Sometimes when you are done having children you are just SO DONE that you don't want to keep that door open any more. Indeed, the most commonly used method of birth control in the United States today is tubal ligation, in which the fallopian tubes are tied, clipped, banded, or cauterized to prevent the egg and the sperm from meeting. But tubal ligation requires anesthesia, and surgical entry into the abdominal cavity to reach the tubes. Vasectomy, in which the vas deferens of the man is tied off, is less invasive because it can be done under local anesthesia and doesn't require an abdominal incision: the vas deferens is reached though the skin of the scrotum. Both of these procedures are very effective (but not 100%) and often are chosen to eliminate the ongoing need to think about birth control once the family is complete.

What are the downsides to tubal ligation and vasectomy?

1. These are permanent procedures. Although operations to reverse sterilization exist, they are quite expensive and typically not covered by health insurance. If you have a new partner or (I hate to even say this) something happens to your children, the choice of having more babies will not be available.
   
   
2. Vasectomy requires a back-up method for several months, while the remaining sperm are washed out of the vas beyond the obstruction. Semen is collected monthly and looked at under the microscope until no sperm remain in the ejaculate.
   
   
3. Tubal ligation has more surgical risk than any other contraceptive option: both the anesthesia and the surgical procedure itself can lead to rare but serious complications.

Several new options are available for women who want long-term safe, effective, convenient contraception. I'll write more about these methods in the coming days.

• Intrauterine devices (not new, but new better versions)
• Progestin implant (Implanon)
• Hysteroscopic tubal obstruction (Essure)

So be sure to talk to your doctor about all the options before you make a permanent decision!