Bilateral salpingectomy is the most effective.

Bilateral salpingectomy - the standard of care for tubal sterilization since 2015 - is essentially 100% effective, so it’s more effective than any long-acting reversible contraceptive methods. It’s also more effective than vasectomy.

Some doctors try to tell you that “IUDs are just as (or more) effective as sterilization”, but they’re attempting to mislead you. It’s especially untrue with bilateral salpingectomy being the standard of care, and it was questionable for years prior to 2015 as well.

Consider aggregate risk.

While the risks of sterilization surgery are minimal, LARCs are generally considered to carry even lower risks. But this fails to take aggregate risks into account. The risks of sterilization surgery are consolidated into a few hours, while the risks of temporary methods are stretched out over a reproductive lifetime. There are side effects associated with the less invasive methods that have not been found with sterilization. Additionally, hormonal birth control has been linked to high blood pressure, weight gain, blood clots, and even an increased risk of breast cancer. Other side effects such as migraines and mood changes are common with hormonal birth control. With IUDs, there is a risk of migration or perforation. The key thing is that all these risks are undertaken continuously for decades. Sterilization is a one-time procedure, so the risks are only undertaken once, not continuously over many decades.

Some doctors recommend trying an IUD before sterilization, which subjects you to the risks of both the IUD and the subsequent sterilization surgery. Such doctors are asking you to take the risks of LARC(s) and surgery, instead of only surgery. There is no medical reason to take on both the risk of LARC + the risk of surgery when the surgery alone would suffice. The surgery will be just as invasive after five years of LARC as it would be at the present time.

If you plan on being sterilized eventually, there is no need to take on the risks of both the LARC method and the sterilization surgery. The worst-case scenario is using hormonal birth control for decades and then undergoing sterilization anyway; then, you face both the aggregate risks of long-term HBC use, plus the risks of sterilization surgery.

Sterilization surgery carries identical risks for those who have and have not had children.

Most doctors who refuse sterilization to childfree patients on the basis of its risks are nevertheless willing to offer the same procedures, with the same risks, to patients who have already had children. Sterilization surgery carries identical risks for those who have and have not had children. The risks are actually lower if one has not had a prior surgery, such as a c-section. Thus, if your doctor is refusing you sterilization on the basis of its risks, but would be willing to sterilize a patient who is older or who has had children, then your doctor is not being forthright with you. We often see doctors use surgical risks as a decoy objection: they claim to object only to the risks, but their true objection is to permanently sterilizing childfree patients; they have no problem offering the same procedures, with the same risks, to patients who have had children.

If this is your doctor’s mindset, you should seek out a new doctor. In most countries, and certainly in the US (where most of our readers are located), you do not need to have tried LARCs before you can be sterilized.