Preparations 

Is pregnancy possible with sterilization? Is it possible to get pregnant after sterilization. is it possible to get pregnant with ligated fallopian tubes and have a baby really want

Instruction

Most often, sterilization is decided by women who have given birth to a certain number, sufficient in their opinion, who want to put an end to the issues of protection once and for all. The meaning of this procedure is to violate the integrity of the fallopian tubes by bandaging, pressing with special clips or cauterizing them with an electric current. At the same time, the egg loses the opportunity to meet with spermatozoa and exit into the uterine cavity, that is, fertilization does not occur, pregnancy does not occur. However, everything is not so simple. The Pearl Index of 0.1 indicates that, although the most minimal, the woman remains at risk. This can happen for various reasons.

Not all doctors mention that sterilization performed during a caesarean section does not always give a 100% guarantee of results. Of course, it is very convenient to combine two medical procedures and, if the abdominal cavity is already narrower anyway. Nevertheless, we must not forget about the abilities of the human body, sometimes bordering on, especially when it comes to fertility. After childbirth, most of the forces of the female body are directed to the restoration of the previous pre-pregnancy state. Traumatized pipes can also be included in the process. The chances that they will recover enough to pass an egg through themselves are negligible and practically no one considers them, but a smaller and more nimble sperm may be able to leak and fertilize the recluse. Pregnancy will come, but not ordinary, but tubal. Therefore, it is so important to track your cycle for at least the first couple of years after the intervention, so as not to miss a possible ectopic pregnancy.

Although sterilization is considered an irreversible operation, women who have gone through it and still want to give birth to another child sometimes turn to doctors. They can be helped by a reverse sterilization procedure - refertilization, when doctors try to quickly restore the patency of the pipes. But the probability of a positive result in such an operation is so small that it would be much more productive to turn your gaze towards in vitro fertilization. IVF pregnancy in general and in general is practically no different from normal and will help a woman give birth to such a desired baby.

The choice of contraception today is quite diverse. If condoms are not suitable for a couple for some reason, then the woman goes to the doctor and resolves this issue with him. One of the most radical ways to protect against unwanted conception can be called sterilization. After some time, the patients come to the gynecologist with the question: I have my tubes tied, can I get pregnant? Let's try to find answers together.

After sterilization, or tubal ligation, there are several scenarios for the development of events:

  • a woman at some point realizes that she wants to regain her fertility;
  • the woman is surprised by the delay in menstruation, because she does not want a child at all now and it is because of this that she chose earlier tubal ligation.

As we have already mentioned, surgical sterilization is a rather rigid method of contraception, involving surgical intervention in the female body. It is believed that the procedure is almost irreversible, although there are still some chances for a future pregnancy. Usually, such contraception is resorted to by those women who already have children and no longer want to give birth. The purpose of the operation is to block the access of the egg to the uterus. She is dying.

Let's look at cases where conception nevertheless took place, despite sterilization.

This rarely happens, but still, although it is low, there is a chance.

  • Technology disruption. The quality of the operation depends on the experience and skills of the specialist. If he makes even the slightest mistake, sterilization is no guarantee.
  • Pipe splicing. The body quite often surprises us with its unpredictability. Spontaneous fusion may open access to the egg. And then the spermatozoa will be able to get to it.
  • conception before surgery. The most unlikely reason, but it cannot be ignored. A woman could be late and come to the operation already pregnant in the early stages.

Tubal ligation during caesarean section

During childbirth, by caesarean section, many patients are asked to tie the tubes at the same time. They are not always warned that such an operation does not guarantee complete infertility. But this intervention is convenient in that it is not necessary to inject anesthesia several times, and instead of two operations, one can be performed.

After childbirth, the body is trying hard to recover. This also includes an attempt to return the pipes to their original state. The chances of overcoming tubal ligation, though small, are still there. Unfortunately, in such cases, the likelihood of an ectopic pregnancy is high. Therefore, with any delay in menstruation, even if you have had sterilization in the past, you should be examined.

How to get pregnant?

Gynecologists often hear the question: I have my tubes tied, can I get pregnant?

In this case, women are offered several ways to become a mother:

  • tubal reconstruction with plasty and laparoscopy.

Laparoscopy

Pipes can be tried to "untie" only if they were tied in a knot or tied with threads. In other cases, the clearance cannot be returned, especially if part of the pipe is removed.

Plastic also allows you to return the pipes to normal. With its help, fertility increases by 50%. The earlier a woman decides to get pregnant, the greater the chance. Therefore, if you decide to have your tubes tied and are planning to have children, it is worth considering the timing as well. If the operation was performed many years ago, then complete atrophy of the organ occurs - the cilia will no longer be able to perform their function, which also leads to ectopic pregnancy. The egg will not reach the uterus.

ECO

In vitro fertilization helps women get pregnant, but the cost of the procedure is quite high.

In order for the fetus to be in the uterus, tubes are not needed. The most important thing is the health of the reproductive organ, where the embryo will be implanted, as well as the hormonal background. Unfortunately, quite often IVF is not successful and the procedure has to be repeated.

In theory, this kind of fertilization looks very simple. An egg is taken from a woman's ovary, fertilized in a test tube, and then planted in the uterus, bypassing the tubes. In fact, the dressing does not interfere with the process. In practice, everything is much more complicated.

  1. The first stage of IVF involves taking bolus doses of hormones to grow several large eggs. The process is monitored by ultrasound. They are then removed with a needle through the vagina. The procedure requires anesthesia and ultrasound control. For several days, the eggs "live" in a specially created environment. Next, they receive sperm from the future father.
  2. The next step will be fertilization in the laboratory. The sperm are mixed with the eggs. The resulting embryos are in the incubator. The excess is frozen. In case of an unsuccessful attempt, this reserve will be used.
  3. And the key point is the transfer of the fetal egg to the uterus. To do this, a woman must take hormones so that the thickness of the endometrium is sufficient for implantation.

After two weeks, you can do a pregnancy test. After the procedure, you are not allowed to get up for about an hour.

As you can see, the condition of the pipes does not play a role for IVF. No one gives guarantees for success, because the embryos may not take root.

Conclusion

Think carefully before agreeing to sterilization. If other contraception is contraindicated for you, and you no longer plan to have children, then be sure to look for a qualified specialist to perform the operation correctly. Your health in the future depends on its outcome. As we already mentioned, any mistake will lead to an unplanned pregnancy. Often, to an ectopic.

To date, tubal ligation is the most effective method of birth control, because after this medical procedure, pregnancy becomes virtually impossible. This method is used for those women who voluntarily refuse possible pregnancies, that is, those who no longer want to have children.

How to tie the fallopian tubes after childbirth: who is allowed

Of course, not all women can undergo this procedure. There are enough contraindications that prevent this operation. Therefore, it is easier to list cases that do not have contraindications for tubal ligation.

When a ligation operation is possible:

  • When a new pregnancy and childbirth threaten the health of the patient;
  • At an age close to menopause, when there is a history of severe genetic diseases;
  • When a woman has two or more children and is under 35;
  • In case the woman is 35 and has a child;
  • When both husband and wife no longer want children.

The operation is not so difficult, because cases of complications are rare. The least traumatic laparoscopic operations. Such an operation is performed under local or general anesthesia, as the patient wants, and what the doctor recommends. The laparoscopic method is used for postpartum sterilization. Perform it 72 hours after the appearance of the baby. The fallopian tubes at this time are located in the navel, which facilitates the operation, and rehabilitation will be faster and easier.

After sterilization, you can get pregnant!

To give birth or not to give birth - this Hamlet question is acute for a certain part of the population of our country. What is the best way to protect yourself? This topic is one of the most popular on women's forums. Recently, chatterbox participants have been discussing surgical sterilization, after which a woman is not able to have children. What really drives the supporters of a “childless” life and whether the state is meeting them halfway, we tried to figure it out.

“You never know what comes into the head of a young girl”

The fact that our legislation does not allow voluntary sterilization of childless women at an early age without medical indications, I think is right, says State Duma deputy, actress Elena Drapeko. - You never know what comes into the head of a young girl. The sterilization process is almost irreversible, and if a woman changes her mind and wants to give birth, it is almost impossible to restore her prescribed function. Those who do not want to have children can use contraception. But we try to do everything to raise the prestige of the family. One of the measures is to increase maternity capital every year. It is important that mothers feel supported.

"I knew what I was getting into"

Oksana SIDOROVOY - 36. By her first education she is an accountant-economist. At the age of 33, she entered the history department of Moscow State University, began to learn Spanish. And then she met Igor, who settled in the Basque Country, and fell in love. However, due to various circumstances, I understood: they could not be together. To rule out the possibility of an unwanted pregnancy, the woman decided to do what she had been mentally preparing for for many years - from the very moment, after reading books, she began to understand where children come from.

Natalia MURGA

I was 12 years old when my mother gave birth to a younger brother. To be honest, I wasn't happy with this "gift". There was a feeling that with the advent of this eternally screaming, wet lump, my childhood was over. Favorite activities and hobbies receded into the background, and instead I had to help my mother. I wanted my mother to ask me about my studies, how I performed in the school play, but she only saw me as a nanny for her brother.

At 17, I started dating men. Partners changed, but I did not experience the pleasure of sex. Each time, the thought was spinning in my head: “God, I can get pregnant!” The process of childbirth terrified me. In addition, I saw how childbirth undermined the health of my mother.

I was in no hurry to create my own family - first my studies, then my career, that's how my parents oriented me. I lived with them until the age of 33. She dragged her sick father on herself, leaving work.

For the last eight years I have lived without sex and was ready to give it up further, if only not to "fly". When Igor appeared, he also said that a child in our relationship is undesirable. And I finally decided on sterilization.

I was 33 then, and I knew that in Russia this operation would not be done until I was 35, so I asked Igor to help. But he said that only degenerate women go for it, and advised him to consult a psychologist. After that, my feelings for him faded.

I learned everything about the operation in Spain myself. There, such operations are performed from the age of 18 at the request of the woman herself. I bought medical insurance, but it turned out that they could operate on me for free only after six months. I did not wait and paid 1.5 thousand euros.

Before giving anesthesia, the doctor once again asked: do I understand what I'm going for? And that's all - no exhortations. There was a scar in the lower abdomen of five centimeters. But the problem is gone.

I do not urge women not to give birth, Oksana assures. - I just don’t understand why in Russia you can get rid of the fear of pregnancy only after 35 years or after giving birth to at least two children? Why is abortion not considered a crime and from the age of 18 they are allowed to change sex, which also does not increase the birth rate? At the great Leonardo da Vinci there were no children - he died in the hands of the students. But the whole world remembers him for so many centuries. Maybe I also want to continue myself not in children, but in something else. It is my right.

Fortunately, most women think about surgical sterilization after childbirth, having done what nature intended for her. To whom this operation is done and what the consequences may be - this was told by an obstetrician-gynecologist, candidate of medical sciences Irina DUSHKINA.

Nadezhda PANTELEEVA

As we found out, according to the law adopted in our country back in 1993, both women and men are sterilized if they already have two or more children growing up or they are 35 years old and have firmly decided not to give birth again. Or not to give birth at all, if you still have not acquired offspring. But first of all, the operation is carried out for medical reasons - there are more than fifty diseases on the list, including severe damage to the heart, kidneys, diabetes mellitus and others.

Everything is so, but in life there are many nuances, - explains Irina Dushkina. - When a 35-year-old woman comes, who already has three, four, five children, and even had a caesarean section, I will strongly support her decision to sterilize. But if there are no children or only one child, if the woman’s health is all right, I personally will never offer sterilization, even if she is over 35. And I will try to dissuade younger ones. I think it is very important to convey that the operation is most likely irreversible and if they eventually want to give birth, it will be too late. Then only IVF can help, but it is not always successful, and it is also expensive.

Many women only closer to 40 think about offspring. They remarry, connect their lives with men, often younger than themselves, who want to have children. Therefore, I would not advise anyone to rush.

I have a patient - the first time she came to the appointment when she was 35. The woman is constantly taking oral contraceptives. I tell her: we need to take a break, because the ovaries will forget how to work. She says why? I'm not going to give birth. Until the age of 35, her career was in the first place. And at 35, she realized that she no longer needed it, although she was not ripe for motherhood either. Very pretty, well-groomed, but at the same time she was engaged in wrestling, and I do not rule out an androgynous failure in her. She was also very irritated by menstruation - even those three days when she arose when contraception was canceled. But at the same time, she does not discuss the issue of sterilization.

- Where did this milestone come from - 35 years, after which sterilization is allowed for those who do not have children?

Apparently, the average age is indicated between 15 and 50 years - the duration of the reproductive period. But today, I repeat, I do not advise women at 35 to give up on themselves and offer different methods of protection. However, if such exhortations do not work, we have no right to refuse. A woman must write a statement that she agrees to the operation and is informed about its consequences.

- Consent of the husband in such cases is required?

No. Doctors proceed from the fact that an adult woman is able to make her own decisions.

- If the couple has a question about sterilization, who is safer to do it - a man or a woman?

The operation to cut the vas deferens in men - it's called a vasectomy - is technically easier. It is performed under local anesthesia and the patient goes home the same day. In addition, if the need arises, it is more likely to restore childbearing function in men. I have a married couple who, ten years after the sterilization of their husband, decided that at 42 they needed another baby. The couple turned to the Institute of Andrology, where the man's vas deferens were restored. After that, the woman did IVF. But these people are lucky - in 70 percent of cases, recovery is impossible, especially if many years have passed after the vasectomy. By the way, sometimes men are advised to freeze sperm before surgery. Just in case.

Measure seven times

- And if a woman wants to return the “lost”, is it real?

Theoretically - yes, but a very difficult, truly jewelry plastic surgery is ahead to restore the patency of the fallopian tubes - through them the spermatozoa enter the uterus. During sterilization, they intersect, after which the adhesion of their walls is necessarily carried out by coagulation. If the walls are not “soldered”, the passage in the fallopian tube may open, and then an ectopic pregnancy is not excluded.

Sometimes adhesions occur at the intersection of the fallopian tubes, and in this case it is almost impossible to restore the childbearing function. More chances of success if the operation is done laparoscopically, in which the risk of adhesions is lower. But to restore the patency of the pipe, most likely, abdominal surgery will be needed.

How does sterilization affect the delicate female body? They say that after it comes an early menopause and the ladies age dramatically.

A woman cannot grow old because of this, because the fallopian tube does not produce hormones. It performs the function of moving the egg into the uterus, and that's it. The ovaries continue to work, menopause does not occur ahead of time, menstruation and PMS persist. Sexual desire does not disappear and even, they say, increases, as the fear of pregnancy disappears.

- What should be done to prepare for the operation?

Sterilization implies a full-fledged surgical intervention, so it is necessary to prepare for it, as for any operation. Donate blood for general and biochemical analysis, make an ECG, fluorogram, coagulogram, colposcopy, ultrasound of the pelvic organs. Based on the results of the examination, the therapist makes a conclusion whether there are any contraindications for the operation.

The operation is performed under general anesthesia and lasts from 15 to 30 minutes. After that, the patient is under observation for another day. As for pain, they depend on the threshold of sensitivity - some get up immediately after anesthesia. Three weeks after sterilization, you can return to sexual activity.

- Complications happen?

The same as with any operation: bleeding, infection, adhesions. An ectopic pregnancy is especially dangerous. If there is prolonged spotting, you need to urgently see a gynecologist.

Ronaldo closed the "factory"

Four years ago Brazilian footballer Ronaldo, the famous Nibbler, decided on a vasectomy - the intersection of the vas deferens. "I closed the channels... I closed the baby factory," the two-time Ballon d'Or winner said after having four children with three women. So did the king of football Pele who also has four heirs. Later, the athlete wanted another child, and Assyria's wife went to IVF to give 55-year-old Pele twins.

Oppressive emptiness or extraordinary lightness?

Women who have undergone or were offered to undergo sterilization speak of conflicting sensations and feelings. They write about it on the forums.

* “The husband insisted on sterilization. We already have two children, he said that these need to be put on their feet. He's against abortion, and the pills don't work for me. After the operation, I feel like a dummy inside. It's hard to accept that I can no longer have children - NEVER!

* “I had my tubes tied after a caesarean at 27. Five years have passed, until I regret it, sex has become much better. Before that, I drank pills and put a spiral - horror!

* “My experience is sad. Before the second cesarean, she wrote an application for voluntary sterilization. She was made. But... my daughter died 19 hours after birth. I really regret taking this step. Girls, if you want to do it, then think it over well.

* “Someone said that sterilization is a sin. Where is it written? Abortion is a more serious sin, I think many will agree with me.

* “I refused sterilization, although the doctor strongly recommended, citing the fact that I am already 32, I have two children, I will hardly come for the third. I didn't agree. I don't like doing "irreversible things".

* “It is very unpleasant that the state does not allow a normal woman who pays taxes to dispose of her body. At the same time, it’s fun: I was with a cat at the veterinarian, they say there: hormones are very harmful, it is necessary to sterilize. That is, women can be poisoned.

* “Did a laparoscopic sterilization at the request of a lover. He paid. You say stupid? Maybe. But happy."

* “Having children is the most awesome orgasm you can experience. Women, give birth! No one else but us! If you can give your child the warmth of the soul, there is a place to live, then do not be afraid of anything - the rest will follow. I’m 45, I have two children, I’m going to be sterilized for health reasons and I really regret that I didn’t give birth more.”

Get it done in 45 minutes

Female sterilization is one of the most reliable methods of contraception. Previously, such operations were carried out only for medical reasons, and since 1993 in Russia - at the request of a woman. This method of protection has many advantages and, most importantly, a high degree of efficiency: the likelihood of spontaneous pregnancy after tubal ligation is practically reduced to zero.

For many, female sterilization is associated with a similar procedure in animals, in particular cats. After that, pets gain weight, become more passive and indifferent to others. But, despite similar terms, the essence of the procedures is different. In women, sterilization involves only the ligation of the fallopian tubes with the preservation of all organs. In cats, the ovaries are removed during the sterilization process, often in combination with the uterus.

Reasons for sterilization

Given the fact that surgical sterilization is a serious surgical intervention, its implementation is strictly regulated by law. In Russia, tubal ligation is allowed in the following cases:

  • after 35 years- regardless of the number of children;
  • after 18 years- if there are two children;
  • after repeat caesarean section- in the presence of living and healthy children;
  • for medical reasons- by a woman.

To perform sterilization, the consent of the woman in writing is required. For medical reasons, the operation is performed in the presence of mental illness, serious somatic pathologies in which pregnancy is contraindicated (for example, decompensated diabetes or arterial hypertension of III-IV degree), malignant diseases in the past.

Features of the

Independent pregnancy in healthy women is possible if the egg meets the sperm and fertilization occurs. The female sex cell matures in the ovary, and the male comes with sperm to the vagina and cervix. Fertilization occurs in 90% of cases in the fallopian tube.

In order to exclude conception, during sterilization, a mechanical obstacle is created in the way of germ cells at the level of the fallopian tubes - they are dissected, tied up or cauterized. The egg undergoes regression in the fallopian tube from the ovary or in the abdominal cavity. All other structures remain intact, so no other changes in well-being, sexual life are noted. In fact, tubal infertility is artificially formed in a woman.

The following options are available for sterilization:

  • separately- as a separate operation;
  • during a caesarean section- as a stage of surgical intervention;
  • after natural childbirth- on the fifth or seventh day or after six weeks.

For caesarean section

Tubal ligation is usually performed by caesarean section. The benefits are as follows:

  • no need for additional operation;
  • no additional examination is needed the day before;
  • the fact of tubal ligation can be hidden from other people.

After a caesarean section, you should think about a reliable method of contraception for at least one and a half to two next years. And if the couple does not plan to replenish, or there are some medical indications (for example, thinning of the scar on the uterus, signs of placenta ingrowth in the area of ​​the old seam), sterilization is an ideal method of contraception.

After natural childbirth, tubal ligation is performed less frequently. This is due to the danger of an additional operation for a weakened organism. In addition, the special hormonal background of a woman often complicates the perception that she herself makes herself infertile.

Examination the day before

Sterilization includes a complete examination the day before, except when it is performed during a caesarean section. The list is as follows:

  • blood and urine tests;
  • coagulogram;
  • fluorography;
  • blood tests for hepatitis, HIV, syphilis;
  • therapist examination.

Anesthesia

Depending on the technique of the operation, different anesthesia is used:

  • laparoscopic- only intubation anesthesia with temporary mechanical ventilation (artificial ventilation of the lungs);
  • laparotomy- spinal anesthesia ("prick in the back") or endotracheal anesthesia with mechanical ventilation.

Sterilization does not involve the removal of part of the organ or formations, so the postoperative period proceeds relatively smoothly. Pain is associated only with a wound on the anterior abdominal wall.

Operation types

Depending on the clinical situation, preference is given to one or another type of surgical intervention. Sterilization during caesarean section - as a stage of the operation. In other cases, the options are presented in the table.

Table - Sterilization techniques

Peculiarities Laparoscopy Minilaparotomy Colpotomy
Technique Special instruments are placed into the abdominal cavity through 2-3 small incisions in the iliac region and near the navel A 4-5 cm incision is made in the anterior abdominal wall horizontally or vertically Access through an incision in the vaginal mucosa
pros - Minimal tissue trauma;
- short rehabilitation period;
- seams and scars are invisible		 - Performed even with adhesions and overweight;
- the technique is simple;
- no "non-standard" tools needed		 - Less traumatic;
- no marks on the body;
- rehabilitation no more than a week
Minuses - Not performed with a pronounced adhesive process, obesity;
- requires special equipment and trained specialists		 - Traumatic;
- rehabilitation of at least 2-3 weeks;
- there is a noticeable seam		 - Not performed during the adhesive process;
- possible technical difficulties

A mechanical obstruction at the level of the fallopian tubes can be created in various ways:

  • direct tubal ligation- at the same time, the fallopian tubes are tightened with non-absorbable suture material;
  • cauterization- the fallopian tube is cut into two parts with an electrode, more often used for laparoscopy;
  • dressing and cauterization- the fallopian tubes are tied up, then dissected and the ends are additionally coagulated;
  • ligation and incision- the fallopian tubes are tightened with suture material, and then dissected;
  • clips, clamps- used for laparoscopy, while the patency of the fallopian tubes is disturbed.

The literature describes methods of sterilization when performing hysteroscopy. At the same time, a substance or special conductors are introduced into the lumen of the mouths of the fallopian tubes from the side of the uterine cavity, over time, obstruction (infection) of the lumen occurs. However, due to the high incidence of complications and the decrease in the effectiveness of contraception, such methods are not widely used.

Contraindications

Contraindications to sterilization are due to limitations in anesthesia, as well as a high risk of complications in some conditions. The operation was excluded for acute inflammatory diseases of the pelvic organs. List of relative contraindications:

  • cardiovascular diseases;
  • tumor formations in the small pelvis;
  • diabetes;
  • somatic diseases in the stage of decompensation;
  • pronounced adhesive process;
  • obesity III-IV degree.

Permission for the operation is given by the therapist and gynecologist after the examination.

Postoperative period

The severity of the postoperative period depends on the method of intervention. When performing isolated sterilization (not during a caesarean section or other operation), a woman can be discharged home on the second or third day with recommendations:

  • physical and sexual well-being- in two weeks;
  • exclusion of visiting baths, saunas- within three weeks;
  • postoperative wound care- as directed.

Possible Complications

Complications that may occur:

  • during the operation bleeding, damage to the intestines, ovaries;
  • after discharge - mental disorders, changes in the menstrual cycle and hormonal failure.

Late complications are extremely rare, the likelihood of their occurrence is associated with existing diseases in a woman, as well as with complications that were during the operation.

Advantages and disadvantages

The decision on the need for sterilization is made by each woman independently. The advantages and disadvantages of the method are presented in the table.

Table - Pros and cons of tubal ligation

chances of conception

Sterilization eliminates the possibility of spontaneous spontaneous conception. You can get pregnant after surgery only in the following ways.

  • microsurgical operation. Allows you to restore the fallopian tubes after ligation, dissection and cauterization, ligatures. The duration of the operation is at least two to three hours; a special microscope is required for the operation, which allows distinguishing structures less than 1 mm. Efficiency from 40 to 85%. Conventional laparoscopy will not cope with this.
  • Assisted Reproductive Medicine. Women after sterilization are similar to those who, for other reasons, have tubal infertility. There are no obstacles to performing IVF, but this is an expensive procedure that requires a serious hormonal load on the woman's body.

Alternative

There are alternative methods of protection. They have the same efficiency as sterilization (about 99%).

  • Hormonal pills, vaginal rings, patches. Reliable, but have many contraindications, give side effects. They are not cheap. Sometimes it is difficult to find a drug. You need to follow the schedule. And the patch or ring needs to be replaced.
  • Intrauterine device (IUD). Installed for three to five years. affordable method. But some do not fit, because of which there are abundant painful periods. Can not be installed in the pathology of the cervix. The IUD causes inflammation in the uterine cavity.

Female sterilization is an effective and safe method of contraception. Menstruation, general well-being of the patient and feelings during intimate relationships after the operation do not change in any way. The procedure is regulated by law - it is prohibited for girls under 18 and childless women under 35.