For most people who aren’t actively attempting to grow their families, there’s a good chance birth control plays a role in their lives. Specific methods are more numerous than ever, but most couples still opt for the pill, according to the Centers for Disease Control and Prevention. Not that there’s anything wrong with this; the pill has come a long way in term of safety and efficacy since it was approved for contraceptive use in 1960. Even still, remembering to take this prescription every day is a major inconvenience for those who don’t want to reproduce in the future. For these folks, permanent birth control is often more appealing.
Before anyone books a consultation appointment to eliminate their chances of procreating forever, they should get more familiar with the concept. Everything from your age to your relationship status to your budget matters when it comes to permanent birth control, and you don’t want to wind up in a position where you feel like you made a mistake. Before deciding to take the plunge, read up.
1. Both men and women have options
Birth control often ends up being the woman’s responsibility, but there’s no reason this has to be the case. She’s clearly the one who would get pregnant, but her partner also plays a pivotal role in the process. For this obvious reason, procedures exist for both men and women. The two most well-known types are tubal ligation (aka tying your tubes) for women and a vasectomy for men.
We’ll start with tubal ligation since it’s by far the more popular of the two. For this procedure, the surgeon makes two small cuts near the belly button to gain access to the fallopian tubes. According to MedlinePlus, the surgeon will then either cauterize the tubes or use a small band to clamp them shut. Once this happens, your ovaries are no longer able to release an egg into your uterus every month. In a slightly different type of procedure, surgeons will actually remove a portion or all of the fallopian tubes.
With a vasectomy, the idea is sort of similar. The surgeon will make a small incision or puncture in the scrotum to gain access to the vas deferens, which supplies sperm to a man’s semen. The surgeon will next cut the vas deferens then clip or cauterize the ends. According to Mayo Clinic, the whole procedure takes 10 to 30 minutes. For married couples or long-term partners, this is often the best choice because, as Urology Care Foundation explains, it’s second only to abstinence for efficacy. But keep in mind, it’s not immediately effective. According to The New York Times, it’s usually best to wait for about six weeks.
2. Surgery isn’t the only way to go
In 2002, the FDA approved a product called Essure that blocks off a woman’s fallopian tubes without the need for incisions. It might sound confusing, but Bedsider explains the procedure is like a more involved pelvic exam that uses local anesthesia. The doctor uses a very small catheter to pass through the cervix, which allows access to the fallopian tubes. He or she uses the catheter to insert the devices, which are essentially small metal coils, into the patient’s tubes. Over time, scar tissue builds up around these coils to permanently block off the fallopian tubes.
The main caveat to keep in mind with this procedure is it takes time, usually about three months, for the tubes to become fully blocked. This means, women who opt for the procedure will still need to use an alternative birth control method in the interim. And it’s not wise to simply assume everything worked after three months. The same article from Bedsider says it’s critical to get an X-ray or MRI to confirm everything went as planned.
3. It might be reversible, but it might not be
While the idea of permanently avoiding unwanted pregnancy might spur people to sign up immediately, it’s not the type of decision anyone should make lightly. More and more people are finding they regret their decision, opting for reversals after changing their minds about rearing children. While these procedures exist, they don’t guarantee you’ll be able to have kids. Johns Hopkins Medicine says only 50% to 80% of women become pregnant after reversing tubal ligation.
As for those who opt for Essure, it’s really hard to say. Because the treatment is so new, information about pregnancy rates after removal is shaky at best. In-vitro fertilization, however, is still an option.
Men tend to have more success, but there’s still no guarantee he’ll be able to father children. Part of it depends on the method of reversal. According to a recent review, anywhere from 72% to 96% of men can expect to reopen the blockage. This still doesn’t guarantee pregnancy, though. The same review reported pregnancy rates of 28% to 40%. It’s maybe more important to note the studies referenced have all been relatively small. For all we know, the chances of successfully becoming pregnant could be significantly higher or lower.
4. There’s no such thing as a no-pregnancy guarantee
Though rare, any form of permanent birth control bears some risk of pregnancy. Different studies suggest different pregnancy rates for the various procedures. The important thing to note is there are always cases where women find themselves unexpectedly expecting. The CDC reports the risk of pregnancy is 0.15% with vasectomy and 0.5% for female sterilization.
5. There are risks
Any type of procedure comes with some risk, so sterilization is no different. For both males and females, there’s potential for pain, bleeding, and infection. With vasectomies in particular, Washington University School of Medicine says some men experience chronic pain after the procedure. The story also mentioned some studies have linked the procedure to an increased risk of prostate cancer, but it’s still too early to say for sure.
Essure is a slightly different story. Scores of women have come forth with complaints of pain and major health complications after undergoing the procedure. In 2018, the FDA restricted the sale of the product.
6. More options are on the horizon
Though a vasectomy is currently the only choice for men, this may change in the coming years. Researchers have been testing an injection called Vasalgel for years, and results continue to prove promising. It’s essentially a gel, which a doctor injects into a man’s vas deferens, that allows fluid but not sperm to pass through. Another plus? It’s potentially easier to reverse. You can read more about it over at Parsemus Foundation, a not-for-profit organization working to bring the product to market.
One study published in Basic and Clinical Andrology found Vasalgel to be nearly 100% effective when tested on rabbits. Before you get too overjoyed, though, it’s still important to look at the details. For starters, this was an animal study. The sample size was also rather small, just 12 rabbits. There’s still more testing to be done, but it’s slated to move forward.
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