What are definitive methods of birth control?
Definitive methods are methods that put an end to the possibility of becoming pregnant or bringing about a pregnancy. This can be achieved by sterilization of the man or sterilization of the woman. The term final is only relative. Sometimes fertility restoration is possible. Sometimes fertility can also recover spontaneously, resulting in a pregnancy.
Male or female sterilization eliminates the possibility of egg or sperm transport: ova and sperm are still being produced, but cannot reach each other.
In the case of male sterilization, both spermatic strands are cut and tied off. As a rule, this is done on an outpatient basis under local anesthesia. The surgery can be performed by any doctor who has been trained in it. This is usually done by a urologist or surgeon, but some GPs, gynecologists and doctors affiliated with an institution for contraception, sexuality and abortion assistance are also carrying out the procedure.
In the case of sterilization of the woman, both fallopian tubes are usually undercut by laparoscopy (abdominal surgery). Usually rings or clips are placed on the fallopian tubes. If this is not technically possible, the fallopian tubes are sometimes also burned shut or removed. A laparoscopy is performed in day admission under short-term general anesthesia.
Sterilization in women can also be performed via a hysteroscopy (spinal surgery in the womb). In this case, outpatients are usually closed under local anesthesia with access to the tubes with silicone (the Ovabloc® method) or with a feather with nitinol (the Essure® method).
Sterilization of the woman is performed by a gynecologist who is trained in the technique used.
After sterilization of the woman via laparoscopy, infertility starts immediately. After sterilization of the man or after sterilization of the woman via hysteroscopy, additional contraception is required for a period of 3 months. Additional contraception can be stopped after male sterilization if there is no longer any moving sperm when sperm is checked and the total sperm count does not exceed 1 million per ml. After sterilization via hysteroscopy in women, additional contraception can be stopped if a control photo shows that the fallopian tubes are closed.
How reliable are the definitive methods?
Final methods of birth control are very reliable. Nevertheless, pregnancy can occur after spontaneous recovery of the patency of one of the male sperm leaders or one of the fallopian tubes. The younger the age when performing sterilization, the greater the chance of spontaneous recovery. The experience of the operator also plays a role. The less experience the greater the chance of pregnancy. Definitive methods are more reliable than pill and copper IUD. The hormone rod Implanon®, the hormone coil Mirena® and the copper implant Gynefix® are just as reliable as sterilization.
What are the side effects of the definitive methods?
The absolute risks associated with performing a sterilization are low. However, if the chance of complications with sterilization of women is compared with that of men, the chance of serious complications in women is about 20 times greater than in men. This is due to the fact that female sterilization is an intra-abdominal procedure (with the exception of hysteroscopically performed sterilization) and male sterilization can take place under local anesthesia. To give you an idea: 1.5 to 4 per 100,000 women worldwide die as a result of the anesthesia complications or as a result of sepsis or bleeding. In 1 to 6 women per 1000 damage occurs to the intestine, ureter, bladder or blood vessels. The man sometimes has an after bleeding or a local infection.
Both after male sterilization and after female sterilization, menstrual problems can develop in women over a period of several years, especially if a hormonal form of contraception such as the pill has been used prior to sterilization. This is estimated to be the case for approximately 1 in 4 women who have been sterilized or whose partner has been sterilized. The chance of this is greater if the pill was started earlier because of heavy or painful periods.
When to the doctor?
If the decision to have yourself sterilized is taken, a visit to the doctor is necessary to discuss all the ins and outs of the intended procedure. The doctor will then arrange a referral to the person who can perform the desired procedure.
After sterilization, a visit to the doctor is required if:
- menstruation fails to exclude a pregnancy. That visit should not be postponed for too long because after sterilization of the woman the chance of ectopic pregnancy is around 50%.
- violent or painful menstrual periods occur
- a recovery operation is desired
The chance of recovery from the fallopian tubes with subsequent pregnancy is greatest (approx. 80%) after sterilization with rings or clips. Recovery is not possible after hysteroscopic sterilization. In that situation, pregnancy can sometimes still be achieved via ectopic fertilization (IVF). The chance of pregnancy is then approximately 50%. The chance of recovery of the spermatic cord in the man with subsequent fertility is 20 – 40%, depending on the period that elapsed after the sterilization.
The more time there is between sterilization and recovery, the smaller the chance of fertility recovery. This is because after sterilization, antibodies are often produced against their own sperm cells, which greatly reduces the chance of fertility.
Is a definitive contraception method suitable for you?
Definitive methods are ideally suited if the family is considered to be complete. Even if a subsequent pregnancy involves high health risks, a definitive method of contraception is also suitable. Definitive methods are unsuitable for unstable relationships or emotional events such as immediately after an abortion or during caesarean section .
General advice and precautions
Sterilization only protects against pregnancy, not against sexually transmitted diseases (venereal diseases). To be protected against sexually transmitted diseases, the use of a barrier agent such as a condom or female condom is necessary. More about this can be read in the brochure barrier means.
Extra protection is not required only in a stable sexual relationship. It is recommended to use extra protection in a new relationship and to test both partners after 3 months for the most common sexually transmitted diseases such as chlamydia and HIV. Testing can be done via the doctor, or if desired anonymously via a GGD institution.
Source : dokterdokter