Birth control isn't what it used to be. For a long time, if you wanted your "tubes tied," you got a tubal ligation. Doctors would cut, clamp, or cauterize your fallopian tubes, and that was that. But things have changed lately. Now, if you ask a gynecologist about permanent sterilization, they’ll probably mention a bisalp.
It’s the gold standard.
A bilateral salpingectomy—which is just the medical mouthful for bisalp—is the complete removal of both fallopian tubes. It sounds more intense than a "tie," but honestly, it’s becoming the preferred way to handle permanent pregnancy prevention for a whole lot of reasons that have nothing to do with just "not having kids."
What exactly is a bisalp?
Let's break down the anatomy. Your fallopian tubes are the bridges between your ovaries and your uterus. In a traditional tubal ligation, surgeons just block the bridge. In a bisalp, they tear the whole bridge down and haul away the debris.
It’s usually done laparoscopically. That means they aren't slicing you open from hip to hip like a C-section. Instead, a surgeon makes two or three tiny incisions—usually one in the belly button and a couple of others near the hip bones. They pump your abdomen full of carbon dioxide gas so they can see what they're doing, and then they use small instruments to snip the tubes away from the uterus and the ovaries.
The ovaries stay. This is huge.
Because the ovaries remain untouched, your hormones don't change. You don't go into early menopause. You still get your period (assuming you aren't on other hormonal meds), and your body still goes through its natural cycles. You just don’t have the "hallway" for the egg and sperm to meet.
The cancer connection most people don't know about
Why go through the trouble of removing the whole tube instead of just clipping it? The answer is largely about cancer prevention.
For years, we thought ovarian cancer started in the ovaries. It makes sense, right? It’s in the name. But recent medical research, including studies highlighted by the American College of Obstetricians and Gynecologists (ACOG), suggests that a significant portion of high-grade serous ovarian cancers actually start in the fimbriae. Those are the little finger-like fringes at the end of the fallopian tubes.
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By removing the tubes entirely, you are significantly lowering your risk of developing these types of aggressive cancers. It’s a two-for-one deal. You get the permanent birth control you wanted, and you get a massive boost in preventative health.
The surgery day experience
It’s a "day surgery." You go in, you get the general anesthesia, and you’re usually home by dinner time.
Recovery isn't exactly a walk in the park, but it’s manageable. The biggest complaint most people have isn't actually the incisions; it's the gas pain. Since they use $CO_2$ to inflate your abdomen, some of that gas gets trapped and irritates the phrenic nerve. Weirdly enough, this manifests as sharp pain in your shoulders. Walking around and using heating pads helps, but it’s definitely a "stay on the couch for three days" kind of situation.
Most people are back to desk jobs within a week. If you lift heavy stuff for a living, you're looking at more like two to three weeks of light duty.
Why the "tubal" is fading away
You might be wondering why anyone would still choose a traditional tubal ligation. Honestly? Sometimes it's just what a specific surgeon is most comfortable with, or what an insurance company covers more easily (though that's changing).
But a traditional "tie" has a higher failure rate. It’s rare, but tubes can actually grow back together, or a small passage can form through the scar tissue. This leads to an increased risk of ectopic pregnancies—where the embryo implants in the tube instead of the uterus. This is a life-threatening medical emergency.
With a bisalp, the tube is gone.
There is no "growing back." The risk of pregnancy after a successful bilateral salpingectomy is virtually zero. There are only a handful of cases ever reported in medical literature where a pregnancy occurred after this procedure, usually due to a pre-existing pregnancy or a very rare fistula. It is as close to 100% effective as humanly possible.
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Is it reversible?
No.
Absolutely not.
If you go into a consultation for a bisalp, your doctor is going to grill you on this. You have to be certain. Unlike some tubal ligations which can occasionally be "undone" (with varying degrees of success), a salpingectomy is permanent. Once those tubes are gone, they are sent to pathology and then disposed of.
If you change your mind later, your only real option for biological children is IVF (In Vitro Fertilization). Since your ovaries still produce eggs, a doctor can harvest them, fertilize them in a lab, and implant them directly into your uterus. But IVF is expensive, physically grueling, and not a "backup plan" you want to rely on.
Cost, Insurance, and the ACA
Money matters. Under the Affordable Care Act (ACA), many insurance plans are required to cover female sterilization as a preventative service at 100%.
However—and this is a big "however"—some insurance companies categorize a bisalp as a "treatment" or "procedure" rather than "preventative sterilization." They might only cover a tubal ligation at 100% and expect you to pay a deductible or co-insurance for a salpingectomy.
You have to call your provider. Ask for the specific CPT codes (Current Procedural Terminology). Usually, a bisalp is coded as 58661. Check that against your plan’s "Summary of Benefits." Don't just take the front desk's word for it.
Common Myths vs. Reality
- Myth: It will mess up my sex drive.
- Reality: Nope. Since your hormones stay the same, your libido shouldn't be affected. For many, it actually gets better because the fear of unplanned pregnancy is gone.
- Myth: I'll start growing facial hair or lose my hair.
- Reality: That's a menopause thing. Since you keep your ovaries, you aren't in menopause.
- Myth: It's a huge scar.
- Reality: The incisions are tiny, usually about half an inch long. They fade into almost nothing over a year.
Realities of the consultation
Getting a doctor to agree to this isn't always easy, depending on where you live and how old you are. It’s an unfortunate reality of the medical system.
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Some doctors still adhere to the "Rule of 120" (your age multiplied by your number of children should equal 120) or other outdated metrics. If you’re young and don't have kids, you might run into "What if your future husband wants them?"
That's why the "Childfree Friendly Doctors" lists found on places like Reddit or specialized health forums have become so vital. They help people find surgeons who respect bodily autonomy without the lecture.
Actionable Next Steps
If you're serious about getting a bisalp, don't just jump into surgery.
First, track your cycle for a few months so you know your baseline. This helps you realize if any post-surgery changes (like heavier periods) are actually just your body returning to its natural state after stopping hormonal birth control.
Second, schedule a consultation specifically for "permanent sterilization options."
When you go, bring a "sterilization binder." This sounds overkill, but it works. Include:
- A signed statement of your intent.
- Your knowledge of the procedure (mentioning the cancer risk reduction shows you've done your homework).
- Your plan for recovery.
- A brief history of why other birth control methods haven't worked or aren't desired.
Confirm your insurance coverage using the CPT code 58661 and ask if it's covered under the ACA’s preventative mandate. If they say no, ask about an internal appeal or if they would cover it if the surgeon codes it specifically for "permanent contraception."
Lastly, prepare your "recovery nest." Buy some loose-fitting high-waisted pants (nothing should touch your belly button), stock up on peppermint tea for the gas pain, and clear your schedule for at least five days. You’ll be back on your feet soon, but giving your body that initial window to heal is non-negotiable.