a. Female sterilization is the leading popular method of fertility control in the United States, especially in women over 30 years old.
b. Fifty percent are done at the time of delivery; 50% are done outside of pregnancy (interval).
c. Women should be carefully counseled before they make such a permanent decision.
d. All possible future situations should be discussed (i.e., divorce, remarriage, death of a spouse or child, future improvement of economic situation).
e. Women younger than 30 years old have a greater tendency to regret the decision and seek reversal. Between 5% and 15% regret it. Only 1% to 2% seek reversal.
f. Only the partner who has made the decision to end the possibility for child bearing should have the permanent procedure done.
g. All other birth control options should be reviewed with the patient because she may not realize the benefits connected with other birth control options and the importance of keeping the option to have children in the future open.
h. Also, it must be made very clear to the patient that this procedure should be viewed as permanent even though it has a failure rate.
(1) Pomeroy technique
(a) The technique was published in 1930; it’s considered “the gold standard.”
(b) A loop of fallopian tube is grasped with a babcock clamp. An absorbable, plain, catgut suture is tied around the loop; the loop is excised and is sent to pathology.
(2) Irving technique
(a) Described in 1924.
(b) Destroys no tube, is highly effective, and is highly reversible.
(c) The tube is divided at the isthmus. The proximal end is buried in the myometrium, and the distal end is buried in the broad ligament.
(d) There is no known failure rate.
(e) The morbidity is higher than for other tubal ligation methods.
(a) The procedure is not reversible; it is permanent.
(b) Fimbria is totally excised, including the fimbria ovarica (portion of the tube connected to the ovary).
(c) Failures are secondary to not excising the fimbria ovarica.
(4) Postpartum tubal
(a) It is done 1 day postpartum.
(b) The incision is a small infraumbilical incision and may be done transversely very close to the umbilicus. Often the incision is hidden within the umbilicus and is no larger than a laparoscopic incision.
(1) Uchida technique
(a) A saline epinephrine solution is injected into tubal musculature to separate the serosa from the inner circular muscle of the tube.
(b) The edematous tube is incised on its antimesenteric side.
(c) The inner circular muscle of the tube is excised.
(d) The proximal stump is buried beneath the edematous serosa and the distal stump outside the serosa.
(e) The excised portions are sent to pathology.
(2) Clip application technique.
Techniques for tubal sterilization
(a) Spring loaded clips are used (same as for laparoscopy).
(b) The isthmus of the tube is stretched between two babcock clamps.
(c) The clip is put on by hand by holding the jaws of the clip between the thumb and the third finger. The index finger pushes the spring into locked position.