When you don't want children — ever — contraception becomes a crucial part of preserving that decision.

It's why some childfree people opt for sterilisation, a permanent form of contraception.

After publishing a series of articles on being childfree, we heard from several men and women who had undertaken tubal ligation or vasectomy.

It was particularly interesting to hear the experiences of younger people.

"It literally changed my life," 34-year-old Jess Hill from Brisbane, who had tubal removal two years ago, says.

Melbourne's Phil*, who asked we don't use his real name, has also chosen to be childfree and underwent a vasectomy at age 30.

"I feel so relieved and happy and unburdened by the fact I've had it done," the 32-year-old says.

Both Jess and Phil describe having taken control of their fertility as freeing, but their experiences are very different.

That's because of a "significant reluctance" from most doctors to perform sterilisation on young, childfree people.

As we heard from the experts, it's a balancing act between the evidence of regret, and a patient's right to choose.

'One doctor laughed at me'

Jess describes her sterilisation story as a "decade-long battle".

The receptionist and dance teacher has never wanted kids, saying she couldn't give a child everything they deserve and would potentially experience hereditary health issues.

She's also concerned about the environmental impact it would have.

Jess wanted tubal ligation since her early 20s and says she felt "trapped" while using other contraceptives that disagreed with her physically and mentally.

"I just had a really bad time on all of it."

But her requests for a tubal ligation referral from GPs were always dismissed.

"A lot of doctors just said 'No-one will do it for you', 'You need to have kids first', 'You'll change your mind' … one doctor laughed at me," she says.

By age 32, she was experiencing depression and chronic pain caused by what she believes was using progesterone IUD.

Jess eventually hunted down a gynaecologist who would perform the procedure, and sought the required referral from a GP who "respected" her decision.

She opted for tubal removal, because evidence shows it can reduce ovarian cancer risk by up to 40 per cent.

"I've only ever been relieved and happy since. It literally changed my life — birth control had been giving me so many side effects including depression.

"I got my life back from the fog of the person I didn't know."

Have you felt empowered by taking control of something health-related in your life? Email us at life@abc.net.au

Types of sterilisation

Tubal ligation (tubes tied)

The fallopian tubes are closed to block the sperm and egg from meeting. They can be cut and then tied off, or clamped.

While tubal ligations can sometimes be reversed, the chances of falling pregnant are about 50 per cent.

Tubal removal

This includes the total removal of the fallopian tubes and cannot be reversed.

Removing the tubes can reduce ovarian cancer risk by up to 40 per cent.

Vasectomy

There are two types of vasectomy: closed- and open-ended.

In a closed-ended vasectomy, the two ends of the vas deferens are sealed.

In an open-ended vasectomy, the end connected to the testicles is left open, which allows the sperm to freely escape into the intra-scrotal space. The sperm then die and are reabsorbed by the body. The end connected to the prostate gland is closed permanently which leads to sterility.

"Anecdotal evidence is that reversal is easier on the open-ended cases because the testicular end is undamaged," Marie Stopes lead vasectomist Justin Low says.

Why doctors are often reluctant

'One in four woman have regrets if too young'

While there are some exceptional circumstances where sterilisation will be performed in younger people, generally there is a "significant clinician reluctance" to perform tubal ligation on a woman who hasn't had a baby and is under 30 years of age, explains gynaecologist and doctor Talat Uppal.

"There have been multiple studies which have looked at regret and remorse after female and male sterilisation procedures, and in a minority of patients, they might have feelings of regret," the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) fellow says.

The likelihood of regret is higher if the person is childless, young or when there is conflict in existing relationships, Dr Uppal explains.

One study has shown if the decision was taken when the woman was aged 18 to 24, she was four times more likely to request reversal than if she was over 30.

There are also other predictors such as not being in a relationship, coercion by a spouse or requesting the procedure after a difficult pregnancy.

'Finding a balance' to allow women access to sterilisation

But Dr Uppal believes with the right multiple-step processes and assurances, a woman under 30 without children should be granted tubal ligation if she wishes.

"That balance is so critical," Dr Uppal says.

"For me personally, if I'm sure that a woman has considered and fully understands, she is able to consent, she has thought it through, she has written and verbal information, and has gone away to process that, and then come back and asked for the procedure, I would perform it in individual situations.

"At the end of the day that is her right to choose what she wants to do with her body."

A 2005 paper analysing the ethics around sterilisation of young, competent and childless adults advised while "young childless women are most likely to regret the decision to be sterilised", "sterilisation of young, childless adults for non-medical reasons is ethical if they are properly informed of all the risks, including regret".

'I've taken that burden of responsibility off sexual partners'

Phil* researched sterilisation and several different clinics before settling on his decision to have a vasectomy. ( Unsplash: Glenn Carstens-Peters )

Phil's main reasoning for not having kids is about maintaining his current lifestyle and having the freedom to travel.

"Since adulthood and probably earlier, I have never really had any affinity towards children," he says.

Not wanting to "leave anything to chance", at 30 Phil decided to pursue a vasectomy.

"I could see far enough into the future that that mindset wouldn't change," he says.

It wasn't difficult for Phil to find someone willing to give him a vasectomy despite his childfree status.

A pamphlet in his GP's office prompted him to do some research, and from there he found a clinic he was happy with.

"I went through a counselling process — I wouldn't call it that, they called it that — to talk to nurse on the phone before I got it done," he says.

"It was a 10 to 15-minute chat. When she was satisfied with my mindset and rationale of getting [the vasectomy] done, she was able to recommend booking in for the procedure."

Being 30 years of age made it easier for Phil to find a willing doctor.

Men can also have regrets

Dr Low says evidence shows that, like for women, a man is more likely to regret a vasectomy if performed in their 20s.

"We want to respect people's wishes, but we also have to make a decision about informed consent and a little bit of maturity of the person — have they really thought it through?" he says.

"In Australia there are more surgeons who will certainly consider it — it's case-by-case."

A study from 1994 found of the men who had a vasectomy under the age of 30, 20 per cent regretted it.

Marie Stopes asks all childless men under 30 to seek independent counselling, and then attend an interview with the doctor before moving forward with the procedure.

"Someone who has spoken to his loved ones, thought through the reversal rates, considered sperm banking, fostering and adoption … I feel more comfortable with that," Dr Low says

"A guy who presents to us saying he doesn't like using condoms, that's why he wants a vasectomy — that's when we feel more uncomfortable."

Phil says he's had no regrets since having the vasectomy.

"My mindset has always been this is the best course of action for my life."

He says being able to take control has been empowering.

"The other aspect of it is taking that burden of responsibility off sexual partners," he says.

"By default, if you're in a medium-term relationship, in my experience, the default is for the girl to go on the pill.

"Why does the responsibility lie on the female and not the male?"

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The reaction to sterilisation

Both Jess and Phil were in relationships at the time of their permanent contraceptive procedures.

Jess is still with her partner of two and a half years. He also doesn't want children.

Jess's boyfriend doesn't want children. "He was stoked," Jess says of when he found out she felt the same. ( Supplied: Jess Hill )

"He thought he would just have to have kids to be in a long-term relationship. He was stoked he doesn't have to do that," she says.

Phil says his girlfriend at the time was "incredibly supportive".

"I have told sexual partners since then that I have had the procedure done, which has generally been met firstly with surprise, and then acceptance," he says.

"However, for at least a couple of sexual partners, it was a 'deal-breaker' because of their desire to have children in the future."

Having a vasectomy has made dating easier, Phil says. There's "less ambiguity" around whether he'll change his mind.

"It can be quite an off-the-cuff remark to say 'I don't want children'. People might not take that seriously for a variety of reasons.

"If you can definitely say, as I can, 'I'm reasonably confident it won't reverse itself', then that is saying something [about your decision to not have kids]."

*Name changed for privacy.