Vincent Mazzarella, MD

Sterilization is the act of permanently preventing the possibility of a spermatozoa and an ovum from meeting. Spermatozoa and ova normally meet either in the uterus or in the Fallopian tubes. Dividing or occluding the Fallopian tubes prevents the ova and spermatozoa from coming in contact so that fertilization (and therefore conception) never occurs.

The American College of Obstetricians and Gynecologists publishes several pamphlets (available online):

* Sterilization for Women and Men
* Sterilization by Laparoscopy (Esterilización por laparoscopia, en Español)
* Patient Education Pamphlets (Panfletos para la Educación de Pacientes, en Español)

Also see:

* Patient information: Permanent sterilization procedures for women (UpToDate for Patients)

Tubal ligation is the generic term that refers to several similar procedures for accomplishing this:

* Division of the Fallopian tubes by cutting or burning them.
* Placing a rubber band on the Fallopian tubes to kink them (causing occlusive scarring).
* Using sutures to tie (with or without the division of) the Fallopian tubes.
* Placing a clip to occlude the Fallopian tubes (Filshie clip or Hulka clip).

In his practice Dr. Mazzarella has performed all methods of tubal ligation and division methods except rubber banding. However, he has come to prefer one method above the others: the Hulka clip.

After reading the rest of this page (and the relevant links), if you are interested in this procedure, then click here (consent forms are also here). Other methods can be accommodated by request.

The application of the Hulka clips is tolerated extremely well, with little or no post-operative discomfort. Furthermore, they are able to be placed laparoscopically using one 5 mm camera port (about 1/5 of an inch wide) and one 10 mm port for the clip applier (about 2/5 of an inch wide). There is no cutting involved, and recovery is immediate (because the holes are so small). The operation takes between 10-20 minutes, on average.

In contrast, burning the Fallopian tubes (with electrocautery) in order to divide them almost always causes post-operative pain that can last up to 2 weeks. Although the incidence is less, cutting and tying the tubes can also cause post-operative discomfort due to the subsequent inflammation of the cut ends of the tubes.

Further, burning, cutting, or tying the Fallopian tubes is associated with a low but quantifiable risk of necrosis of the divided ends of the tubes, which can then scar or even heal back together after the necrotic ends "slough" (or fall) off. The ends of the tubes are then sometimes free to heal back together.

Every procedure has a remote possibility of complications, however, including serious ones. The American Academy of Family Physicians publishes an online summary of issues related to contraception and sterilization, which also discusses some of these risks:

* Counseling Issues in Tubal Sterilization (2003)

As is common, there is a significant amount of misinformation about these procedures (and their complications, real or imagined) on the Internet, so it is best to always refer to scientific medical journals and physician-published literature in evaluating what is best for you.

Services that are not provided:

*Post-partum tubal ligation. Any obstetrician that performs deliveries and C-sections should be able to perform this operation at the time of a normal delivery or C-section. Because reimbursement for this procedure is not available except for the obstetrician, Dr. Mazzarella no longer provides this service. Ask your obstetrician to do it for you. However, a laparoscopic tubal ligation can be done as early as 2 weeks after a normal delivery, and as early as 3-4 weeks after a C-section.

*Open procedures. Dr. Mazzarella performs almost all his operations laparoscopically (using a camera and tiny incisions). Although it is possible to perform any tubal ligation through a larger "open" incision, it can take up to an hour or more to accomplish (about 10 times as long as a laparoscopic procedure), sometimes can have a rather painful and prolonged recovery period, and is associated with a much higher complication rate. There is no reason to create a large, painful scar for this procedure.

*Abortion of any type. Dr. Mazzarella does not and will not perform abortions. The listed tubal ligation methods prevent fertilization only. Tubal ligation does not promote or cause abortion in any way, even accidentally. Furthermore, all patients must undergo a pregnancy test immediately before the procedure (and no one who is pregnant is allowed to undergo the procedure). Our planet is rapidly being overpopulated (causing global warming). Elective sterilization is one of the only methods to slow this process (and is therefore one of the most ethical methods of birth control). Almost all ethical religions espouse this concept.

*Under age 21. In general, sterilization procedures are not reimbursable for individuals under 21 and in no circumstances for Medicaid (Medi-Cal) patients under 21.

*Over 300 lbs. Our operative suites are not designed for extremely obese individuals. Anyone between 250 and 300 lbs. will be considered, but must undergo evaluation and approval by our anesthetist in advance, and must have two pre-operative evaluations in the clinic.

* Tubal ligation reversals. This is not a complex operation, but it cannot be done laparoscopically. Furthermore, insurance companies do not seem to be reimbursing for this operative procedure anymore. In vitro fertilization (through a fertility clinic) has had better pregnancy success rates (65-86%) than tubal ligation reversals (65% in expert hands) and is comparable in cost. It is therefore a good alternative to tubal ligation reversal.

More resources and counseling regarding birth control methods:

* Patient information: Birth control; which method is right for me? (UpToDate)
* Birth Control (National Institutes of Health)
* Birth Control Guide (Mayo Clinic)
* Patient Information Booklet -- Sterilization (US Dept. of Health and Human Services) (en español)
* Los Anticonceptivos, en Español (Colegio Americano de Obstetras y Ginecólogos)
* Tomar la decisión para una cirugía de esterilización (Institutos Nacionales De la Salud)
* Esterilización, Esta hoja informativa (Womenshealth.gov)

Questions? Call the clinic at (530) 458-3243.