When a woman “gets fixed,” the medical term is tubal sterilization. The two most common procedures are tubal ligation (often called “getting your tubes tied”) and bilateral salpingectomy (complete removal of both fallopian tubes). Both are forms of permanent birth control, though they work in slightly different ways and carry different benefits.
Tubal Ligation vs. Bilateral Salpingectomy
Tubal ligation blocks the fallopian tubes so eggs can’t travel from the ovaries to the uterus. Surgeons have historically done this by placing clips or silicone bands on the tubes, or by using electrical energy to seal them shut. The goal is the same in each case: close off the pathway so sperm and egg never meet.
Bilateral salpingectomy takes things a step further by removing both fallopian tubes entirely. This approach has become increasingly common, and many surgeons now recommend it over traditional ligation. The reason is a significant added benefit: research has shown that most ovarian cancers, particularly the most aggressive type, actually originate in the fallopian tubes rather than the ovaries themselves. A large Swedish study found that women who had both tubes removed had a 65% lower risk of developing ovarian cancer compared to women who hadn’t. That cancer-prevention benefit doesn’t come with traditional ligation, which leaves the tubes in place.
If a woman undergoes sterilization during a cesarean delivery, the surgeon typically removes the entire fallopian tubes through the incision already made for the birth.
What the Surgery Is Like
When performed on its own (not during a C-section), tubal sterilization is usually done laparoscopically. That means the surgeon makes one or two very small incisions in the abdomen and uses a thin camera to guide the procedure. The surgery itself takes about 20 to 22 minutes on average. Most women receive general anesthesia, though some facilities offer the option of local anesthesia with sedation.
It’s typically an outpatient procedure, meaning you go home the same day. Recovery time in the facility after waking up is usually under 15 minutes before you meet the criteria to be discharged.
Recovery Timeline
Most women return to normal daily activities within two or three days and can go back to work shortly after that. You’ll want to avoid heavy exercise for the first several days and skip lifting anything heavier than about 10 pounds (roughly a gallon jug of milk) for three weeks. Beyond those restrictions, recovery is relatively quick for most people.
Effects on Hormones and Periods
A common concern is whether sterilization will change your hormones, periods, or push you into early menopause. It doesn’t. The ovaries, which produce estrogen and progesterone, are left completely untouched during both tubal ligation and salpingectomy. A study that tracked hormone levels in sterilized women over two years found no significant changes in estrogen or progesterone compared to their pre-surgery levels or to a control group of women who hadn’t been sterilized. Your menstrual cycle continues as before.
How Effective It Is
Tubal sterilization is highly effective, but not 100% perfect. In rare cases, tubes can heal or a clip can shift, allowing pregnancy to occur. When pregnancy does happen after sterilization, there’s a meaningful risk it will be ectopic, meaning the embryo implants in the fallopian tube rather than the uterus. This is a medical emergency.
The 10-year risk of ectopic pregnancy across all sterilization methods combined is about 7.3 per 1,000 procedures. That risk varies significantly by method and age. Women sterilized before age 30 using bipolar cautery (the most common non-postpartum technique) had the highest rate: roughly 32 ectopic pregnancies per 1,000 procedures over 10 years. Women who had a partial salpingectomy after giving birth had the lowest rate, around 1.2 per 1,000. Full bilateral salpingectomy, by removing the tubes entirely, essentially eliminates this risk.
Can It Be Reversed?
Tubal ligation is considered permanent, but surgical reversal is possible in some cases. A surgeon reconnects the cut or blocked segments of the fallopian tubes in a procedure called tubal reanastomosis. Success depends heavily on how the original sterilization was done. Methods that destroyed large sections of the tube (like cautery) leave less tissue to work with than clips, which damage a smaller area.
Overall pregnancy rates after reversal are around 52 to 56%, which is notably higher than the per-cycle success rate of IVF. In Europe, IVF achieves pregnancy in about 27% of cycles, while U.S. clinics average around 36.5% per cycle. However, IVF can bypass the tubes entirely, making it the better option when the tubes are too damaged for reconnection. The choice between reversal and IVF depends on your age, the original method used, and how much healthy tube remains.
Bilateral salpingectomy cannot be reversed, since the tubes are completely gone. IVF is the only fertility option after that procedure.
Age and Waiting Period Requirements
If your sterilization is covered by Medicaid or other federally funded insurance in the United States, specific legal requirements apply. You must be at least 21 years old and sign a federal consent form at least 30 days before the procedure. This mandatory waiting period is designed to ensure the decision is fully voluntary. In emergency situations, such as during an unplanned C-section, the waiting period can be shortened to 72 hours, but only if the consent form was already signed. Private insurance may have different policies, and some providers set their own age guidelines, but the 30-day rule is a federal requirement for publicly funded procedures.