanent male sterilization.
This surgical procedure is usually performed as an outpatient, using local anesthetic,
and lasting a few minutes. The vas deferens (tube connecting the testicle to the urethra)
on each side is tied off. After a number of later ejaculations, during which the remaining
downstream sperm disappear from the system, permanent sterilization is achieved.
It is approximately 99% effective (failure rate of about 1%).
It should be considered permanent and irreversible, although in some cases, it can be
reversed. The greatest success rates at reversal are achieved if reversal occurs soon
after the vasectomy. The longer reversal is delayed, the less effective it is likely to
be. For men who may wish to have children in the future, vasectomy is not a good choice.
The advantages are permanent sterilization, with no need for hormones, mechanical or
chemical methods to prevent further pregnancy.
The disadvantages relate primarily to the surgical procedure itself: infection,
bleeding, injury to other organs, and anesthesia complications. These are uncommon with
this type of surgery.
The cost of vasectomy varies with the clinical setting and technique,
but ranges between $300 and $1500, about one quarter the cost of many
tubal ligations.
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