Another report circulating on TikTok a few weeks ago by a woman who got pregnant by her vasectomized partner ten years ago. As in most cases, the two had to resort to a DNA test to confirm paternity.
This is because tubal ligation (surgical contraceptive for women) and vasectomy (male sterilization) have a 1% risk of failure — according to Febrasgo (Brazilian Federation of Gynecology and Obstetrics Associations), these are 99% effective methods.
Being aware of this possibility of procedural failure is essential, since they have become more accessible to younger people recently, when Law nº 14.443/2022 came into force.
The main changes in the legislation, originally from 1996, were:
• Now, women and men can undergo tubal ligation and vasectomy, respectively, starting at age 21 (previously it was after age 25);
• Those who have at least two living children can undergo the procedure even if they are under 21 years of age;
• Spousal consent is no longer required for surgery;
• The woman can undergo tubal ligation after giving birth, which was not allowed before (but she must request the procedure 60 days in advance).
To avoid early sterilization, the law maintained the requirement that the request for surgery be made in writing and notarized. This process follows the conversation with the doctor or the health center.
Until February 2023, according to data from SIHSUS (Hospital Information System Database), the number of outpatient and hospital vasectomies performed in the public network was 2,779 and 9,113, respectively.
Considering the same period, tubal ligation totals 9,012 procedures. Surgery soon after cesarean delivery, allowed by the new legislation, totals 9,015.
Tubal ligation characteristics
Tubal ligation is considered a simple surgery, with a failure rate that varies between 0%, 0.5% and 1%. This is because it blocks a fundamental channel for fertilization.
“The sperm goes to the end of the tube, to the third that we call distal, which is on top of the ovary, and there it finds the egg — there the fertilization takes place. After five or six days, he [vai e] glue to the inside of the uterus — a process called implantation. So, if you interrupt the passage of the sperm to the egg, fertilization will not happen”, explains the gynecologist Ilza Maria Monteiro, vice-president of the National Commission Specialized in Contraception at Febrasgo.
This obstruction of the tube occurs through a section (division). That is, a portion of the uterine tubes is removed.
“Cut off the two stumps [parte superior da trompa] and do or a cauterization [queima]when performed laparoscopically. When it is done by open surgery, which we call laparotomy, a stitch is made — a knot is made on each side. A portion of around 0.5 cm, 1 cm or 1.5 cm is removed. This is the traditional tubal ligation”, reports Ilza.
In addition to cauterization, there is also the possibility of blocking the region with staples or surgical rings, for example. But the most used method is burning, because it causes damage that prevents the stump from recovering.
In general, nowadays, it is a surgery that does not bring discomfort, when done correctly, because the laparoscopy (video technique) only requires a cut around the navel and in the lower part of the abdomen (inguinal region). In the past, the cut was similar to that of a cesarean section (about 10 cm), which demanded more from the patient.
With the new law, it can also be performed after childbirth, an advantage for women who are already sure about the procedure.
“When a woman undergoes tubal ligation after childbirth, for example, for a normal delivery, what do we do? At this stage the uterus is still very large, [então] A cut is made around the navel, because we can get the tube through this cut without needing videolaparoscopy, because the large uterus leaves the tube up there. When it regresses, it doesn’t work anymore”, says the gynecologist.
Certainty about surgery is required not only after delivery, but in all cases. For the specialist, tubal ligation has to be an option when there is nothing else to be done.
“She [cirurgia] it is indicated when you really cannot, with the reversible methods that you have available, offer satisfaction. [Por exemplo], the person puts on an IUD, is expelled. Put an implant, it doesn’t stop leaking. You cannot take the pill. Anyway, you close all the possibilities”, warns Ilza.
This is because methods such as IUDs and implants, according to the gynecologist, are similar in effectiveness to tubal ligation and can be reversible.
“It’s important for women to know that regret can happen. There really must be no other way around it. It is not something that can be considered reversible, on the contrary; in principle, it is irreversible. If you can reverse it, it’s another story, ”she warns.
Not all cases have a remote possibility of reversing the surgery, but they do exist.
“A new laparoscopy is performed and we see how much of the stump is left, because [para reverter] I need to remove the part that was damaged, then the tube opens again. You imagine a bladder that was tied on top, you took the knot off, it has a little hole again. So this stump will have to be connected to the other […] Depending on the condition of the tube, you may have some recovery, [em torno] 40% or 50% under the best conditions”, explains Ilza.
It’s a complicated process, done with extremely fine wires and in stages. When this reversal is not possible, women have to resort to in vitro fertilization, a costly procedure.
There is also a risk that the ligation fails — this risk increases with time — due to reanastomosis (spontaneous recovery of the stump). But, like the processes mentioned above, it cannot be counted on to occur.
SEE TOO
about the vasectomy
Vasectomy is a safe surgery performed under local or general anesthesia. It is relatively quick and lasts around 45 minutes to 1 hour, sometimes less – it depends on the professional’s experience.
The operation consists of cutting the vas deferens — channels that carry sperm from the testicles to the penis — to stop the flow of microgametes, not sperm.
Similar to tubal ligation, each cut end is sectioned and cauterized. But unlike her, it requires greater care with the post-surgical period.
“The man needs to keep his wife’s current contraceptive method, whether condom, oral pill, or IUD, because he still ejaculates sperm after surgery”, warns urologist Daniel Suslik Zylbersztejn, member of the infertility department of the SBU (Brazilian Society of Urology) and medical coordinator of Fleury Fertility.
According to the specialist, for this reason, sexual intercourse without contraceptive protection is only released about 2 to 3 months after surgery, when a spermogram is performed.
If the test finds azoospermia (absence of sperm), he is allowed to have unprotected sex.
“This man’s risk of getting his partner pregnant [após a azoospermia] is not zero, but it is close to zero. It’s very rare. This number is one case for every 2,000 patients operated on. [0,0005%]”, said Suslik.
However, this low risk does not eliminate the need for condom use, both for men and women, since the dangers of contracting an STI (Sexually Transmitted Infections) remain the same.
Furthermore, rumors that vasectomy causes sexual impotence or prostate cancer are false. The urologist reiterates that it is a surgery that “does not cause any harm to the health of the man.”
In matters of irreversibility, vasectomy has to be treated as an irreversible procedure. That is, it requires family planning and the man has to be 100% sure of his decision
But she has a possibility of reversal.
“We have a surgical procedure that uses a microscope [para restaurar o fluxo de espermatozoides]except that this reversal procedure is not covered by the SUS or by any insurance, it is not on the list of the ANS [Agência Nacional de Saúde Suplementar]”, relates Suslik.
For this reason, surgery should be the last option. If the man is determined to do so, he can freeze the semen beforehand, in case of a future decision change.
@rauaneleandraJeez, you’re going to have to sue the hospital, which does the vasectomy
