After Roe decision, an increased interest in sterilization procedures. What to know.

After the U.S. Supreme Court’s Dobb decision, which overturned Roe v. Wade and eliminated the constitutional right to have an abortion, many are reconsidering their birth control and pregnancy prevention methods — and some may be considering long-term, permanent options, doctors say.

In the weeks since the Supreme Court’s decision, requests for sterilization procedures — generally, vasectomies and tubal ligations — have reportedly increased in Texas, Florida, California and Iowa, among other states.

Doctors we talked to in the Triangle are seeing an increase in requests for the procedures, too.

Dr. Amy Bryant, an OB-GYN with UNC Health, told The News & Observer that she received three or four requests for tubal ligation procedures within the past week — an increase from the requests she would normally only receive “every once in a while.”

Bryant said that, considering the timing of the increased requests in relation to the overturning of Roe v. Wade, she thinks the increase in requests is “definitely due” to the Supreme Court’s decision.

“I think people are quite legitimately scared of having their reproductive autonomy taken from them and not being able to, you know, make decisions that might be the right one for them,” Bryant said.

Dr. Marc Rogers, a urologist and director of men’s health at UNC Health, said he received 45 requests for vasectomies in June — up from 20 requests in April and 28 requests in May. In just one day last week, Rogers said, he saw three patients who mentioned the Roe decision in their reasoning to receive a vasectomy.

With the potential increased interest in these procedures recently, there are common questions about the procedures that you, or someone you know, may have.

We spoke with Bryant and Rogers to answer some of those questions, including how the procedures work, whether your spouse or partner has to consent to the procedure, whether insurance will cover the procedure and more. We also consulted information from the N.C. Department of Health and Human Services and Planned Parenthood.

Here’s what you should know about sterilization procedures and the increased requests for them in North Carolina post-Roe.

What is female sterilization? Tubal ligation vs. bilateral salpingectomy

There are two main procedures used to perform female sterilization: tubal ligation (also commonly referred to as having your “tubes tied”) and bilateral salpingectomy.

Both procedures are surgical, and target the fallopian tubes, where eggs sit after moving from the ovaries during ovulation, waiting for sperm to fertilize them. By blocking, or completely removing, the fallopian tubes, an egg cannot travel to the fallopian tubes from the ovaries, and sperm is unable to reach the egg, the Mayo Clinic writes.

▪ In a tubal ligation, the fallopian tubes are blocked, cut or tied to prevent the egg and sperm from meeting.

▪ In a bilateral salpingectomy, both fallopian tubes are removed entirely from the body.

What is a vasectomy?

A vasectomy is a surgical birth control and sterilization procedure for males.

The procedure targets the vas deferens tubes, or the tubes that carry sperm to semen. By blocking the tubes, sperm is unable to enter semen and cause a pregnancy by meeting an egg in another person’s body.

How effective is sterilization?

The American College of Obstetricians and Gynecologists ranks sterilization, both female and male, as one of the most effective forms of birth control, with the procedures resulting in fewer than 1 out of every 100 people becoming pregnant each year.

In other terms, both male and female sterilization procedures are about 99% effective at preventing pregnancy.

You can technically still get pregnant after both types of female sterilization procedures with the help of IVF, in which a fertilized egg is implanted in the uterus, but it generally won’t happen naturally (and not at all if you’ve had a bilateral salpingectomy).

Are there risks associated with sterilization procedures?

Like any medical procedure, there are some risks associated with sterilization procedures — but both Bryant and Rogers noted that they’re generally very minimal and rare.

▪ For female sterilization, risks from the surgical procedure include bleeding, a reaction to general anesthesia and rarely, infection, according to Planned Parenthood. There’s also a chance — this happens very rarely, Planned Parenthood says — that the fallopian tubes could reconnect or become unblocked, and a pregnancy could develop in the fallopian tube, creating a very dangerous ectopic pregnancy.

▪ With vasectomies, patients may experience bleeding, bruising or swelling after the procedure. The risk of infection is generally less than 1%, Rogers told The N&O.

▪ Rogers said one of the biggest risks associated with vasectomies is recanalization, or when the vas deferens reconnect, effectively reversing the procedure. The risk of recanalization occurring is about one in every 2,000 vasectomies, Rogers said.

▪ Planned Parenthood notes that, in general, a vasectomy is “an easier procedure and has fewer risks than female sterilization,” which may be worth noting if you’re in a long-term relationship and exploring permanent contraceptive methods with a partner of the opposite sex.

▪ Aside from physical and medical risks, sterilization procedures also carry the “risk of regret,” as one Texas doctor told Business Insider.

Since the procedures are designed to be long-lasting and permanent, effectively eliminating someone’s ability to naturally become pregnant or get someone else pregnant, deciding whether to undergo sterilization is a big decision that will have lasting consequences on your life — especially if you were to decide later on in life, after the procedure, that you actually do want children.

The risk of regret for undergoing sterilization is likely higher for people who decide to undergo the procedures at a younger age, as well as those who do not already have children.

If you’re unsure whether sterilization is the right contraception choice for you at this moment, there are other, non-permanent methods worth exploring, and your doctor or another health care provider should be able to help you work through which option is best for you.

Are tubal ligation or vasectomy procedures reversible?

Both female and male sterilization procedures are designed to be long-lasting and permanent. But technically, some sterilization procedures are reversible — though the success of reversals isn’t guaranteed, and most doctors will still advise you to think of the procedures as permanent.

Vasectomies are generally more easily reversed and the reversal procedure is less invasive than reversing female sterilization, Rogers said, but whether the reversal is successful largely depends on how long it’s been since the vasectomy was originally performed and what type of reversal procedure has to be done.

“A vasectomy reversal’s success rate is inversely proportional to the time from the vasectomy,” Rogers said. “So, the closer they are to vasectomy, one to two years is more successful than 10 to 15 years, for example.”

Rogers said that about 10% of all vasectomies performed are reversed later on.

Rogers also said there are options that men can opt for pre-vasectomy, such as freezing sperm, that could allow them to have kids of their own later on without having to reverse the vasectomy.

With female sterilization procedures, only tubal ligations could technically be considered reversible — though, again, you should think of the procedure as permanent and reversal isn’t guaranteed.

“It’s a procedure that can be complicated and not that easy to achieve,” Bryant said of reversing tubal ligations. “So, if we do a tubal ligation, we want people to understand that it’s not certainly not easily reversible.”

Bilateral salpingectomy procedures, which remove the fallopian tubes from the body entirely, are not reversible.

Naturally or spontaneously occurring pregnancy is generally not possible after female sterilization, but pregnancy may be possible — even in the case of a bilateral salpingectomy — with the help of IFV, though that option may be expensive or have other drawbacks that you should consider and discuss with your doctor before undergoing sterilization.

Are younger people undergoing sterilization?

You may think mostly of people seeking sterilization procedures after they’ve already had children and have decided that they want no more children.

Now, though, after the Supreme Court’s decision to overturn Roe v. Wade, there may be more of a shift toward younger people, including those who have not already had children, seeking the procedures — though it’s likely too early to tell, and the trend of younger people seeking sterilization seems to have been ongoing for a few years already.

In North Carolina, you must be at least 18 years old to undergo sterilization, according to state law.

Rogers said in general, most of the patients he sees seeking vasectomies are in their 30s or early 40s “with several kids already in hand, who seek no more kids,” but about 10-15% of patients are in their 20s or early 30s.

Rogers said he won’t see most of the patients who have requested vasectomies since the Supreme court’s decision for a couple more months, so it was difficult for him to say whether those patients will skew younger.

Bryant said she’s “definitely seen a trend towards younger people” seeking the procedure over the past few years. She pointed to the “child-free” movement that has grown on Reddit and in other online spaces as one indicator of the trend.

Note: To have public insurance, such as Medicaid, cover sterilization procedures, you must be at least 21 years old.

How much do sterilization procedures cost?

Planned Parenthood estimates that a vasectomy procedure can cost “anywhere between $0 and $1,000, including follow-up visits,” depending on where you receive the procedure, whether you have insurance and other factors.

Planned Parenthood estimates that female sterilization procedures can cost “between $0 to $6,000, including follow-up visits,” also depending on where you receive the procedure, whether you have insurance and other factors.

Does private insurance cover sterilization procedures?

In general, private insurance providers should cover female sterilization procedures, though they are not required to cover male sterilization.

▪ Planned Parenthood says most insurances are required to cover the “full range” of birth control methods, including female sterilization.

▪ Most insurances are not required to cover male birth control, including vasectomies, Planned Parenthood says, but some plans may cover it.

You should check with your insurance provider to see what’s covered under your plan, as well as to see if there are any stipulations or additional requirements for coverage.

Does Medicaid cover sterilization procedures?

In North Carolina, Medicaid does cover sterilization procedures — tubal ligation, bilateral salpingectomy and vasectomy — but there are federal and state requirements that must be met in order to qualify.

For example, some requirements include that you must:

▪ Be at least 21 years old.

▪ Not be declared mentally incompetent.

▪ Give informed consent for the procedure. A federal consent form is required to be signed at least 30 days, but no more than 180 days, before the procedure. The consent form only requires consent from the patient and the physician, not the patient’s spouse or partner.

Additional information about eligibility and coverage of sterilization procedures under Medicaid in North Carolina is available at medicaid.ncdhhs.gov/media/7785/open.

Is there any waiting period required before sterilization procedures in NC?

If you have private health insurance there is not a legally required waiting period between when you express interest in the procedure to when you can actually undergo the procedure.

If you are on public insurance, such as Medicaid, there is a federally required waiting period of 30 days between when you sign the federal consent form to when you can actually undergo the procedure.

Does my spouse or partner have to consent to the procedure?

You may have heard that your spouse or partner has to consent to your sterilization procedure, but that is not true.

Spousal or partner consent is not a legal requirement to undergo sterilization, male or female, Bryant and Rogers told The N&O.

What are other pregnancy prevention methods besides sterilization?

If you don’t think sterilization is the right contraception method for you, or if you’d just like to explore other options, there are other options available that are not permanent.

“There are plenty of reversible options for contraception,” Bryant said. “No method is perfect, but there are lots of different options that work really well for a lot of different people.”

For women, those methods include intrauterine devices (IUD), birth control implants, birth control pills, birth control patches and more.

You can learn more about contraception options for men and women at plannedparenthood.org/learn/birth-control or acog.org/womens-health.

Additional information about sterilization procedures in NC

Additional information about sterilization procedures in North Carolina is available at:

▪ Female sterilization: plannedparenthood.org/learn/birth-control/sterilization

▪ Male sterilization: plannedparenthood.org/learn/birth-control/vasectomy

You may also consider asking your doctor or another health care provider questions you have about the procedures and how to decide whether they’re right for you.