Sterilisation is usually carried out using a technique called tubal occlusion (blocking the fallopian tubes). A cut is made in your abdominal wall to access your fallopian tubes.
An alternative method called hysteroscopic sterilisation involves inserting implants into your fallopian tubes. It does not require any cuts to be made into your body. The National Institute for Health and Clinical Excellence (NICE) has published guidance about hysteroscopic sterilisation. However, the technique is not yet widely available.
Both procedures are described below.
Tubal occlusion
First, your surgeon will need to access and examine your fallopian tubes, using either laparoscopy or mini-laparotomy.
Laparoscopy
This is the most common method of accessing the fallopian tubes. The surgeon makes a small cut in your abdominal wall near your belly button and inserts a laparoscope. A laparoscope is a small flexible tube that contains a light source and a camera. The camera relays images of the inside of your body to a television monitor. This allows the surgeon to clearly see your fallopian tubes.
Additional cuts can be made in your abdominal wall if other instruments, such as surgical scissors, need to be inserted.
See the Health A-Z topic about Laparoscopy for more information.
Mini-laparotomy
This involves a small incision, usually less than 5cm (2 inches), just above the pubic hairline. Your surgeon can then reach into your pelvis and access your fallopian tubes through this incision.
A laparoscopy is usually the preferred option because it is faster. However, a mini-laparotomy may be recommended for women who:
Blocking the tubes
The fallopian tubes can be blocked using one of the following methods:
- applying clips: plastic or titanium clamps are closed over the fallopian tubes
- applying rings: a small loop of the fallopian tube is pulled through a silicone ring, then clamped shut
- tying and cutting the tube: this destroys 3-4cm (1.2-1.6 inches) of the tube
Hysteroscopic sterilisation (fallopian implants)
The implants are usually inserted under local anaesthetic (painkilling medication to numb the area). You may also be given a sedative to relax you.
A narrow tube with a telescope at the end called a hysteroscope is passed through your vagina and cervix. A guidewire is used to insert a tiny piece of titanium metal called a microinsert into the hysteroscope, then into each of your fallopian tubes. This means that the surgeon does not need to cut into your body.
The implant causes the fallopian tube to form scar tissue around it, which eventually blocks the tube.
You should carry on using contraception until an imaging test has confirmed that your fallopian tubes are blocked. This can be done with one or more of the following:
- an X-ray – when radiation is used to examine the inside of your body
- an ultrasound scan – when high-frequency sound waves are used to create an image of part of the inside of your body
- a hysterosalpingogram (HSG) – a type of X-ray that is taken after a special dye has been injected to show up any blockages in your fallopian tubes
Removing the tubes (salpingectomy)
If blocking the fallopian tubes has been unsuccessful, the tubes may be completely removed. Removal of the tubes is called salpingectomy.
