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Failure of Sterilization
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In its basic form, there are two types of surgical sterilization. There is female sterilization, also called a tubal ligation. There is also male sterilization, known as a vasectomy. Both types of sterilization are effective in preventing pregnancy in a couple but both have their risks and benefits. Both types of sterilization can fail, tubal ligation having the highest failure rate.
In a tubal ligation, the surgeon can do it at the same time as a cesarean section or in a separate procedure involving a small incision at the umbilicus. Air may be pumped into the belly to better see the tubes and an endoscope is used to see the fallopian tubes up close and to manipulate the tubes. The tubes are separately localized by the endoscopic camera. A section of the tube is isolated and clamped in two places. The tube is tied off in two places and a small section of the tube is removed and looked at under the microscope to make sure actual fallopian tube was cut. Some doctors burn the edges of the tube to make it unlikely that the tube will reconnect.
Even if all things go as planned, a fallopian tube can reconnect at some time in the future. Tubal ligations can fail. The failure rate of a tubal ligation is about 1 out of every 200. Even so, it is important to ask your doctor to provide for the microscopist a sample of what was cut and tied. If it isn't the fallopian tube found under the microscope, you are not protected from pregnancy and need to have another procedure to correct the mistake in the previous tubal ligation. The pathology report for the tubal ligation won't be returned for about three days so you will already be recovering from the first procedure. After you completely recover from that, you will need the additional procedure.
There are risks in having a tubal ligation. Bleeding complications are always possible. There can be damage to the bowel or urinary tract that necessitates further surgery to correct the damage. Infection in any surgery is always possible, including peritonitis and sepsis, which can be severe. You can have anesthetic risks such as allergy to medications given as part of anesthesia. You can have heart problems while under anesthetics or breathing problems, including pneumonia as a result of the anesthesia intubation. There is a greater risk for tubal pregnancies if the tube partially or incompletely heals itself.
A male sterilization is called a vasectomy. It is usually done as an outpatient procedure in a doctor's office or surgery center. A cut is made on each side of the groin just above the scrotum after a local anesthetic numbs up the area around the scrotum. The surgeon then pulls out a bundle that contains some nerves, blood vessels and the vas deferens. The vas deferens is isolated from the rest of the bundle and a small section is cut out. Clips or sutures will be used to tie off the vas deferens and the same procedure is repeated on the other side. Small stitches are placed in the incision lines, which are about 1 centimeter or less in diameter. The doctor will have the sections of vas deferens studied under the microscope so as to make sure it is the vas deferens that was ligated and removed.
Risks of a vasectomy include bleeding complications, damage to the nerve supplying the testicles and scrotum or infection as a result of an unclean surgery. Antibiotics and local heat can be used to treat the infection, which is usually minor.
A vasectomy is not generally considered successful immediately after the procedure. It will take between 15 and 20 ejaculations in order to clear the vas deferens of active sperm. You can get a woman pregnant before the vas deferens is clear and you need two negative specimens of ejaculate to be declared sterile by means of vasectomy. The failure rate of the vasectomy is low. The failure rate of a vasectomy is about 1 in 2000 cases.