In a Post-Roe World, Interest in Sterilization Spikes

Faced with the loss of reproductive autonomy, individuals are increasingly turning to sterilization and tubal ligation. Here's a closer look at the options and what's involved.

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In a now-viral TikTok video that was shared on February 1, Abby Ramsay made an important announcement: They would be undergoing female sterilization, fulfilling their goal of living a child-free life.

"I'm excited to take control of my own body," Ramsay wrote in the caption. "I'm not a baby maker."

Though unknown at the time, Ramsay's decision would precede another that would determine the reproductive fate of individuals across the United States. Just months later, on June 24, the Supreme Court went on to overturn Roe v. Wade, the landmark ruling that guaranteed a person's constitutional right to a safe and legal abortion. The right to abortion is now up to individual states—many of which have already outlawed the procedure.

Faced with the loss of their reproductive autonomy, an increasing number of people are opting to undergo permanent sterilization.

"On June 24, traffic to our webpage about how to get a sterilization increased by 2,205%, and has increased by more than 400% through July 14," Diana N. Contreras, MD, MPH, chief healthcare officer at the Planned Parenthood Federation of America, told Health.

Taraneh Shirazian, MD, a board-certified gynecologic surgeon at NYU Langone Health, has also seen an uptick in the number of patients coming in for female sterilization procedures—a rise that was evident even before the Supreme Court decision.

"It was definitely a younger group of patients than I've seen in the past; it's been women 20 and 30," said Dr. Shirazian, who is also the director of NYU Langone's Division of Global and Community Women's Health. "I asked them anecdotally what prompted their decision and they all pointed to the fact that they [had] wanted this for some time, but the thing that compelled them to do it now was that Roe was being overturned."

With requests for female sterilization on the rise, here's a closer look at what the procedure involves, its risks, benefits, and long-term considerations.

What Is Sterilization?

Sterilization, which is also sometimes called tubal sterilization or female sterilization, is a permanent form of birth control. It involves closing off or removing the fallopian tubes, according to the American College of Obstetricians and Gynecologists (ACOG). This procedure stops an egg from moving down a fallopian tube, preventing sperm from meeting with it. Sterilization is different from a hysterectomy, or the surgical removal of the uterus.

Tubal sterilization can be achieved through a few different methods. A tubal ligation involves permanently cutting and closing off the fallopian tubes. Another approach is what's known as a bilateral salpingectomy, which involves complete removal of the fallopian tubes.

"Traditionally we would buckle the tube, cut it, and cauterize it… severing the tube instead of removing the tube. That's called tubal ligation," said Dr. Shirazian. "Now we surgically remove the fallopian tubes in its entirety. The reason that has become the standard of care is because it has been shown that tubal removal will offer women long-term benefits against ovarian cancer. It's unrelated, but it offers preventative opportunities for the future."

When the fallopian tubes are completely removed, the procedure is not reversible. While tubal ligation is technically considered reversible, even that is extremely limited and often will not work.

"Some types of tubal ligation can be reversed," Adi Katz, MD, director of gynecology and director for the obstetrics and gynecology residency program at Lenox Hill Hospital. "It only works 50% of the time and these patients are at a significantly increased risk of ectopic pregnancy."

What Are the Risks Associated With Sterilization?

Sterilization is considered to be a very safe procedure, but, like any surgical procedure, there are associated risks. These include anesthesia-related complications, bleeding, infections, and injury to other organs, but there are typically few complications from the procedure.

In very rare situations, the fallopian tubes can reconnect or become blocked. Pregnancy after tubal ligation is possible but also rare. This is called an ectopic pregnancy—when a fertilized egg implants and grows in a fallopian tube—and can be extremely dangerous. However, the risk of ectopic pregnancy is lower after a tubal ligation than it is in women who do not use any form of birth control, according to ACOG.

Sterilization also does not have an effect on an individual's hormone levels. "There is no strong evidence of effect on ovarian reserve or age of menopause," said Dr. Katz. That means, depending on age, you will continue to get your period after sterilization; the procedure will not cause menopause. There may also be a decreased risk of ovarian cancer, added Dr. Katz.

However, research shows that in some cases, feelings of regret can also be linked to sterilization: Approximately 25% of sterilized reproductive-aged women in the U.S. express the desire to have their sterilization procedure reversed—but what leads to those feelings is not yet fully understood.

"There have been several factors that were found to be associated with permanent sterilization regret," said Dr. Katz. "Young women under 30 have higher regret rates; Black women and younger women were the most at-risk for regret, single marital status, and immediate postpartum sterilization."

How To Determine if Sterilization Is Right for You

The ACOG stresses that, in choosing sterilization, you should be secure in your decision that you never want to get pregnant.

Sterilization should never be a decision made by anyone other than the person electing to undergo the procedure; nor should it be a quick fix to any problems that are considered to be temporary—that can mean marriage or sexual issues, short-term mental or physical illnesses, or financial issues.

If you're even slightly unsure about sterilization, your best bet may be to try out an intrauterine device (IUD), or have a conversation with a male partner about the male option for sterilization—a vasectomy, said Dr. Katz.

"We have wonderful long-acting contraceptive options, both hormonal and non-hormonal," said Dr. Katz. "Also, [it's] important to note that vasectomies can be done as an office procedure that does not require general anesthesia and is a safe alternative to tubal ligation."

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