For Millions, Sterilization Is the Answer--but Regrets Are Not Uncommon

Every year, about 1 million men and women in the United States choose to have themselves permanently sterilized, a procedure that has become the most popular form of birth control here and worldwide.

Most are parents and know for sure they want no more children. Others simply cannot abide the perceived risks, side effects, or bother of products like condoms, the Pill or IUDs.

To sterilize women, doctors clamp or cauterize the two Fallopian tubes that carry eggs from the ovaries to the uterus. For men, they clamp or sever tubes in the scrotum that carry sperm from the testicles to the penis.

Twice as many women as men choose sterilization even though vasectomies are “simpler, cheaper and safer” than tubal ligations, said Arthur Wisot, a physician at the Redondo Beach-based Center for Advanced Reproductive Care. “They’re scared, afraid it will do something to their sexuality.” In addition, “men are not used to going to doctors and having things done to them. They don’t have to go in for an annual Pap smear.”

Sterilization is not entirely foolproof. It fails less than 1% of the time, but is only the second most effective method of contraception, slightly behind Norplant. Its success often depends on the surgeon’s skill.

Doctors say it is not uncommon for men and women who were sterilized during their first marriage to regret their decision when they remarry. Phil Kurzner, chief of urologic surgery at West Los Angeles Kaiser Permanente Foundation Hospital, cites the “classic story” of a man seeking vasectomy reversal: “the 45-, 50-year-old-man who has two grown children in college, he’s been divorced, it’s five years down the road, and he’s now married a 28-year-old woman who’s never been married and never had a child.”

Wisot says some women seek a reversal to replace a child who died. “One patient in her 40s had a tubal ligation after her second child. Sadly, her baby died of sudden infant death syndrome,” Wiscot said. “She wanted her tubes reversed. We did it, but she never got pregnant again.”

Some insurance companies cover sterilization, but most do not cover reversals, which can cost up to $6,000 for men and $10,000 for women.

Doctors suspect that sterilization may become less popular with the new, longer-lasting products on the market such as Norplant (which can last up to five years), the injectable Depo Provera (three to six months), the ParaGard intrauterine device (eight years) and birth control pills that can be safely taken by nonsmoking women up until menopause.

“If someone doesn’t want any side effects and just wants it to be over, sterilization is one way,” said Mitzi Krockover, an internist in women’s health at the UCLA Medical Center. “If they are not sure they want to give up that opportunity to conceive, they may go for the longer-acting contraceptives. We don’t have enough experience yet to see what the trend is going to be.”