Female Sterilisation
Version:
1.0
Implementation date:
1July 2017
Review Date:
1July 2018
Category:
Restricted / The Procedure
Female sterilisation is considered a permanent form of contraception. The operation involves cutting, sealing or blocking the fallopian tubes. This prevents the eggs from reaching the uterus (womb) where they could become fertilised, resulting in pregnancy.
Access Criteria
MKCCG makes the following recommendation regarding Female Sterilisation is categorised as a Restricted procedure, and therefore a GP or Consultant must seek approval for an individual before treatment is carried out.
Female sterilisation should only be considered when full counselling on all alternative contraceptive methods and particularly on the long acting reversible methods has occurred. Male sterilisation (vasectomy) should be carried out in preference to female sterilisation for couples seeking sterilisation as a method of contraception. Clinicians should ensure sterilisation is discussed with both partners whenever possible. The benefits of vasectomy should be discussed with all women seeking female sterilisation.
Female sterilisation will only be considered where the male partner is unwilling or unable to consent to vasectomy or the female does not have a single permanent partner.
Patients are informed, and written consent is sought before the sterilisation operation is carried out, that the sterilisation procedure is irreversible and the reversal of sterilisation operation would not be routinely funded on the NHS.
Female sterilisation is funded (after appropriate counselling), at the same time as a caesarean delivery. Good practice would be to apply the same criteria as below and have patient led discussions on caesarean at early stages of pregnancy, being mindful of the context for decision making.
Referrals for sterilisation will generally be accepted if points 1,2,3,4,5 plus either of 6 & 7 are met:
  1. The woman must be certain her family is complete or that she never wants children.
  1. The woman must be aware that the procedure is considered permanent and that reversal is NOT routinely funded on the NHS.
  1. The woman must receive counselling about her options including consideration of all other forms of long-acting contraceptives and her other contraceptive options.
  1. If the woman has a partner has he considered a vasectomy?
  1. The woman must be deemed to have sound mental capacity? (Please see RCOG Female Sterilisation Consent Advice No. 32)
  1. The woman has a medical condition making pregnancy dangerous.
  1. The woman declines a trial of long-acting reversible contraception after counselling.
In addition, patients with a BMI of 30 and above should receive advice and support to aid weight loss prior to consideration for sterilisation in order to reduce anaesthetic and post-operative complications.
Prior to any referral, consideration must be made to any religious beliefs that may impact on surgical options.
Treatments which are undertaken without approval will not be funded.
Procedure Codes / Q271 / Open bilateral ligation of fallopian tubes
Q272 / Open bilateral clipping of fallopian tubes
Q278 / Other specified open bilateral occlusion of fallopian tubes
Q279 / Unspecified open bilateral occlusion of fallopian tubes
Q281 / Open ligation of remaining solitary fallopian tube
Q283 / Open clipping of remaining solitary fallopian tube
Q284 / Open clipping of fallopian tube NEC
Q288 / Other specified other open occlusion of fallopian tube
Q289 / Unspecified other open occlusion of fallopian tube
Q351 / Endoscopic bilateral cauterisation of fallopian tubes
Q352 / Endoscopic bilateral clipping of fallopian tubes
Q353 / Endoscopic bilateral ringing of fallopian tubes
Q358 / Other specified endoscopic bilateral occlusion of fallopian tubes
Q359 / Unspecified endoscopic bilateral occlusion of fallopian tubes
Q361 / Endoscopic occlusion of remaining solitary fallopian tube
Q362 / Endoscopic placement of intrafallopian implant into remaining solitary
Q368 / Other specified other endoscopic occlusion of fallopian tube
Q369 / Unspecified other endoscopic occlusion of fallopian tube
Evidence /
  1. NICE Clinical Knowledge Summaries on Contraception - sterilization – - Last revised June 2016
  1. Royal College of Obstetricians and Gynaecologists –
- Female Sterilisation Consent Advice No. 3 (February 2016) replaces Royal College of Obstetricians and Gynaecologists (RCOG) Consent Advice No. 3 Laparoscopic Tubal Occlusion, published in October 2004.