Editing Tubal ligation (section)

== Risks and complications ==
{{See also|#Procedure technique|#Tubal ligation methods}}

=== Risks associated with surgery and anesthesia ===
Most tubal ligation procedures involve accessing the abdominal cavity through incisions in the abdominal wall and require some form of [[anesthesia]]. Major complications from laparoscopic surgery may include need for [[blood transfusion]], [[infection]], conversion to open surgery, or unplanned additional major surgery, while complications from anesthesia itself may include hypoventilation and [[cardiac arrest]].<ref name=":02" /> Major complications during female sterilization are uncommon, occurring in an estimated 0.1–3.5% of laparoscopic procedures, with mortality rates in the United States estimated at 1–2 patient deaths per 100,000 procedures.<ref name=":02" /> These complications are more common for patients with a history of previous abdominal or pelvic surgery, obesity, and/or diabetes.<ref name=":02" />

=== Failure ===
While female sterilization procedures are highly effective at preventing pregnancy, there is a small continuing risk of [[unintended pregnancy]] after tubal ligation.<ref>{{Cite journal|last1=Lawrie|first1=Theresa A|last2=Kulier|first2=Regina|last3=Nardin|first3=Juan Manuel|date=5 August 2016|editor-last=Cochrane Fertility Regulation Group|title=Techniques for the interruption of tubal patency for female sterilisation|journal=Cochrane Database of Systematic Reviews|volume=2016 |issue=8|pages=CD003034|language=en|doi=10.1002/14651858.CD003034.pub4|pmid=27494193|pmc=7004248}}</ref>  Several factors influence the likelihood of failure: increased time since sterilization, younger age at the time of sterilization, and certain methods of sterilization are all associated with increased risk of failure.<ref name=":02" /> Pregnancy rates at 10 years after sterilization vary depending on the type of procedure used, documented as low as 7.5 per 1,000 procedures to as high as 36.5 per 1,000 procedures.<ref name=":02" />

=== Ectopic pregnancy ===
Overall, all pregnancies, including [[ectopic pregnancies]], are less common among patients who have had a female sterilization procedure than among patients who have not.<ref name=":02" /><ref>{{Cite journal|date=March 2018|title=ACOG Practice Bulletin No. 193: Tubal Ectopic Pregnancy|journal=Obstetrics & Gynecology|language=en|volume=131|issue=3|pages=e91–e103|doi=10.1097/AOG.0000000000002560|pmid=29470343|issn=0029-7844|author1=American College of Obstetricians Gynecologists' Committee on Practice Bulletins—Gynecology|s2cid=3466601}}</ref> However, if patients do have a pregnancy after tubal ligation, a greater percentage of these will be ectopic; approximately one third of pregnancies that occur after a tubal ligation will be ectopic pregnancies.<ref name=":02" /> The likelihood of ectopic pregnancy is higher among patients sterilized before age 30 and differs depending on the type of sterilization procedure used.{{citation needed|date=May 2023}}

=== Emotional after effects ===
The majority of patients who undergo female sterilization procedures do not regret their decisions. However, regret appears to be more common among patients who undergo sterilization at a young age (often defined as younger than 30 years old),<ref>{{Cite journal|last1=Curtis|first1=Kathryn M.|last2=Mohllajee|first2=Anshu P.|last3=Peterson|first3=Herbert B.|date=February 2006|title=Regret following female sterilization at a young age: a systematic review|journal=Contraception|language=en|volume=73|issue=2|pages=205–210|doi=10.1016/j.contraception.2005.08.006|pmid=16413851}}</ref> patients who are unmarried at the time of sterilization, non-white patients, patients with public insurance such as [[Medicaid]], or patients who undergo sterilization soon after the birth of a child.<ref name=":02" /><ref>{{Cite journal|last1=Chi|first1=I. C.|last2=Jones|first2=D. B.|date=October 1994|title=Incidence, risk factors, and prevention of poststerilization regret in women: an updated international review from an epidemiological perspective|journal=Obstetrical & Gynecological Survey|volume=49|issue=10|pages=722–732|issn=0029-7828|pmid=7816397|doi=10.1097/00006254-199410000-00028}}</ref> Regret has not been found to be associated with the number of children a person has at the time of sterilization.<ref name=":02" />

===Side effects===

==== Menstrual changes ====
Patients who have undergone female sterilization procedures have minimal or no changes in their menstrual patterns. They were more likely to have perceived improvements in their menstrual cycle, including decreases in the amount of bleeding, in the number of days of bleeding, and in menstrual pain.<ref name=":02" />

==== Ovarian reserve ====
Studies of hormone levels and ovarian reserve have demonstrated no significant changes after female sterilization, or inconsistent effects.<ref>{{Cite journal|last1=Ercan|first1=Cihangir Mutlu|last2=Sakinci|first2=Mehmet|last3=Coksuer|first3=Hakan Ko|last4=Keskin|first4=Ugur|last5=Tapan|first5=Serkan|last6=Ergun|first6=Ali|date=January 2013|title=Ovarian reserve testing before and after laparoscopic tubal bipolar electrodesiccation and transection|journal=European Journal of Obstetrics, Gynecology, and Reproductive Biology|volume=166|issue=1|pages=56–60|doi=10.1016/j.ejogrb.2012.09.013|issn=1872-7654|pmid=23036487}}</ref> Evidence does not indicate a strong association between tubal ligation and earlier onset of menopause.<ref>{{multiref2
| The following study found "tubal ligation did not affect age at natural menopause in the three large cohorts": {{cite journal | last1=Ainsworth | first1=Alessandra J. | last2=Baumgarten | first2=Sarah C. | last3=Bakkum-Gamez | first3=Jamie N. | last4=Vachon | first4=Celine M. | last5=Weaver | first5=Amy L. | last6=Laughlin-Tommaso | first6=Shannon K. | title=Tubal Ligation and Age at Natural Menopause | journal=Obstetrics & Gynecology | publisher=Ovid Technologies (Wolters Kluwer Health) | volume=133 | issue=6 | year=2019 | issn=0029-7844 | doi=10.1097/aog.0000000000003266 | pages=1247–1254| pmid=31135741 | pmc=8543885 | doi-access=free }}
| This study qualified that tubal ligation "when performed correctly, should not compromise ovarian function" and that "if tubal ligation interferes with vascular supply to the ovaries, it may not be substantial enough to result in an earlier onset of menopause": {{cite journal | last1=Arinkan | first1=Sevcan Arzu | last2=Gunacti | first2=Mert | title=Factors influencing age at natural menopause | journal=Journal of Obstetrics and Gynaecology Research | publisher=Wiley | volume=47 | issue=3 | date=2020-12-21 | issn=1341-8076 | doi=10.1111/jog.14614 | pages=913–920| pmid=33350022 | s2cid=229351757 }}

| The following study found tubal ligation "was associated with a modestly higher risk": {{cite journal | last1=Langton | first1=C R | last2=Whitcomb | first2=B W | last3=Purdue-Smithe | first3=A C | last4=Sievert | first4=L L | last5=Hankinson | first5=S E | last6=Manson | first6=J E | last7=Rosner | first7=B A | last8=Bertone-Johnson | first8=E R | title=Association of oral contraceptives and tubal ligation with risk of early natural menopause | journal=Human Reproduction | publisher=Oxford University Press (OUP) | volume=36 | issue=7 | date=2021-04-02 | issn=0268-1161 | doi=10.1093/humrep/deab054 | pages=1989–1998| pmid=33822044 | pmc=8487650 }}
}}</ref>

==== Sexual function ====
Sexual function appears unchanged or improved after female sterilization compared with non-sterilized females.<ref>{{Cite journal|last1=Costello|first1=Caroline|last2=Hillis|first2=Susan D.|last3=Marchbanks|first3=Polly A.|last4=Jamieson|first4=Denise J.|last5=Peterson|first5=Herbert B.|last6=US Collaborative Review of Sterilization Working Group|date=September 2002|title=The effect of interval tubal sterilization on sexual interest and pleasure|journal=Obstetrics and Gynecology|volume=100|issue=3|pages=511–517|issn=0029-7844|pmid=12220771|doi=10.1016/s0029-7844(02)02042-2|s2cid=23735040}}</ref>

==== Hysterectomy ====
Patients who had tubal occlusion surgeries have been found to be four to five times more likely to undergo hysterectomy later in life than those whose partners underwent vasectomy.<ref name=":02" /> There is no known biologic mechanism to support a causal relationship between tubal ligation and subsequent hysterectomy, but there is an association across all methods of tubal ligation.<ref name=":02" />

==== Postablation tubal sterilization syndrome ====
{{main|Post-ablation tubal sterilization}}
Some females who have undergone tubal ligation prior to an [[endometrial ablation]] procedure experience cyclic or intermittent pelvic pain; this may happen in up to 10% of women who have undergone both surgeries.<ref>{{Cite journal|last1=McCausland|first1=Arthur M.|last2=McCausland|first2=Vance M.|date=June 2002|title=Frequency of symptomatic cornual hematometra and postablation tubal sterilization syndrome after total rollerball endometrial ablation: a 10-year follow-up|journal=American Journal of Obstetrics and Gynecology|volume=186|issue=6|pages=1274–1280; discussion 1280–1283|doi=10.1067/mob.2002.123730|issn=0002-9378|pmid=12066109}}</ref>