For couples searching for permanent sterilization, a vasectomy and a tubal ligation are the most popular options.
A vasectomy is a procedure that removes a portion of the vas deferens, which carries sperm into the ejaculate. A tubal ligation is a surgery that either cuts, closes, or removes a piece of the fallopian tube, which carries the egg into the uterus.
In this article, we are going to explore both procedures and help you make the most informed decision on which is right for your family!
Vasectomy vs Tubal Ligation
A vasectomy is an office-based procedure that can be done with or without nitrous oxide as a “sedative”. Even with the use of nitrous oxide, patients are able to drive themselves home. The usual amount of time spent in the office, including the procedure, is around one hour. It involves one incision in the scrotum.
A tubal ligation is a surgical procedure that is performed in the operating room under spinal (epidural that numbs the lower half of the body) or general anesthesia (fully asleep). This is typically an outpatient surgery procedure. While patients come and go home the same day, this typically comprises the majority of a day. The patients have to arrive at the hospital/surgery center a few hours prior to the procedure and can only go home once they have had time to recover from the anesthesia. Patients will need a ride home afterwards. About half of female sterilizations are performed in the immediate postpartum phase out of convenience, however, it can also be performed at any time. It involves 3+ incisions within the abdomen, depending on the provider.
Safety Comparison and Complications
Both vasectomy and tubal ligation are safe procedures. However, a tubal ligation inherently has more risks. There are two main reasons for this: anesthesia and entry into the abdomen. The risks of general anesthesia depend on the medical history of the patient, but are generally very low. These include heart attack, stroke, blood clots in the legs or lungs, and rarely death. Additionally, because of entry into the abdomen, there is a small risk of injury to organs or blood vessels within the abdomen. There is also an increased risk of ectopic pregnancy after tubal ligation. This is a pregnancy that occurs outside of the uterus and can be life threatening in certain scenarios.
A vasectomy has very low rates of complications, and most are minor. These may include bleeding/hematoma, infection, or risk of chronic testicular pain. Because the incisions are made to the scrotum, risk of injury to surrounding structures is very limited.
Effectiveness
Both tubal ligation and vasectomy are highly effective. For both procedures, the efficacy depends on the technique/method of ligation of the tubes and the patient having the procedure.
The failure rate for a tubal ligation ranges between 7.5 and 54.3 pregnancies per 1000 sterilization procedures over the span of 10 years. The rates of post-tubal pregnancy tend to be higher in younger women due to increased fertility.
The failure rate for a vasectomy ranges between 7.4 to 11.3 pregnancies per 1000 sterilization procedures over the span of 5 years.
Recovery
After a vasectomy, it is recommended that patients take it easy for the first 2-3 days before resuming light activity. Normal activity can typically be resumed around 10 days or once pain-free.
Restrictions are a bit more strict following a tubal ligation. This is because the strength layer of the abdominal wall is disrupted with the incisions. This makes the recovery a little more painful immediately after and the healing process also takes longer. Patients are restricted to lighter activity and are not supposed to do any heavy lifting for 4-6 weeks following surgery to prevent hernias or weaknesses at the incision sites.
Benefits and Considerations
Cost
One big benefit of a vasectomy over a tubal ligation is the cost. The average cost of a vasectomy is around $1000 whereas the average cost of a tubal ligation is $2,800.1 The reason for this difference is likely the requirement of a tubal ligation to have some form of spinal or general anesthesia as well as the procedure being performed in the operating room instead of the office. It should be noted that location and insurance can affect these costs.
Regret
Another consideration of having a sterilization procedure done is regret. Both men and women experience regret following a vasectomy and tubal ligation, respectively. However, the rates of regret in men who underwent a vasectomy were less than 5% compared to 26% in women who underwent tubal ligation. There are many different factors that may go into regret including age, marital status, timing (post-partum), and money.1 Before undergoing a permanent sterilization procedure, make sure it is the best decision for you and your partner.
Reversal
No one wants to think about the possibility of needing to reverse a sterilization procedure. However, as above, regret down the line does happen. The first step is to make sure you are 100% sure that permanent sterilization is what you want. But, if down the line your mind somehow changes, let’s talk about the possibility of reversal.
Rates of pregnancy after reversal of both tubal ligation and vasectomy are highly variable. Tubal ligation reversal has a pregnancy rate ranging from 25%-87%. Vasectomy reversal has a pregnancy rate ranging from 7%-89.5%1. Both typically require general anesthesia.
Tubal ligation reversal is not always possible and depends on how much of the tube is removed in the initial surgery. This requires another laparoscopic surgery in the operating room which again has the small risk of injury to the abdominal organs due to entering the abdomen. Reversal of a vasectomy is a minimally invasive procedure requiring small scrotal incisions.
Expert Insights
While both vasectomies and tubal ligations are great options for permanent sterilization, a vasectomy is an office-based procedure that does not require general anesthesia. It is minimally invasive and carries much less risk and has a shorter recovery time compared to a tubal ligation. A vasectomy is also more cost-effective compared to a tubal ligation. Purely vasectomies will provide an affordable, comfortable, convenient, and safe method for permanent sterilization!
References:
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Trussell J, Lalla AM, Doan QV, Reyes E, Pinto L, Gricar J. Cost effectiveness of contraceptives in the United States. Contraception. 2009 Jan;79(1):5-14. doi: 10.1016/j.contraception.2008.08.003. Epub 2008 Sep 25. Erratum in: Contraception. 2009 Aug;80(2):229-30. PMID: 19041435; PMCID: PMC3638200.
