Contraceptives are also called birth control methods which are used to deliberately prevent or reduce the likelihood of a woman becoming pregnant. They are devices or methods or procedures which reduces the likelihood of the fertilization of an ovum by a sperm.

Nowadays, there is a vast number of different contraceptive methods. There are many different contraceptive methods available and different methods suit people at different times of their lives. It is very important for the woman and her partner to decide on the method of contraception most suited to them. There are barrier methods like condoms, cervical diaphragm. Then there are hormonal methods like pills which are very commonly used. Besides, devices like IUCD are placed in the uterus. But all these are temporary methods. That means they are reversible. But for few people, permanent birth control is a more reasonable option. This option is considered when the couple:

   * Does not want to have children in the future, no matter how the life may change.
   * Have a partner who also does not want children in the future but does not want to have a vasectomy
   * Have also considered other methods of birth control and do not want the side effects, risks, or costs of those methods.
   * Have health problems that would be made worse by pregnancy.
   * Have a hereditary condition that one does not want to pass on.

What is surgical contraception?

Permanent birth control methods are practically irreversible processes actually require surgical intervention. So they are also called surgical contraceptives. Sterilization is when a man or woman has an operation to prevent pregnancy. It safeguards individual health and rights, preserves our planet's resources, and improves the quality of life for individual women, their partners, and their children. For females there are two methods:

# Tubal ligation

It is often referred to as "having the tubes tied," is a surgical procedure. The fallopian tubes, which carry the eggs from the ovaries to the uterus, are blocked or cut and sealed off so that the eggs can't reach the uterus and be fertilized by sperm. Instead, the eggs are reabsorbed by the body.

# Tubal implants

They are small metal springs that are placed in each fallopian tube in a non-surgical procedure (no cutting is involved). Over time, scar tissue grows around each implant and permanently blocks the tubes.

Both these methods are considered to be permanent methods of birth control for women. Both procedure stops eggs from travelling from the ovaries into the fallopian tubes, where the egg is normally fertilized by a sperm. Reversing a tubal ligation is possible, but it is not highly successful.

How is it done?

Tubal ligation and tubal implants are considered to be permanent procedures. They come under surgical procedures. The female must make sure to talk to her gynaecologist openly to understand what is best for her. The choice of birth control depends on factors such as a person's health, frequency of sexual activity, number of sexual partners, and desire to have children in the future.

Before surgery

A pregnancy test is administered beforehand, because a pregnant woman can't undergo sterilization. After a detailed case history taking, the physician may advice for certain tests, depending upon the clinical indications. The patient will be advised to fast before the surgery. The doctor may choose to give either general anaesthesia or epidural.

The doctor injects a harmless gas (carbon dioxide) into the abdomen, which inflates the abdominal cavity, making it easier to see the internal organs. The doctor then makes a tiny incision near the navel and inserts a long, thin instrument (called a laparoscope) that contains a small lens and lighting system to magnify and illuminate the structures inside the lower abdomen. The physician may make a second incision just above the pubic hair to insert an instrument for grasping the fallopian tubes. The tubes are closed by one of the following means:

Benefits and drawbacks

Tubal ligation and tubal implants are permanent methods of birth control and allows the female to be sexually active without worrying about becoming pregnant. Although these methods are expensive but it is a one-time cost. These procedures are usually covered by medical insurance, and there are no costs after the surgery is done. The cost of other birth control methods, such as pills or condoms and spermicide, may be greater over time.

Above all, both these methods do not change the biological rhythm of the body. There is no change in monthly menstrual cycle. One will still release an egg each month (ovulate) and have menstrual periods. The female will go through menopause at the same time that she would have if she had not had the surgery. On the sexual front also there is no change. Infact women claim of feeling more relaxed about having sex because she doesn't have to worry about becoming pregnant.

The major disadvantage is that Tubal ligation and tubal implants do not protect against sexually transmitted diseases (STDs), including infection with the human immunodeficiency virus (HIV).

Risks and Complications

Major complications of tubal ligation are uncommon. Minor complications include infection and wound separation. They affect about 11% of women after mini-laparotomy, and 6% of women after laparoscopy. Major complications include heavy blood loss, general anesthesia problems, organ injury during surgery, and need for a larger laparotomy incision during surgery. They affect 1.5% of women after mini-laparotomy, and 0.9% of women after laparoscopy.

Although fewer complications occur with laparoscopy than with other kinds of tubal ligation surgery, these complications can be more serious. For example, on rare occasions, the bowel or bladder is injured when the laparoscope is inserted. But by choosing a skilled laparoscopic surgeon, these risks can be avoided.

The risk of pelvic infection is greater with tubal implants. There is a slight risk of becoming pregnant after tubal ligation. This happens to about 5 per 1,000 women after 1 year. After a total of 10 years following tubal ligation, about 18 per 1,000 women will have become pregnant. Pregnancy may occur if:

   * The tubes grow back together or a new passage forms (recanalization) that allows an egg to be fertilized by sperm. The health professional can discuss which method of ligation is more effective for preventing tubes from growing back together.
   * The surgery was not done correctly.
   * One was pregnant at the time of surgery.

If a tubal ligation or implant fails and the female becomes pregnant, she may run into the risk of having ectopic pregnancy. This means that the egg after getting fertilized implants itself into the fallopian tubes instead of uterus.