Tubal ligation: Difference between revisions

Tubal ligation (edit)

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 ==Complications and risks==
-[[File:Ectopic Pregnancy Diagram.jpg|thumb|A diagram of a non-viable type of pregnancy in which an embryo implants in a fallopian tube. This can happen after tubal ligation if the tube has not been successfully cut, tied, blocked, or destroyed.]]
+[[File:Ectopic_Pregnancy.png|thumb|Some types of ectopic pregnancies in a uterus that hasn't had tubal ligation. Dangerous ovarian and tubal pregnancies can happen after tubal ligation if the tube has not been successfully cut, tied, blocked, or destroyed, or if the tube later reconnected.]]
 Statistics show that sterilization by tubal ligation is safer than giving birth.<ref name="strauss 1984">Strauss LT, Huezo CM, Kramer DG, Rochat RW, Senanayake P, Rubin GL. Sterilization-associated deaths: a global survey. International Journal of Gynaecology and Obstetrics. 1984 Feb;22(1):67-75. doi: 10.1016/0020-7292(84)90106-1. PMID: 6144595.</ref> Since tubal ligation is a surgery done under general anesthesia, it has the same risks of any such surgery, plus a few of its own distinctive risks, depending on the method used. Like any surgery, the most common serious risks are from infection, complications from the anesthesia, and bleeding too much (hemorrhage).<ref name="strauss 1984" /> Death from tubal ligation is extremely rare, and is usually caused by a reaction to anesthesia.<ref name="planned parenthood" />
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 Tubal ligation does not increase the risk of cancer, not even breast cancer.<ref name="brinton cancer" /> Tubal ligation correlates with a significantly lower rate of ovarian cancer.<ref name="brinton cancer" /><ref>Miracle-McMahill HL, Calle EE, Kosinski AS, Rodriguez C, Wingo PA, Thun MJ and Heath CW Jr (1997) Tubal ligation and fatal ovarian cancer in a large prospective cohort study. Am J Epidemiol 145: 349–357</ref>
-Tubal ligation makes it virtually impossible to get a pregnancy of any kind. It is extremely rare for a pregnancy to happen afterward anyway, but it can happen if the fallopian tubes weren't fully cut, tied, blocked, or destroyed, so that there was still enough of an opening in the tube for an egg or sperm to pass through. There is a tiny risk that if someone does get pregnant after a tubal ligation, then the embryo might implant in the wrong part of the uterus. This is called an ectopic pregnancy. Whether the embryo implants in the ovary (an ovarian pregnacy) or in the fallopian tube (a tubal pregnancy), it can cause the pregnant person to suffer circulatory collapse and die.<ref>Raziel, et al. “Ovarian pregnancy—a 12-year experience of 19 cases in one institution.” 2003.</ref> If someone gets an ectopic pregnancy, it is a life-threatening emergency that can only be fixed by removing the embryo (an abortion), which can sometimes only be done by surgery. For every 1,000 women who have their tubes cut, about 5 will later get pregnant, and of those, about 1 in 3 gets an ectopic pregnancy,<ref name="planned parenthood" /> which is still much rarer than ectopic pregnancies in people who have not had a tubal ligation. For comparison, even if someone has had their uterus removed, but still has ovaries, there is still a chance that they could get an ectopic pregnancy. The only kind of surgery that makes it completely impossible to get pregnant is removal of the ovaries, but that means the person's body won't make hormones anymore.
+Tubal ligation makes it virtually impossible to get a pregnancy of any kind. Rarely, a pregnancy can happen if the fallopian tubes weren't fully cut, tied, blocked, or destroyed, or if the tubes later reconnected (recanalization), so that there was enough of an opening in the tube for an egg or sperm to pass through. There is a tiny risk that if someone does get pregnant after a tubal ligation, then the embryo might implant somewhere wrong. This is called an ectopic pregnancy. Whether the embryo implants in the ovary (an ovarian pregnacy) or in the fallopian tube (a tubal pregnancy), the embryo generally can't survive,<ref>{{cite journal | vauthors = Zhang J, Li F, Sheng Q | s2cid = 35923100 | title = Full-term abdominal pregnancy: a case report and review of the literature | journal = Gynecologic and Obstetric Investigation | volume = 65 | issue = 2 | pages = 139–41 | date = 2008 | pmid = 17957101 | doi = 10.1159/000110015 }}</ref> and it can cause the pregnant person to suffer circulatory collapse and die.<ref>Raziel, et al. “Ovarian pregnancy—a 12-year experience of 19 cases in one institution.” 2003.</ref> If someone gets an ectopic pregnancy, it is a life-threatening emergency that can only be fixed by removing the embryo (an abortion), which can sometimes only be done by surgery. Worldwide, pregnancy happens after tubal ligation in 1 in 200 cases; of those pregnancies, 1 in 10 of them were ectopic pregnancies.<ref name="Date">Date, Shilpa Vishwas et al. “Female sterilization failure: Review over a decade and its clinicopathological correlation.” International journal of applied & basic medical research vol. 4,2 (2014): 81-5. doi:10.4103/2229-516X.136781</ref> However, the preferred method, salpingectomy, destroys the whole fallopian tubes, which makes it far safer for preventing pregnancies (ectopic or otherwise) than tubal ligation methods that only cut, tie, or block the tubes. There have only been two reported cases worldwide of spontaneous pregnancy after bilateral salpingectomy.<ref name"Bollapragada">Bollapragada, Shrikant S et al. “Spontaneous pregnancy after bilateral salpingectomy.” ''Fertility and sterility'' vol. 83,3 (2005): 767-8. doi:10.1016/j.fertnstert.2004.07.970 Full text: https://www.fertstert.org/article/S0015-0282(04)02993-0/fulltext</ref>
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