Maternity - Preconception, part 3: Permanent Sterilization and Infertility

by Meris Shuwarger August 25, 2021 Updated: September 12, 2021

Full Transcript

Hi. I'm Meris. And in this video, I'm going to be talking about permanent sterilization methods. And just as a trigger warning, I am also going to be discussing infertility. There are chapters here, so if you would like to skip infertility, or if you want to know when it's coming up, you will be able to see that. I'm going to be following along using our maternity nursing flashcards. These are available on our website, And if you already have a set of your own, I would definitely invite you to follow along with me. Okay, let's get started.

All right. So first of all, we are going to be talking about sterilization. So sterilization is any sort of procedure that is going to render a patient sterile. Meaning, unable to conceive. So female sterilization or sterilization of anybody with a uterus is going to be something that is typically called a tubal ligation. So it is where they ligate. Meaning, tie the fallopian tubes. So tubal ligation. Not only do they tie, but in most instances they cut and cauterize. When I had my tubal ligation, my OB-GYN said, "I need you to understand, when I do your surgery, part of your fallopian tubes will be gone forever. If you ever wish to conceive again, you will have to do in vitro fertilization." And I said, "Totally understood. Totally on board." But the reason I'm saying this is because it is not reversible, okay? This is a permanent thing that cannot ever be reversed. This is invasive. This does require a laparoscopic procedure in most cases. It can also be done at the time of a C-section. If a patient is pregnant and knows that they want this to be their last baby, and they are already having a C-section.

Now, sterilization of somebody with a penis is going to be called a vasectomy. So the reason it's called a vasectomy is because it is cutting the vas deferens. So that is the tube that transports semen out through-- well, it actually combines with the seminal fluid. But anyway, point being, it actually severs the connection where the semen can be transported. So the sperm are still produced, but they just don't get to the semen. So this is very important to understand, that it's not just we do the procedure and okay, goodbye, you're good. You have to do follow up testing. So after the vasectomy is done, a follow-up sperm count should be done to ensure that there are no sperm in that semen. Otherwise, it could lead to pregnancy. So this one though, reversal may be possible. Not always, but it may be. But again, you don't want to use this as a form of contraception if you are intending to conceive again in the future. There are other options available to prevent pregnancy.

Educate your patients that for all intents and purposes, they should be treating these as permanent procedures. Now, there's something that's not on this card that I do want to mention briefly, that is the Essure procedure, or it is the fallopian tube coils. So these are coils that are inserted through hysteroscopic imaging. Meaning, with a camera in the uterus. So it's not invasive in terms of you're not cutting into the body. And small coils are placed into the fallopian tube. The body recognizes it as foreign, and scar tissue grows around it. This is kind of becoming falling out of favor. And you can look into the reasons for that. But I just want to bring that up in case you've never seen that, or heard about it, and you have a patient who mentions it.

Okay. So moving on. This is where we're going to be talking about infertility. And if this is a sensitive subject for you, I genuinely, truly, completely understand, and would invite you to skip this because I do not want to do anything that would be upsetting to you or your mental health. Just as a disclaimer, I am someone who had infertility. And so I have been through the infertility treatments myself, and I know how disruptive and distressing it can be to a patient's life. So let's talk about infertility a little bit. So infertility is defined as the inability to conceive for one year, 12 full months for anybody under the age of 35. For patients over the age of 35, it's six months. So just very important to know. Just because I decided I'm trying to get pregnant, and I don't get pregnant after four months, it doesn't mean that I have infertility.

So there's a lot of different risk factors on here I would invite you to take a look at. But then what I really want to call your attention to are the diagnostics that can be done to investigate infertility. The one that most doctors will start with is going to be a semen analysis, because it's very easy, it's not invasive, it's more affordable. And then it essentially allows the provider to rule out or to rule in the male partner. So this is very much often where infertility exploration begins. Now, if we identify the cause, cool, maybe we can stop there and start addressing it. But if not, then we are going to move on.

A hysterosalpingography. Hysterosalpingogram is a very fancy word. Hystero means of the uterus. Salpingo means of the fallopian tube. And gram means a picture of, like on Instagram. So a hysterosalpingogram is a picture of the uterus and fallopian tubes. Now, this is done usually while the patient is awake, or perhaps twilight sedation. A camera is placed into the uterus and take a visual look around. And then a contrast dye is actually infused into the uterus. And using fluoroscopy, the medical provider can look and see, is the dye going through the fallopian tubes or not? Are they open or are they shut?

And then we also have a hysteroscopy. A hysteroscopy is just looking at the uterus using a camera. So the reason that I said it happens than HSG is because they're very often combined. We do one and then the other, but they are separate procedures and can be done separately. So a hysteroscopy can often be done in the office as well. So very important to understand that there are treatments available for these patients. There are lots of different treatments. There's intrauterine insemination, IUI. There is IVF, which is in vitro fertilization. There is surrogacy. There is embryo adoption, where you actually transfer an embryo that was not yours to begin with. And then donor eggs and donor sperm. And then, of course, for some patients, they choose to say this is too expensive or too distressing or too upsetting, and go on to adopt.

So that is a little bit about sterilization and infertility. I hope that review was helpful for you. If it was, please go ahead and like this video so that I know. If you have anything great to add, any really good ways to remember things, I would love to hear it. Leave me a comment below, and I will absolutely read it. And you definitely want to be sure to subscribe to our channel. This is actually it for the preconception playlist for maternity. So you want to be the first to know when the pregnancy playlist starts getting posted. Thanks so much, and happy studying. I did just want to say that my infertility treatments did work. These are my two kiddos. I don't know if you can see that very well. But both of them were infertility success stories, and very, very thankful to have them. So yes, there was definitely - there were a few rainbows on the other side of our thunderstorm.

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