Female sterilization and male vasectomy are permanent
methods of contraception and are highly effective. They are usually chosen by
relatively older couples who are sure that they have completed their families.
Occasionally, individuals who have no children or who, for example, carry an
inherited disorder may choose to be sterilized. The uptake of female
sterilization and vasectomy in the UK is relatively high compared to many other
European countries, with around 50 per cent of couples over the age of 40 years
relying on one or other permanent method.
Vasectomy is easier, cheaper and slightly
more effective than female sterilization. It does not require a general
anaesthetic. Semen analysis has to be checked after the procedure to ensure that
it has been successful.
Technically, both female sterilization and vasectomy
can be reversed, with subsequent pregnancy rates of about 25 per cent, but
reversals are not funded by the NHS in many parts of the UK. Individuals should
not have a sterilization procedure performed if there is a chance that one day
they might want to have it reversed.
It is estimated that around 10–15 per cent
of individuals in the UK subsequently regret the decision to be sterilized.
Regret is more common in individuals who are aged less than 30 years at the
time, have no children or in women who are within a year of delivery.
Long-acting reversible contraception is
highly effective and the option to use these methods instead of a sterilization
procedure should always be raised in the counselling session. They are
reversible should a woman wish to keep her options open for a future pregnancy.
This involves the mechanical blockage of
both Fallopian tubes to prevent sperm reaching and fertilizing the oocyte. It
can also be achieved by hysterectomy or total removal of both Fallopian tubes.
Female sterilization will not alter the
subsequent menstrual pattern as such, but if a woman stops the combined pill to
be sterilized, she may find that her subsequent menstrual periods are heavier. Alternatively,
if she has an IUD removed at the time of sterilization, she may find her
subsequent menstrual periods are lighter.
Sterilization in the UK is most commonly performed
by laparoscopy under general anaesthesia, which enables women to be admitted to
hospital as a day case. Alternative techniques are mini-laparotomy with a small
transverse suprapubic incision or, less commonly, through the posterior vaginal
fornix (colpotomy). Mini-laparotomy is the technique of choice when the
procedure is carried out post-natally (the uterus is enlarged and more
vascular) and in developing countries where laparoscopic equipment is not
available.
Essure® is a newer technique which is
becoming popular. It involves insertion of metal springs into each Fallopian
tube guided by the hysteroscope. Scar tissue grows round the metal springs and
blocks the tubes. It can be performed under local anaesthetic or light sedation
making it a cheaper and easier option than conventional laparoscopic
sterilization.
Vasectomy involves the division of the vas
deferens on each side to prevent the release of sperm during ejaculation. It is
technically an easier and quicker procedure than female sterilization and is
usually performed under local anaesthesia. Various techniques exist to block
the vas, and their effectiveness is related primarily to the skill and experience
of the operator. Vasectomy differs from female sterilization in that it is not
effective immediately. Sperm will still be present higher in the genital tract
and azoospermia is therefore achieved more quickly if there is frequent ejaculation.
Men should be advised to hand in two samples of semen at 12 and 16 weeks to see
if any sperm are still present. If two consecutive samples are free of sperm,
the vasectomy can be considered complete. An alternative form of contraception
must be used until that time.
