If a woman and her partner have decided they have enough children or want no children, then there are two options for them: tubal ligation or vasectomy.
These days, tying your tubes is the operation selected most often by two to one.
If this has been your decision, maybe you are wondering about the tubal ligation procedure.
What happens during the surgery? And just so you know should you change your mind later which 25% of women do, tubal reversal can be done for all of these procedures with varying degrees of success.
First let's start with a little anatomy lesson.
The fallopian tubes are what is most often affected during the tubal ligation procedure.
There are two of them, one on each side of the uterus and connected to it by the interstitial segment.
At the other end is the fimbrial segment which looks like a bunch of hairy fingers.
The "hair" are cilia which capture the egg as it is released by the ovary which lies outside the fallopian tubes and direct it into the tubes where the egg travels to the uterus.
To become pregnant, the sperm must meet the egg within the fallopian tubes and fertilize it.
The embryo continues to develop as it travels on down to the uterus to be implanted within the uterine wall.
The fallopian tubes themselves are about 4 inches long or 10 centimeters.
During the tubal ligation procedure, a doctor will work to interrupt this process.
Usually this is done by creating a blockage or gap within the fallopian tubes.
There are various techniques or methods used in the tubal ligation procedure.
While ligation actually means to apply a ligature or "tie", some of these methods do not involve actual ligatures.
Those that do are the Pomeroy, Irving and Parkland.
In the Pomeroy technique, a segment of the fallopian tubes is doubled up and a ligature is tied around it.
Next, the loop of doubled up tubes is cut away.
In a few days the ligature is absorbed and the cut ends scar over.
Now there is a gap between the ovarian or fimbrial end and the end connected to the uterus.
This method is over a hundred years old.
With the Irving and Parkland techniques, ligatures or ties that can't be absorbed are tied in two places on each tube.
The segment in between the ties is cut away.
In the Irving version, the segment still attached to the uterus is sutured to the back side of the uterus making the distance between the two pieces of each tube even further apart.
All of these methods can be reversed with a tubal reversal and have a very good success rate.
Another form of tubal ligation procedure that does include ligatures is fimbriectomy.
In this, the hairy finger-like end of the fallopian tubes nearest the ovaries is tied with a ligature and then cut off.
This cut end will scar over.
This method is more difficult to reverse and tubal reversal success is only about 30 - 40%.
Rings and clips can also used in tying your tubes.
With rings, a section of each tube is again doubled up and the ring slips over that section.
When released from the tool that applies it, it tightens up over the tube cutting off the blood and eventually forming scar tissue creating the tubal blockage.
Clips are applied over the narrowest part of the tube cutting off the blood and forming scar tissue once in place.
This latest form is the easiest to reverse through tubal reversal should one have any doubts about her sterilization.
Next are methods which do not actually involve ligation.
These include coagulation or "burning" and the hysteroscopic methods of the Essure and Adiana devices which are relatively new.
With coagulation, either bipolar or monopolar electricity conducting forceps are applied in at least one spot on each tube.
Not only does it burn through the tube, but these create some damage beyond the immediate location of the burn.
Monopolar causes more damage.
Some doctors will burn the tubes in more than one place.
Successful tubal reversal will depend upon how much damage has been done and how much of the tubes will be left after removing the damage.
The Essure and Adiana are devices that are introduced into the fallopian tubes via the cervix and uterus.
This means no surgery in this tubal ligation procedure which technically speaking they are not.
Each device has some manner of inducing scar tissue to form around and in them to create blocked fallopian tubes.
These are more difficult to remove in a tubal reversal and do require more extensive surgery than most other forms of tubal ligation procedures.
However, a handful of surgeries have been done with at the first Adiana reversal done this year already resulting in a pregnancy.
To decide upon which tubal ligation procedure is best for you will take discussion with your doctor.
Many times, the choice you get is determined not by what is best for you but what procedure your doctor is familiar with and performs.
If you want a different tubal ligation procedure done, like say the newer Adiana or Essure, you may need to seek out a physician who performs that tubal ligation procedure.
Just remember, for the quarter of all women who have this done but then change their minds, a tubal reversal is a very real possibility.