After Roe, more and more Americans are getting their tubes tied. Here’s what you need to know.


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After the Supreme Court overturned Roe vs. Wade in June, gynecologists across the country reported seeing an increase in the number of patients seeking fallopian tube ligation. But it is not always easy to get the procedure. The Washington Post asked doctors about tubal sterilizations; here is what they said.

After Roe, more Americans want their tubes tied. It is not easy.

1. What is tubal sterilization?

Tubal sterilization, also known as tubal ligation or “tubal ligation,” is a form of permanent sterilization that involves closing the fallopian tubes or removing them entirely (called a bilateral salpingectomy). The fallopian tubes carry eggs from the ovaries to the uterus and are the site of fertilization with sperm, allowing pregnancy. Once closed or removed, the tubes can no longer allow fertilization, preventing pregnancies with a success rate of over 99.5%.

2. How old do I have to be to have my tubes tied?

There is no legal age to have your tubes tied, and the minimum age may vary by state, insurance company, and doctor. Many younger patients have faced, and continue to face, doubt and denial from doctors, and some are denied the procedure entirely. If you are under 21, Medicaid will not cover the procedure.

3. Will my insurance cover the procedure?

Under the Affordable Care Act, private insurance companies are required to cover tubal sterilizations, but patients may still have to pay part of the cost. Patients using Medicaid to cover sterilization must wait at least 30 days receive the procedure after giving consent – another requirement that some say is a hindrance. “For people who are pregnant and want a tubal at the time of delivery, or immediately after delivery, [the Medicaid waiting period] has become a problem,” said Amy Lasky, OB/GYN in Stony Brook, NY Out-of-pocket costs for the procedure can range from zero dollars with insurance to $6,000 without it — several times the cost of a vasectomy, a form sterilization that prevents sperm from flowing through the sperm duct and combining with semen.

Men rush to get vasectomies after Roe ruling

4. Is tubal sterilization reversible?

It depends. Most types of tubal sterilization are irreversible, but some procedures are technically reversible by major surgery which is not always effective and can be expensive. However, doctors encourage patients to be sure they want to tie their tubes, as the procedure is not meant to be reversible. “It’s meant to be considered permanent,” Lasky said. “I think it’s a common misconception people have when they talk about tying their tubes, that it’s like a tie that you can then untie. I’ve heard that before, but that’s not it. It’s considered sterilization. [that is] permanent.” Bilateral salpingectomies, which are increasingly common, are not reversible because they involve the complete removal of the fallopian tubes, said Franziska Haydanek, OB/GYN in Rochester, NY, who does TikTok Videos inform patients about tubal sterilizations.

5. What can I expect during my first consultation for tubal sterilization?

According recommendations of the American College of Obstetricians and Gynecologists, physicians are advised to emphasize to patients the permanence of the procedure, to discuss with patients other reversible contraceptive options, and, “where appropriate”, to discuss sterilization of male partners “as a lower risk option”. and more effective than female sterilization. You may be asked how certain you are of being sterilized, especially if you are younger, and informed of the risk of regret. Many younger patients said they faced resistance from doctors during consultations.

6. How difficult is it to perform tubal sterilization?

In addition to the obstacles some patients report regarding performing the procedure, it is important to note that the procedure itself is a surgical procedure, unlike a vasectomy, which is an office procedure. “It takes about less than 30 minutes,” Lasky said. “But compared to vasectomy, it’s much more invasive.” Although it’s a minor surgery with usually three incisions, she said she has surgical limitations: no heavy lifting for at least four weeks, no exercise, waiting to return to work until until you feel ready. “Although for minor surgery, I have a lot of people going back to work next week,” Lasky said, adding that the pain and recovery is also “different for everyone.”

7. Can I still get pregnant after tubal sterilization?

Tubal ligations are more than 99.5% effective in preventing pregnancy, Lasky said. But if you decide to have children after tubal sterilization, you can still pursue a planned pregnancy through in vitro fertilization (IVF) or surrogacy. However, IVF is an expensive procedure and typically costs $15,000, according to Haydanek. And there are fears that the IVF procedure will become more complicated and expensive after the Dobbs Decision.

Roe’s reversal could make IVF more complicated and expensive

8. Where can I schedule tubal sterilization and find resources?

In addition to make informative TikTok videosHaydanek has set up a list of gynecologists she describes as “willing to perform tubal ligation on any patient, 18-21 and older, regardless of marital status or number of children”. Lasky created a Twitter feed with resources. And r/childless on Reddit offers resources for patients seeking tubal sterilization. Patients have also reported taking sterilization binders to appointments gathered from online how-to guides to answer questions from their doctors.

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