matas – Page 4 – Birth Control Methods

Pregnancy after tubal ligation

About 20% of all women undergoing tubal ligation regret the decision and want to restore their fertility. One of the most frequent questions is whether it is possible to become pregnant and give birth to a child or not after the reversal is performed. 6% of women, whose fallopian tubes were ligated, decide that they really want to have more children and, therefore, undergo tubal ligation reversal.

Effectiveness of the procedure

Women, who undergo common tubal ligation reversal procedure, usually have a possibility from 70% to 80% become pregnant within a year after the procedure. Microsurgical techniques tend to have higher rates for success, showing that about 95% of women, who undergo microsurgical tubal reversal, are able to get pregnant and give birth to a baby within one year after the surgical procedure.

These numbers are for women, who are at the age under 40. One should know that the possibility to become pregnant after the procedure decreases when a woman gets older. Smaller rates of success are for women over the age of 40, however, these rates are still higher than in vitro fertilization ones.

Warnings

Even though the success rates of microscopic tubal ligation reversal are rather high, there is a greater risk of having ectopic pregnancy, when a fetus grows outside the uterus, after the reversal procedure. However, this possibility is still very low and a woman usually is able to regain her fertility, become pregnant and give birth to a child within one year after tubal ligation reversal procedure.

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Tubal ligation reversal

Once a woman decides she does not want to have any more children, she can choose tubal ligation as a permanent method of birth control . However, sometimes the decision may change with time. There are various reasons why a woman would want to regain her fertility. The main ones are new marriage after divorce or death of the partner, death of a child and others. This is actually possible once tubal ligation reversal is performed.

What is tubal ligation reversal?

Tubal ligation reversal is a major surgery for a woman to regain her fertility. It is performed under general anesthesia and takes about 2 – 3 hours. The procedure is done by microsurgical technique. A doctor unclamps and reattaches the fallopian tubes, so that they are passable again. The surgeon also places an implant into the tubes in order for them to be just as functional as prior to tubal ligation. Once this type of surgery is performed, a woman’s fallopian tubes begin to function again and an egg can go down the tubes to the uterus, where it is able to meet with sperm and fertilization can occur.

Tubal reversal just like tubal ligation is a serious surgery, and therefore requires in-patient care and a longer stay in hospital after it. A woman should take time off work for about a week and should only practice light physical activity and exercise for about two weeks after the procedure. A woman is allowed to restart her sexual life once she feels comfortable and happy about it. Complete recovery is considered to be after two or three months after surgery.

While microsurgery technique is applied, the procedure may be performed under local anesthesia. This allows a shorter time of surgery and fewer complications.

Good candidates for tubal ligation reversal

Even though a woman decides to have tubal reversal, she might not be able to undergo this surgery due to a few factors. The doctor should decide whether the fallopian tubes can be reversed or not. The surgeon usually performs laparoscopy in order to decide if a woman is suitable for tubal ligation reversal.

The doctor generally evaluates a woman’s fallopian tubes. The surgeon also needs to know, how tubal ligation was performed. Also, a woman’s age and her general health status should be considered before final decision whether a woman is a good candidate for the procedure or not. Women, older than 40, should consider thoroughly their decision to undergo the reversal because they have very slight chances for successful operation.

Alternatives of tubal ligation reversal

Even if a woman is not able to have her fallopian tubes reversed, there is an alternative method for her to be able to conceive. This alternative method to get pregnant is in vitro fertilization (IVF). The overall time from the beginning of hormonal therapy and embryo transfer is from one to two months. However, the possibility to become pregnant and give birth to a child is significantly lower, compared to tubal reversal, and varies from 39% to 50%.

Complications of tubal ligation reversal

As with any surgery, the tubal ligation reversal procedure includes certain risks and side effects. Side effects and complications are very rare but they can still occur from time to time. Mostly, the risk for complications depends upon the qualification of a surgeon and the type of the surgery. Laparoscopic surgery technique is a less invasive procedure, which largely decreases the risk for possible side effects. The most common complications include inflammation at the surgery site, infection and bleeding. Complications due to anesthesia are also possible though very rare. The risk for these complications may be reduced by applying local anesthesia.

Tubal ligation reversal cost

Most of insurance companies do not cover the cost of tubal reversal procedure. However, check with your insurance company policies to find out whether insurance covers the costs of tubal ligation reversal or not. Total price includes the surgeon’s fee, the hospital fee for the use of the operating room and ambulatory care facility, and the fee for anesthesia. The price is between $5,000 and $10,000. Higher prices are in New York State, whereas lower prices are in California. Bear in mind that a single cycle of in vitro fertilization usually costs more than $10,000.

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Pregnancy success

Advantages and complications of tubal ligation

Female sterilization is an ideal choice for woman, who is looking for effective and permanent birth control method. However, tubal ligation also has some risk and complications.

Advantages

Tubal ligation is a permanent method of birth control offering immediate and highly effective protection against unexpected pregnancy. Women, who are sterilized, have the same sexual desire and function since the hormone levels remain the same as before, and can enjoy more spontaneous sex life. This mean of birth control has very few side effects. It is cost-effective in a long term and requires no daily attention. Moreover, tubal ligation effectively protects women, whose lives would be in danger if they were to conceive.

Disadvantages

Tubal ligation is a surgical procedure and therefore has the risks associated with surgical intervention and anesthesia. Unlike male sterilization, vasectomy , it is a more complicated and risky procedure. It involves possible discomfort at the surgical site.

Tubal ligation does not offer any protection against sexually transmitted diseases (STD’s), therefore, a condom should be used.

Every woman should understand that female sterilization is a permanent method of birth control , and therefore, it is very important to consider thoroughly before deciding to go through the procedure. Although reversal is technically possible, it is not always possible in practice, and when performed, only 60% to 80% of women are able to conceive a baby. Hence, some women may have regrets for what the have done.

Risks and complications

As with any surgery, tubal ligation has possible risks and side effects, although they are found to be minimal. Complications are rare but still possible, and involve infection and uterine perforation, which is very seldom.

Even though the method has a very high efficiency rate in protection against pregnancy and pregnancy is not likely to occur, if a woman gets pregnant she has a higher risk to have ectopic pregnancy.

A woman has a risk to experience abnormal bleeding and bladder infections after surgery.

Some physicians report that women have post-tubal ligation syndrome, which involves irregular and painful periods, bleeding in a mid-cycle, or no menstrual periods. Although some doctors claim there is no proof for the existence of such syndrome, some extra research should be done to confirm it or not.

Tubal ligation

There is a variety of birth control methods that protect against unexpected pregnancy. However, if a woman wants a permanent birth control , there is only one choice — tubal ligation. It is very suitable for couples, who for some reason are not planning to have more children. Permanent female sterilization is a safe, effective and permanent method of birth control. Therefore, it is vital to consider all the pros and cons before the procedure, since tubal ligation reversal is possible but very expensive, complicated, and has a relatively low rate of success.

What is it?

Tubal ligation is a surgical procedure during which the fallopian tubes are cut and sealed in order to make it impossible for the egg to travel down from the tubes to the uterus. It also stops sperm from entering the uterus and the egg and sperm cannot meet each other, hence, fertilization cannot happen. It is a female sterilization method and permanent mean of contraception .

This surgical procedure is highly effective immediately and has the efficiency rate in contraception of 99.5%.

How it works

Each ovary produces an egg every second month. The fallopian tubes carry this egg from the ovaries to the uterus every month and, if it meets sperm, a woman is able to conceive. During tubal ligation each of the fallopian tubes is cut and sealed with rings, bands, clips, or seared with a caustic. An egg then cannot reach the uterus and sperm is prevented from reaching an egg, and hence fertilization cannot occur.

Surgical procedure

Tubal ligation is a minor surgical procedure that is usually performed in an inpatient or outpatient department. If a woman is suitable for the procedure, it can be performed when a patient is sure that she is not pregnant. Female fertilization can be performed under general or local anesthesia.

Most of tubal ligation procedures are performed through endoscopic surgery. This allows a minimally invasive intervention and takes a shorter time to recover afterwards. It involves a small incision close to the navel through which a thin endoscopic camera is inserted. Another incision is made above the pubic hairline through which a surgical endoscopic instrument, that can cut and seal the tubes, is inserted. It takes about half an hour for the surgery to be complete.

A patient is advised to take two or three days off. She is also recommended reduce physical activities and exercise for more than a week. Sexual activities are allowed once a woman feels comfortable, generally, after a week. If surgery was performed through vagina, a patient is told not to insert anything into the vagina for at least two weeks in order to avoid infection.

Some women decide to have tubal ligation performed straight after pregnancy and childbirth. It is very convenient, since a woman is already in the hospital and this procedure does not prolong hospital stay after childbirth. If a woman has a Caesarean section performed, it is very easy for a gynecologist to cut the fallopian tubes through the same procedure.

Therefore if you decide to be sterilized after pregnancy, talk to your doctor and inform him/her about your decision prior to the childbirth.

Cost of tubal ligation

The cost of tubal ligation usually ranges from $1,200 to $6,000. It depends very much upon the state, region and private clinic. Some insurance providers cover at least part of the surgery cost, therefore, you should check with your insurance for more information.

An average price of tubal ligation:

New York	$4.500
California	$3.400
Texas	$2.500
Tennesse	$2.500
Massachusetts	$4.400
Florida	$3.900

Vasectomy reversal

500,000 men annually have vasectomies performed in the United States. This surgical procedure assures that a man is infertile. However, at some point of a man’s life he might wish to restore his fertility for various reasons. Vasectomy reversal makes this possible. 1% of those who had undergone vasectomy want to restore their fertility with the help of a surgeon.

What is vasectomy reversal?

Vasectomy reversal is, a surgical procedure performed in order to return the flow of sperm into a vas deferens. The surgery is usually performed by a specialized microsurgeon, who uses certain surgical instruments and a microscope.

There are two different types of surgical techniques in reversal procedures. A so-called vasovasostomy is a technique used to restore fertility sewing the cut-ends of the vase deferens together. Another technique used is vasoepididymostomy that is usually performed when there is a blockage of sperm in the epididymis (a small gland near testicles) due to former inflammations. The vas deferens is then directly connected to the epididymis to restore the flow of sperm into the vas deferens.

Success rate of vasectomy reversal

Only seldom procedures restoring fertility were successful earlier. Nowadays, with the help of new microsurgical instruments and effective techniques vasectomy reversal is a successful procedure. Data shows that sperm is present in the semen in 85-97% of men who have undergone vasovasostomy. And half of the couples are successful in achieving a pregnancy after surgery. Sperm appears in 65% of men after vasoepididymostomy. And 20% of couples achieve a pregnancy.

Price of the procedure

Check with your insurance company policies to find out whether insurance covers costs of vasectomy reversal or not. Total price includes the surgeon’s fee, the hospital fee for the use of the operating room and ambulatory care facility, and the fee for anesthesia. The price is between $5,000 and $15,000.

Reasons for vasectomy reversal

Men, who want to have vasectomy reversal performed, usually make this decision for the following reasons:

remarriage after divorce or death of a wife;
death of a child;
scrotal pain related to vasectomy;
religious beliefs.

No matter what reason is, new developed surgical equipment makes almost all vasectomies possible to be reversed.

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Advantages and side-effects of vasectomy

Vasectomy is a permanent birth control method , unless a reversal is performed. Once the semen is clear of sperm you will not have to care about other methods of contraception but will still be able to enjoy sex as earlier.
Vasectomy is a minor surgical procedure, much less complicated than tubal ligation in women.

Advantages

You might say that it is a rather expensive procedure, overall you will spend less since you won’t have to pay for other methods of birth control .

It is the most effective method of birth control, the efficiency of which is 99.9-100% once your semen is clear of sperm. However, remember that during 7-10 sexual intercourses you should use additional methods of contraception since your semen does not become sterile (clear of sperm) immediately after surgery. For this reason two tests to check for sperm in semen are performed after surgery. The first sample for the test of the semen should be taken 8-12 weeks after vasectomy, the second one should be taken 2 weeks after the first one. When both of these samples are negative for sperm a man is considered to be sterile and does not have to use alternative methods of birth control.

Side-effects and Complications

Although 500,000 of vasectomies are performed in the United States annually, most of them successfully, as with any surgery there are certain side-effects and possible complications you should be aware off.

Side-effects are very mild including a short numbness of the scrotum until a local anesthetic wears off. Some patients may experience bruising and soreness of the scrotum.

Complications are very rare but still possible. About 10% of patients suffer from bleeding, feel more pain and inflammation than others. In very rare cases the sperm may still be present in the semen within a year after the surgery. The reason for that may be a slower clearing of the sperm from the ducts, or it may be due to recanalization of the ducts resulting in a repeat vasectomy . In addition the sperm that leaks out of the cut ends may accumulate in the surrounding tissues resulting in very painful numbs, called sperm granulomas, which need operative care. Very rarely but inflammation of the sealed off ends of ductus deferens may occur requiring additional medical treatment.

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Vasectomy

Vasectomy is a surgical technique used to cut off and close the tubes, also called vasa deferentia, which connect the testicles and penis and carry the sperm, mainly produced by the testicles. The procedure is a permanent male contraceptive method , although vasectomy reversal is possible. However, some sources report that 60% of all vasectomy reversal procedures are inefficient. Others claim that new reverse vasectomy techniques have the efficiency of 99% in regaining fertility in male individuals, who have sperm at the time of the procedure.

How it works?

It is important to understand the anatomy and functions of a male reproductive system in order to understand the main principle of vasectomy and how it works. Testicles that produce sperm and testosterone are located in the sack, called the scrotum, at the base of the penis. Testes are connected to epididymis — a small tube, where the sperm are kept for 6 weeks while they get mature. These tubes are linked to the prostate gland through vasa deferentia. The prostate produces seminal fluid. The sperm from the testicles and seminal fluid from the prostate gland are mixed during ejaculation to form semen.

During the vasectomy procedure vasa deferentia are sealed off and the sperm therefore cannot mix with the seminal fluid to form semen. A man is still able to ejaculate and reach orgasms. He also produces the same amounts of semen (fluid) when he ejaculates. The only difference is that there is no sperm present in the semen. A male body still produces the sperm after vasectomy but since they cannot mix with the seminal fluid, the sperm are basically reabsorbed by the body. Note that the procedure does not affect a man’s sex drive and libido, as it also does not interfere with the ability to perform and enjoy sex.

The Surgical Procedure

Vasectomy is usually performed in an out-patient department, therefore, no overnight stay in the hospital is needed. It usually takes about half an hour for the surgery to be over under local anesthesia.

A patient is asked to take a shower and wash the scrotum properly on the day of the surgical procedure. He is also asked to bring tight underpants that will be worn after surgery to support the testicles and reduce swelling. Your scrotum will be shaved prior to surgery so that no hair would get into the wound. Some male individuals prefer to do it themselves at home and may do so on the day of the surgery.

Before the procedure local anesthetics are injected in several places of the scrotum, which then numbs for the time of the surgery. The surgeon then finds the vas deferens under the skin and makes a small incision of about 1 cm on the scrotum. The tubes are then revealed and pulled out and cut in two places. The doctor takes a small segment of the vas deferens and then the ends of it are sealed off. The tubes can then be replaced back to the scrotum and the incision is sutured. The procedure is then carried out on the other side of the scrotum.

As an alternative to that is a so called no-scalpel procedure, during which a puncture incision is made instead of a cut. The surgeon uses special forceps to take the tube out, cut and cauterize.

Another alternative is placing a so called vasclip around the tube without any cut and suture.

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Difference between cervical cap and diaphragm

A cervical cap, a thimble-shaped device, is a barrier method of birth control , made of latex or silicone. A diaphragm is also a barrier method of birth control that is made of thin rubber and has a springy, flexible rim. Both these means of contraception act as a barrier to prevent sperm from reaching the uterus and should be used with addition of spermicidal cream or jelly.

The size of these devices

A cervical cap is smaller, more rigid and less noticeable to either partner than a diaphragm. It comes in four or three sizes (depending on a manufacturer) whereas a diaphragm can be of different sizes that are chosen by a professional health care provider.

Use of spermicidal substances

Spermicide needs to be placed only once before use of a cervical cap. It also requires less of this substance than a diaphragm, therefore, the cap is less messy and permits more pleasant oral sex.

Differences in application

A cervical cap should be placed onto the cervix not less than 8 hours before sexual intercourse, whereas a diaphragm should be placed into the vagina not less than 6 hours prior to lovemaking. The first device can be kept in the vagina longer than the other one. The cap can be left for up to 48 hours in the vagina, when a diaphragm should stay there no longer than 24 hours.

Efficiency in birth control

There is a difference in the efficiency of both these methods of birth control . Cervical caps are said to be of the efficacy against pregnancy from 82.6% to 93.6% depending on the use of a cervical cap and manufacturer. The failure rate of a diaphragm in protection against unexpected pregnancy may be as high as 20% with typical use. Although some studies show that there is no difference between the efficiency of these two means of birth control . Additionally, diaphragms are known to slip out of the vagina more easily than the caps. A cervical cap is a good option for women who are not able to use diaphragms due to weak vaginal muscle tone.

Medical safety

When medical safety is concerned both of these methods of birth control are known to be medically safe and approved for use by the FDA. However, a cervical cap is reported to have fewer side effects and risks. As a matter of fact, the cap is one of the safest means of contraception. When these devices are compared, a diaphragm is known to cause various urinary tract infections more often than a contraceptive cap . None of these barrier methods should be used if a woman has a history of Toxic Shock Syndrome or if either of the sexual partners is allergic to latex or silicone.

Prevention against STD’s

Remember that none of these birth control methods protect against sexually transmitted diseases, therefore, male condoms should be worn for prevention of STD’s.

Possible side effects of cervical cap

A cervical cap is easy to use, and women, who use this device, are happy with the benefits they gain, but there are still a few side effects and risks associated with the use of this barrier contraceptive method.

There might be some inconvenience if you forget to remove the cap in time, and then there could be a risk for irritation and inflammation. Although cervical inflammation is very rare condition, it can still occur due to the growth of microorganisms on the cap. Therefore you must wash a cervical cap with antibacterial hand soap and rinse it with tap water after every use. It is also significant not to miss tears on the cap, since it diminishes the efficiency of a cervical cap for birth control. Since this barrier method of protection against pregnancy does not protect from HIV, additional barrier contraceptive methods are to be used during sexual intercourse.

Other disadvantage include the slip out of the cap during lovemaking. Therefore women could feel very uncomfortable and not relaxed during sexual intercourse, as they may worry about the position of a cervical cap in the vagina. Women should also be aware to use a water-based lubricant, if needed, since oil-based lubricants may decrease the efficacy of this birth control method . The correct position of the device is very important, so practicing how to place it correctly is actually not a bad idea.

Although a cervical cap is rather easy to use, it does not release hormones. This method of birth control is known to have very few side effects compared to other types of contraception. It is especially convenient to women, who for some reason cannot or do not want to use a hormonal method of birth control. Even though there are a lot of women worldwide who choose a cervical cap for protection against pregnancy and they are happy and satisfied with it, you have the right to decide and choose what best for you is.

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