How to Consent for Tubal Ligation

There are two important things to discuss with patients when consenting for BTL: permanence and regret.

Permanence

Only 50-56% of women can have a child after a tubal reversal (26% if you're trying to reverse it after age 39). The largest study done on tubal ligation was a prospective, multicenter piece of research done by the CDC, and was called the CREST study. It found that people under the age of 30 are 3.5 to 18 times as likely to request reversal than those over 30 (of those sterilized between 18 and 24, 40.4% requested information on reversal).

Not all insurance pays for the reversal, either. 

Regret

The CREST study found that 14 years after BTL, there is a large amount of regret, especially among patients with certain characteristics. Here are the numbers for regret at 14 years:

• 20.3% of women who were 18-30 years old regretted their sterilization
• 21.7% of black women
• 20.4% of unmarried women
• 17.6% of women who chose BTL within a year of their last child's birth

Regret develops in a linear fashion, meaning that around 5% regret at 3 years, then 10% at 7, then 20% by 14 years. It's difficult to extrapolate 14 years over a lifetime, especially a woman's lifetime, which has a natural time of infertility that can bring on or increase pre-existing regrets.

When women are under the age of 30, black, unmarried, or choosing BTL within a year of delivery, I counsel them that about 1 in 5 women like them regret their decision to get a tubal ligation. I also stress that the real world is not like Friends, and BTLs are permanent. I recommend on pospartum day 1 (or during prenatal care) that they talk about the decision with their loved ones and look into LARCs (and natural methods, of course), which are reversible and can be just as effective.