Michel and I have two children, a boy and a girl, and we think that's more than enough. Now we are looking at which of the two of us will be sterilized, because if I am honest, I do not feel like taking my contraceptive pill daily or having to make safe sex every day. Still, I think it's a pretty scary idea, what if I remember and still want a little more? Could I still turn it back?
What is sterilization?
With the woman
In a woman, a sterilization is an operation or intervention to prevent pregnancy definitively. The fallopian tubes are closed off so that the sperm cells can not reach and fertilize the egg cell. You can opt for a local anesthetic or general anesthesia. In most cases, the general anesthetic is chosen, because during the procedure use must be made of carbon dioxide or laughing gas in the abdomen which often gives an unpleasant feeling and an oppressive pressure on the chest.
With the man
In case of sterilization of the man, also called vasectomy, the vas deferens are interrupted and closed with a thread. Because of this procedure, no sperm cells can enter the seminal fluid and the man is infertile. The procedure takes place under local anesthesia. After the procedure, the ejaculation seems perfectly normal. The only difference is that there are no sperm cells in the seminal fluid, but that can not be seen with the naked eye.
When do you opt for sterilization?
Most couples opt for sterilization when the children's wish is met. Yet there are several reasons to have you sterilized. It can be a medical reason, such as hormonal problems, such as often having fungal infections, migraines, hot flashes, mood swings, and severe intermittent bleeding. Or you are convinced that you do not want children, for whatever reason.
The man or the woman?
Who will undergo the sterilization if you, as a couple, decide that more children are not wanted? What are the possible consequences of a sterilization for you or your partner?
Sterilization in men is less stressful and the chance of a complication is smaller than in women. In the man it is a matter of an outpatient treatment with local anesthesia and two small incisions in the scrotum, allowing the urologist at the vas deferens to cut it and take an inch off and tie it, so that it becomes inaccessible for sperm cells. Also the chance of pregnancy is much smaller if the sterilization is done in the man. In women's sterilization, there is still a small chance of 1 in 2000 that she nevertheless becomes pregnant.
Sometimes women feel the extra burden that they have to endure this procedure after the heavy delivery, while sterilization is a smaller and less stressful procedure for the man. On the other hand, men are fertile to a later age than women and therefore have a longer chance to regret a definitive intervention.
For men there is only one method to sterilize them (see above). For women there are three different techniques that can be applied:
Sterilization during a surgery (laparoscopy). The gynecologist can close the fallopian tubes in different ways. In the Netherlands, the most commonly used method is binding with rings or clips. Coagulation (burning of the fallopian tubes) is occasionally applied, but in this method the chance of pregnancy is higher, unless the entire fallopian tube is burned shut. When the latter is done, you can assume that the chance of success in a recovery operation is minimal.
Fall tubal ligaments
Sterilization during abdominal surgery. When the sterilization takes place during (for example) a caesarean section, the gynecologist can also make use of the aforementioned clips or rings. When the fallopian tubes are too thick, the gynecologist at that time can choose to tie off the fallopian tubes.
Sterilization via hysteroscopy. This technique is also called the Essure® method. The gynecologist goes with a viewing tube (hysteroscope) through the vagina and cervix. 'Feathers' (micro-implants) are placed in the fallopian tubes, which induce a reaction in the fallopian tubes. They will close the fallopian tube in a period of about twelve weeks. This technique has the advantage that it only takes 20 minutes, you do not have to be sedated and you can resume your daily activities immediately after the procedure. A disadvantage of this method is that not every hospital uses this technique and it is not possible for everyone.
Just as every surgery has a chance of complications, this chance also exists with sterilization. Yet the risks are small. If we compare the chance of complications in the procedure with those of the man, the risk of serious complications in her is about 20 times greater than in him. This is mainly due to the fact that the man is only stunned locally, while in most cases the woman can only undergo sterilization under general anesthesia, which entails a lot of risks. In 1 to 6 out of 1000 women develop damage to the ureter, bladder, bowel or blood vessels during the operation. Women also have a chance of severe menstrual problems after the procedure, especially when the pill was used prior to the sterilization to reduce painful periods, among other things.
It almost does not occur, but in some cases it happens that a fallopian tube becomes accessible again, so that the sperm cells can reach the egg cell. This creates the risk of an (extra-uterine) pregnancy.
It may just be that you think you are sure of your case and you allow yourself to be sterilized and a few years later you suddenly find yourself in a completely different waterway, you may have a new relationship and a child wish suddenly starts to get mixed up again. If that is the case, you can choose to undergo a recovery operation even if it does not offer 100% certainty that the woman can become pregnant again. A repair operation depends on the technique used for sterilization. Because the techniques are improved today and the fallopian tubes are often no longer burnt as before, but only one fallopian tube is completely closed or both are closed with a ring or clip, a recovery operation can have a greater chance of success. The smaller the section of the fallopian tube that is 'destroyed', the greater the chance of succeeding in reversing the sterilization. For most recovery operations, laparoscopy with excellent results is used. As many as 70 to 80% of women become pregnant again after a recovery operation.
A recovery operation in the man is also possible in some cases. It depends, as with the woman, on how the sterilization has taken place in order for a recovery operation to be successful. On average, the chance of a successful recovery is about 70%. Only 50% of the couples become (again) pregnant after this procedure.
Yet the chance of a successful recovery in men is smaller than in women. The fertility of the man is often greatly reduced after recovery due to the formation of antibodies.
For a sterilization you always need a referral from your doctor. The costs for sterilization in men are around 310 euros (Jeroen Bosch Hospital). However, the costs for a repair operation are a lot higher, namely around 3000 euros. The costs for a sterilization are not reimbursed if you only have basic insurance. If you have an additional package, it is often reimbursed or partially reimbursed. A recovery operation is reimbursed in some cases, but usually not. Ask your health insurer for this.
The costs for sterilization in women depend on the chosen method, but can rise to around 1,600 euros on average. Ask your health insurer for the reimbursements.
It is sometimes thought that the sense of sex decreases after a sterilization. Nothing is less true. Often the sex becomes even better because the fear of a pregnancy has disappeared.
Some women also think that menstruation stops after the procedure. Unfortunately, this is also a fable, because after the tubal ligature, an egg is still released during the cycle up to the menopause.
Men have the fear - when they have to undergo a sterilization - that they run the risk of impotence or that the intervention affects their libido. That too is a myth. Sperm cells are still produced in the testicles, as are the hormones that regulate the desire for sex. These hormones end up directly in the bloodstream.
Natasha, 35 and two-year-old mother opted for sterilization two years ago because she had many hormonal problems with the contraceptive pill and because she was already blessed with both a son and a daughter - whom she only raises and finds very hard - was the choice pretty easy for her. "No man who can talk to me now. My body is mine and I am at peace with it, "said Natasja.
She had clips around her fallopian tubes under general anesthesia, because she had read on the Internet that the people of the feathers (Essure® method) had strange complaints and since she finds herself a bad luck, she did not dare to take that leap. However, the healing process in this method was terrible. She was in a lot of pain and therefore could not stand on her legs for the first few days. She also wants to advise every woman who opts for a sterilization to get help in the first week, which helps you with everyday things.
Less mood swings
After a month she noticed a lot of changes to herself. Less mood swings, no more annoying fungal infections and after a few months her menstrual cycle was again as it should be and the terrible migraine, which she had been struggling with for a long time, disappeared. She feels herself so much better now that she is not using a pill anymore that she is even considering not having her daughter take a pill to spare her the mess and the misery.
Gerrit, a father of 70 years old, decided in the early 80s together with his wife to no longer want children and for them the most logical step was to have him sterilized. Gerrit has experienced it as a minor intervention and has experienced little inconvenience. He can still remember that he had a short period of trouble with cycling, but otherwise he did well. He had been advised to slow down for a while and not lift heavily. Gerrit and his wife never regretted this decision.