Hi! I'm Alice, and when I was 26, I received a bilateral salpingectomy (aka I had my fallopian tubes removed).
The entire experience of getting my tubes removed was long and frustrating, and my story is unfortunately not uncommon for people who seek sterilization. In an effort to demystify the process, I want to share my experience — from the tough decisions I made, to the hurdles I faced, to everything I learned along the way.
If you're fighting to get this procedure or just exploring your options, I hope you find my story helpful!
People who request permanent sterilization procedures usually want to be child-free, already have kids and don't want more, or have a medical reason. But I don't fit neatly into one of those categories. I haven't known for my full life that I want to be child-free. In fact, I'm not sure whether I want kids even now — four years after my tubes were removed.
I may be open to adoption, legal guardianship, or foster care down the road, but that's something I wouldn't consider until I'm able to provide a child in that situation with the extra support they would likely need.
Growing up, I assumed I'd probably have kids someday, but didn't give it too much thought. I knew I definitely didn't want to get pregnant as a teenager, so I went on the pill at 14 and stayed on it until I got a hormonal IUD in my early 20s.
Everything about getting the IUD was horrible — the insertion was painful, bloody, and traumatic; I had debilitating cramps for months after and even went to the ER twice; and for the next three years I bled almost daily (there was far more blood than just "spotting"). At that point, I started to really consider whether I wanted kids at all.
Ultimately, my decision came down to several factors:
1. I wasn't sure I was mentally, emotionally, physically, or financially capable of being responsible for another human in the way every child deserves.
2. I have ADHD and depend on daily stimulant medication to function, but I would have to go off those meds if I ever got pregnant.
3. I was absolutely terrified of the physical and mental tolls of pregnancy.
4. Being on the pill made me debilitatingly depressed and anxious, and IUDs came with too many negative side effects to be worth it. (My experience is not universal, and both the pill and IUDs are terrific forms of birth control for many people!)
I'll be honest — in a perfect world, I might actually enjoy carrying and giving birth to one or two biological children. Since we don't live in a perfect world, I made my decision and scheduled an appointment with my OB-GYN.
The OB-GYN practice that prescribed my birth control pills and inserted my IUD had only one surgeon on staff, and he was an old white man very close to retirement. When I met with him to request a tubal ligation, I was 21. After listening to all my reasoning, he told me he wasn't comfortable performing a tubal ligation on someone so young.
I'll never forget how laughably cliche all his talking points were:
—"You're too young to know if you really want kids or not." I doubt he says that to his patients who want to get pregnant.
—"What if you regret the decision?" I'd rather regret not having kids than regret bringing a child into the world that I'm not prepared to care for.
—"There are less permanent birth control options available to you." I've tried them, and they made my life a living hell.
—"What if your future husband wants kids?" I would never marry someone who wasn't on the same page as me about having kids.
—"A lot of women actually find that their preexisting health problems improve during pregnancy." A lot of people find pregnancy miserable or even life-threatening; I'm not willing to risk it.
It didn't matter how sure I was of my decision — the doctor refused to perform the procedure, and that was that.
It's no secret that women, other marginalized genders, and intersex people have to fight for reproductive healthcare in a biased medical system, but I lived in a progressive state at the time. I assumed that meant doctors would respect my reproductive autonomy, but I didn't realize how systemic these issues are, regardless of location.
I was frustrated by my conversation with the doctor, but he was right about one thing: I was young, and I had no pressing need to get the surgery at that time because I wasn't in a relationship. But that changed the following year when I started dating the man who eventually became my husband.
Instead of celebrating our first Valentine's Day together, I spent the night in the ER because of multiple oversized ovarian cysts. I was diagnosed with PCOS (polycystic ovary syndrome) that night, although not a single doctor thought to tell me at the time (I didn't find out about this diagnosis until YEARS later).
Some time passed, and my reproductive troubles continued. I received other chronic health diagnoses (although I still didn't know I had PCOS, and I will die mad about it), decided to go back to school, and moved to a different progressive state with my then-fiancé. Days after the move, I scheduled an appointment with a new OB-GYN practice — this time, I made sure my doctor was a young woman.
One thing about me that is both a blessing and a curse is that I can be very, very persistent to the point of obnoxiousness. And in the years since I first requested a tubal ligation, I learned how to advocate for myself within the medical system.
Part of my success is just my entirely too intense personality, but here are a few tips and tricks I learned along the way:
—Always go in with a list of talking points and concerns, and take notes on what your doctor says.
—Be polite but firm. If a doctor shoots you down or dismisses your concerns, don't be afraid to keep bringing them up. A common phrase that works for a lot of people is, "Would you please mark in my chart that you refused to [order a test/refer me to a specialist/investigate my concern further/etc.]."
—Do research ahead of time. Look for information from valid sources (like medical studies or government websites). Don't be afraid to read anecdotes on Reddit or other forums from people who have similar health issues, but don't rely exclusively on anecdotes.
—Think of your doctor as your partner on a group project. They might be frustrating to work with, and they don't know your body as well as you do, but they will have invaluable experience and knowledge that you shouldn't ignore.
—If all else fails, don't be afraid to get a second opinion or switch doctors/medical practices. You owe no loyalty to someone who doesn't have your best interests at heart.
So, before my OB-GYN appointment, I researched sterilization. I read articles and studies, joined online support groups, and even wrote a paper for my Sexuality, Gender, and the Law class on the legal history of reproductive autonomy and sterilization in the US.
This research confirmed my suspicion that there is a demonstrable discrepancy between the length and ease of processes for people requesting vasectomies versus tubal ligations. Despite both procedures being reversible, people who request vasectomies face far fewer legal, cultural, religious, economic, and medical barriers than people requesting tubal ligations.
I also discovered an official recommendation by the American College of Obstetricians and Gynecologists regarding permanent sterilization: "Respect for an individual woman’s reproductive autonomy should be the primary concern guiding sterilization provision and policy."
Incredibly, most of my preparation was unnecessary (although I don't regret any of it). Five years after the first doctor turned me down, my new OB-GYN listened to all my reasons for wanting a tubal ligation and agreed to perform the procedure. She explained that it was clear this was a decision I didn't take lightly, and she respected my autonomy. She did ask a few of the same customary questions out of obligation (what if I regret it, what if my future husband wants kids, etc.), but she didn't question or dismiss my answers.
One important thing I learned in that appointment was that some doctors are starting to recommend removing fallopian tubes entirely (a procedure called a laparoscopic bilateral salpingectomy) over tubal ligations. Apparently, the benefit of tubal ligations is that they are reversible if someone changes their mind — but they also aren't 100% effective in preventing unwanted pregnancy. By removing the tubes completely, pregnancy can only occur via in vitro fertilization. Bonus: it reduces the likelihood of ovarian cancer.
The journey from the moment I first considered sterilization to my actual surgery was anything but easy. But after just one appointment with my new OB-GYN, I left her office with a scheduled laparoscopic bilateral salpingectomy on the books.
My experience was frustrating beyond belief, but it was still somehow much easier than most other people in my position. I was approved for the surgery when I was 26, unmarried, and didn't have any children already; that's practically unheard of.
On July 11, 2019, I walked into a hospital at the ass crack of dawn for my long-awaited laparoscopic bilateral salpingectomy. Several hours later, I returned home without fallopian tubes, and I exhaled a sigh of relief that I didn't realize I'd been holding in for five years.
The worst part of the surgery was the prep — no eating or drinking for 12 hours beforehand, getting up at 4:30 a.m. to scrub my entire body with antibacterial soap and not being allowed to put on lotion or lip balm after (the feeling of dry skin makes me want to die), taking out all my piercings, and sitting around in a shared hospital room wearing nothing but a flimsy hospital gown and diaper (!!!!!) before the surgery.
Obviously, I don't remember the surgery itself. I woke up from the anesthesia for about one second when I was transferred from the gurney to an operating table, but the next thing I remember was waking up in recovery and being entirely unable to hold my head up straight. I wasn't in pain, and I was on a heavy anti-nausea cocktail to counteract the side effects of anesthesia.
I slept almost nonstop for the next day and a half. Because the surgery was laparoscopic with three small incisions that were closed with dissolvable stitches, I only took my prescribed heavy-duty painkillers once before disposing of them. My only notable aftercare instructions were to wash the area around the incisions with antibacterial soap for ten days and to avoid physical exertion for two weeks. (Out of an abundance of caution, I still avoid physical exertion to this day.)
Thankfully, I didn't pay anything for my surgery because the Affordable Care Act "requires most insurance plans to cover female sterilization surgery without any out-of-pocket costs to patients." I also confirmed beforehand that my health insurance would cover the cost of the procedure.
On my hospital's patient portal, I saw that a lab tech had examined my freshly removed fallopian tubes and noted that my "two purple-pink, glistening fallopian tubes" were covered in cysts. This is how I discovered that fallopian tubes glisten (horrifying!!!) — and that I have PCOS.
I finally found out about my PCOS almost two and a half years after the initial diagnosis, which feels criminal but is somehow totally legal.
As I learned more about PCOS after my surgery, I discovered that it's one of the leading causes of infertility. If I'd known about my diagnosis before my tubes were removed, I might've prioritized testing my fertility before deciding on the surgery. Regardless, I'm grateful for the peace of mind I have now, knowing it's 100% impossible for me to get pregnant without IVF.
In the months following the surgery, my hormones were all over the place, and my previously minimal PCOS symptoms became wayyy more noticeable. According to experts at Johns Hopkins, "fallopian tubes do not make hormones," so it's likely that my PCOS would have become more apparent during this time even without the surgery.
I don't regret my decision for a second, but I resent the fact that life sort of forced my hand. On rare occasions, I even mourn the loss of the biological children I'll never have — because although I'm not sure I ever wanted them, the finality of my reproductive situation still inspires fleeting bursts of grief.
More than anything else, this whole experience reiterated for me the importance of reproductive autonomy. I was one of the lucky ones. Some people fight their doctors for decades to no avail because of the patronizing belief in medicine that people with uteruses don't know what's best for our own bodies. And in the wake of the Supreme Court overturning Roe v. Wade, it's even more frustrating, demoralizing, and humiliating it is for people with uteruses to fight for access to reproductive healthcare.
Ultimately, it doesn't matter whether the procedure is elective or medically necessary — from birth control to abortion to sterilization, everyone should be able to make medical decisions about their own bodies.