I had a salpingectomy during my third C-section, primarily for birth control reasons, but also since my OB shared that recent research indicates it reduces risk of ovarian cancer. On the cancer side, given no family history of female reproductive cancers, have I actually reduced my risk of ovarian cancers? Also, at my six-week appointment, the OB said I need to be careful, that the body works in magical ways, and that if I feel funny, I should make sure to take a pregnancy test. What’s the actual likelihood of getting pregnant after a double salpingectomy?
—Tess
Congratulations on the new baby!
Bilateral salpingectomy — removing both fallopian tubes — is a great option for long-term contraception, especially if you are already planning to deliver via C-section. Salpingectomy can often be added easily to your scheduled C-section; it adds just a few minutes to the procedure. And when you are ready to resume having sex, you will already have a contraceptive plan in place.
Bilateral salpingectomy is more than 99% effective as contraception. In order to become pregnant, sperm has to meet an egg in the fallopian tube. In a salpingectomy, most of the tube is removed. A small portion of the tube connected to the uterus may be left behind, but the end of the bit of remaining tube should be thoroughly cauterized so that it is no longer open into the pelvis, so there is no way for the egg to get in to meet the sperm.
Furthermore, when the fallopian tubes are removed, they are sent to pathology — this is true of any tissues removed during any surgery. The pathologist is supposed to confirm that the tubes’ complete circumference was removed.
A meta-analysis of bilateral salpingectomy for contraception found just four pregnancies reported in the literature in women who previously underwent bilateral salpingectomy.
If you are concerned, you might ask your OB if there is something about your case — either her memory of the procedure or the pathology report — that makes her concerned that the procedure might not have been successful. If she doesn’t have particular concerns, I think you can be reassured that you are covered in terms of contraception.
And yes, the current data suggest that bilateral salpingectomy reduces the risk of ovarian cancer in women at typical risk by about 80%. We think that most ovarian cancers — upward of 75% — actually arise from the fallopian tubes, not the ovaries. So if you remove your fallopian tubes, you can dramatically reduce your risk of ovarian cancer.
Ultimately, bilateral salpingectomy is a very effective form of contraception and reduces your risk of ovarian cancer.
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Is the lowered cancer risk + very effective contraception an argument for getting this procedure voluntarily? Or is it too invasive compared to, say, a fallopian tube tie? Thank you for your insights!