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.