One could be forgiven for thinking that sterilisation should be 100 per cent effective since it involves an operation. However this is not so because there is a measurable failure rate for the operation in both men and women. Overall, sterilisations fail in less than 1 per cent of cases but, of course, one partner being sterile does not prevent the unsterilised one from being involved with a third person.
Around 90,000 women are sterilised each year in England and Wales and around the same number of men have a vasectomy. Before the operation counselling is advisable so as to make sure that some other method might not be more suitable. Also the doctor has to be certain that the couple realise that some small risks are involved, that the operation may be irreversible, and that there is a failure rate. Most doctors also like to discuss the reproductive plans of the couple to ensure as far as is possible that there will be no regrets later and to discuss their sex life. A further consideration is to discuss which partner is to be sterilised. Vasectomy is cheaper and less prone to complications than is female sterilisation but many women cannot face up to their man being sterile and ‘over-persuading, them is likely to lead to psychological or marital problems later.
Both male and female sterilisation procedures can be carried out on a day-care basis but more usually women stay one night in hospital.
If the man is brave enough, and most are, a vasectomy can be performed under local anaesthetic. Through two small incisions at the top of the scrotum the vas deferens is located and cut on each side. To reduce the chance of the cut ends joining up again later a length of tube may be removed. Heavy work should be avoided for a couple of days afterwards and sex can be resumed when comfortable but contraception must be continued until the semen is clear of sperm. This can take many weeks and must be tested for. Problems can arise from infection and bruising and the operation can fail altogether if the surgeon thinks the vas had been found but it has not. After the operation both male hormones and semen, which is normal in appearance, are still produced.
When sterilising a woman the abdomen can be opened and the fallopian tubes found and cut but it is much more usual for the laparoscopic method to be used. Usually, but not always, under a general anaesthetic two small incisions are made in the abdominal wall and a device like a thin telescope (a ‘laparoscope’) is inserted. Through another incision a device is introduced either to apply an electric current to each tube thereby destroying a portion of it or to apply a clip or ring to each tube. As in the case of vasectomy, the surgeon may fail to identify the tubes correctly so that they are not obstructed and the woman is not sterile, or the ends can join up again. A failure, in the form of a pregnancy, is more likely to be apparent in the first year after operation rather than later.
There is some risk of stones forming in the kidney after vasectomy and of abnormal menstrual cycles or even a mini-menopause in women following sterilisation.
Family circumstances or reproductive intentions may change and either sex may seek to have the operation reversed. Success is more likely in women if a ring or clip has been used and in men if a large length of vas has not been removed. Reversal rates of between 40-90 per cent success can be achieved in women, depending on the method of sterilisation used, and in good hands the same can apply to men. Lower success rates are usual 10 or more years after the original operation.
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