A couple may decide for many reasons that they are finished— or decide not to begin—having babies. Sometimes it is an agonizing choice filled with uncertainty. Other times it is a decisive, clear choice reached after months or years of deep conversation and mutual agreement between spouses. It was surprising to me to learn that permanent sterilization is the most widely used form of contraception (36% of all contraception users) in the U.S. This figure represents those who have chosen tubal ligation, vasectomy, or the Essure procedure.
Veronica* had a tubal ligation performed immediately after the birth of her third child, before she even left the hospital. All of her pregnancies were rough, and sterilization seemed like the right decision at the time. She did consent, but she felt pressure from her doctor and her husband, in an emotionally stressful time in her life. Half of tubal ligations are performed immediately following childbirth, like in Veronica’s case. She did not know much about fertility awareness methods (FAM) at the time, but after being exposed to them, she told me how much she wishes she had not chosen sterilization. She wants others to know that there is a healthier, less final, and very effective way to avoid pregnancy permanently—the Creighton Model, which is 96.8% effective (real use) in avoiding pregnancy and offers one-on-one professional support and education.
Mary* and Jason*—both in their mid-thirties— thought that having babies might not be a possibility for them. Mary’s health challenges and medication regimen would make it difficult for her to have a healthy pregnancy. Although they strongly desired to have children, they had decided it would be most prudent to avoid pregnancy for a time—perhaps even permanently. That was their intention as they began using fertility awareness. In a few short weeks, cardiac concerns emerged for Mary. She and Jason were sure that the cardiologist would discourage them from pursuing pregnancy as a result of the test results. The test came back negative—there were no issues, and they began using days of fertility to achieve pregnancy. Mary became pregnant in that first cycle and they anticipate their child’s birth in July.
Jennifer* and Robert* had three kids close in age and were physically and emotionally exhausted. The idea of sterilization had been discussed but rejected due to the risks involved. Although they had never used hormonal birth control, they had relied upon withdrawal. Having just turned 40, Robert was nervous and skeptical about abandoning withdrawal and using fertility awareness. However, Jennifer was faithful to attending the sessions and keeping her chart up-to-date. Now, over 20 months into using the system, they have successfully avoided pregnancy and have experienced increased intimacy in their marriage. Jennifer likes the idea of another child in the future, whereas Robert is pretty confident that they will not have any more. By using a fertility awareness rather than sterilization, they can try for another pregnancy if circumstances change or continue to use it to avoid pregnancy indefinitely. There is no pressure to make a decision that one or both spouses may someday regret.
Sterilization—both male and female—alters a healthy body system, rendering it infertile. This has consequences for reproduction, but also for the entire body as each organ is meant to function harmoniously together with the others.
A vasectomy procedure prevents sperm from the vas deferens from entering the ejaculate. The most common current practice involves accessing the vas deferens via the scrotum. Localized lidocaine anesthesia is given to the man to numb the area prior to this in-office procedure.
Potential Side Effects of Vasectomy[i]:
- 20% of men have feelings of incompetence following procedure
- Localized infection
- 1-5% of men have chronic Post-Vasectomy Pain Syndrome
- Small possibility of pregnancy, especially in first 3 months
Tubal ligation is a surgical—rather than in-office— procedure that is done under general anesthesia, epidural, or spinal anesthesia. The fallopian tubes are surgically severed so that the egg cannot pass through the tubes and sperm are blocked from entering the tubes.
Potential Side Effects of Tubal Ligation:
- Hormone imbalance due to blood supply shortage to the ovaries, tissues, and fallopian tubes
- Early menopause and related symptoms
- Increased risk for osteoporosis
- Structural challenges such as endometriosis and pelvic adhesions
- Mild to severe pain and heavy periods
- 1-2% of women have anesthesia-related complications
- Decreased lactation
- Small possibility of pregnancy and higher risk for ectopic tubal pregnancy
During the Essure in-office procedure, small coils are implanted in the fallopian tubes. The coils cause the formation of scar tissue during the next three months, blocking the tubes from the possibility of sperm or egg passing through. Essure has been the focus of a large social media uproar stemming from Erin Brockovich’s campaign to spread the stories of many women who have been harmed from the procedure and want to get it off the market. Women share daily on the 24,000-member Essure Problems Facebook page of the debilitating problems they suffer including, but not limited to migraine headaches, severe cramps and pain, painful intercourse nausea, allergic reactions, autoimmune problems, and colon, organ, and tubal perforation. Many end up having to get a hysterectomy to remove it due to these adverse reactions. Many others report pregnancies, as the effectiveness rate has been found to be as low as 85% rather than the manufacturer Bayer’s reports of 97% effectiveness.
Reversal is possible for vasectomy, tubal ligation, and Essure, however these procedures cost more and come with more complication. They vary in success and it is often necessary to see a specialist. While insurance may cover the sterilization procedures, it does not frequently cover the reversal procedures. Learning how to chart fertility signs, even after sterilization of either the man or woman, can still provide valuable information on regarding the woman’s reproductive health.
The female body gives us signs, that through appropriate instruction, assists the couple to determine times of natural fertility and infertility. Using this information, couples around the world are having great success permanently avoiding pregnancy for years after their families are complete. They are having deep, meaningful conversations about their reasons for avoiding pregnancy and constantly re-evaluating their goals. Know the risks and side effects of sterilization procedures, share this information with family and friends, and consider learning a fertility awareness method today.
*Not their real names
[i] Hilgers, Thomas W. M.D. Reproductive Anatomy & Physiology, Second Edition, Pg. 101.
When this article refers to fertility awareness methods (FAM), or natural family planning (NFP), we are referring to Fertility Awareness-Based Methods, evidence-based methods of cycle charting which can be used as effective forms of natural birth control when learned by a certified instructor.