A vasectomy, a surgical sterilization for those with testes, is up to six times cheaper than a tubal ligation, the surgical procedure designed to permanently prevent pregnancy by interrupting the movement of eggs from the ovaries. The reason for the cost difference is simple, says Peter Weiss, M.D., assistant clinical professor of obstetrics and gynecology at UCLA School of Medicine. “The vasectomy is an in-office or out-patient procedure, which can be done under local anesthesia or at most IV (intravenous) sedation, so there’s only the surgeon’s cost.” By contrast, a tubal ligation, when done via laparoscopy (incision and a lighted tube), requires a surgeon, an anesthesiologist, an operating room, and a recovery room. “It’s a longer and, technically, a more difficult procedure,” Weiss adds.
Still, cost isn’t the only factor to consider if you—or you and your spouse or partner—want to ensure that you don’t have any kids or are happy with the current size of your family. The ease of performing the surgeries, where and when they are done, the risks involved, and, especially, their irreversibility are all things that you should look into and discuss with your partner and doctor before deciding if one of these procedures might be right for you.
Key Takeaways
- A vasectomy, which offers permanent sterilization by blocking sperm, is cheaper, safer, and less expensive than a tubal ligation, a procedure that prevents pregnancy by stopping movement of eggs from the ovaries.
- Reversal options for vasectomies and tubal ligations may not be successful and are expensive.
- Vasectomies performed in a doctor’s office are less expensive than those done in an ambulatory surgical center or a hospital.
- Tubal ligations are often done soon after childbirth, or they may be scheduled for another time.
- Health insurance plans that are compliant with the Affordable Care Act (ACA) are required to cover tubal ligations with no out-of-pocket costs as a part of preventive care; they are not required to cover vasectomies.
- Alternatives to sterilization include the copper IUD and the levonorgestrel IUD, which are both cost effective and long acting.
What Is a Vasectomy?
Vasectomy is a surgical sterilization procedure for people with testes who want to prevent future fertility. An estimated 200,000 vasectomies are performed every year in the U.S., and it is the fourth most commonly used form of birth control, following condoms, oral contraceptive pills, and tubal ligation.
The term “vasectomy” comes from the vas deferens, a thin muscular tube that carries sperm from the testicles into the ejaculate. There are two of these tubes, and each is cut and blocked during a vasectomy.
Considerations
A vasectomy should be thought of as a permanent form of sterilization/birth control because reversal options may not work and are more expensive. The best candidates appear to be those who are in a committed, stable relationship. The procedure is not recommended for people who are younger since their marital status may change sometime after the surgery and request a reversal.
The procedure has a failure rate of less than 1%; rates of complications such as bruising and infection are 1% to 2%. In addition, vasectomy won’t change a person’s sexual function, erections, orgasms, or libido, and it won’t increase the risk of developing prostate cancer, dementia, or cardiovascular disease.
The Procedure
A vasectomy is usually performed in a doctor’s office by a urologist using local anesthesia. Rarely, it may be done in an operating room using intravenous sedation or anesthesia—for example, if a patient is extremely anxious about the procedure. The no-scalpel method, recommended by the American Urological Association, lowers the risk of infection and other complications and generally results in faster healing.
During the minimally invasive operation, the scrotum is numbed with medication, an opening is made in the scrotal skin, and the doctor locates the vas deferens. Each vas is gently lifted outside the scrotum; tied off, cauterized with electrical current, or blocked; and then placed back inside. The entire procedure typically takes no more than 30 minutes.
Afterward
There may be mild pain, swelling, and bruising for two or three days after the procedure. An ice pack and acetaminophen (Tylenol) or nonsteroidal anti-inflammatory drugs, such as ibuprofen, usually provide adequate pain relief.
It’s recommended to refrain from heavy work, vigorous exercise, lifting, and sexual activity and ejaculation for a week afterward. It takes weeks to months for ejaculate to become free of sperm, so it’s critical to use another form of birth control until a lab test called a “post-vasectomy semen analysis (PVSA),” done after eight to 16 weeks, shows that the ejaculate contains no sperm.
Vasectomies and tubal ligations do not protect against HIV and other sexually transmitted infections.
What Is a Tubal Ligation?
A tubal ligation (also known as a “tubal sterilization” or “getting your tubes tied”) is a surgical procedure for those who want a one-and-done method to prevent pregnancy by stopping eggs from being fertilized. Approximately 600,000 to 700,000 tubal ligations are done each year in the U.S., with about half of them performed just after giving birth.
“Tubal” refers to the fallopian tubes though which an egg, released from the ovaries each month, travels to the uterus. The fallopian tubes are ligated—surgically cut and tied off or clipped—so that sperm cannot reach and fertilize the egg. Patients may have the procedure shortly after giving birth, having an abortion, or at another time.
Considerations
Like a vasectomy, tubal ligation is considered a permanent form of birth control. “The patient should be absolutely sure that she does not want any more children,” says Weiss. Given the limited odds of irreversibility, regret is the primary complication, according to a 2018 study in Obstetric Anesthesiology. Those who regret their decision after a tubal ligation are likely to be younger (under 30), unmarried, inadequately counseled about the permanence of the procedure, making the decision on their own, or pressured by a spouse/partner to opt for it. They may also have recently changed partners or marital status. Consent documents must be signed 30 days before the procedure.
Research has found that tubal ligation works well to prevent pregnancy, with effectiveness rates of 99%, according to Planned Parenthood. The procedure may also have other benefits, including a lower risk of ovarian or tubal cancers, and possibly an improvement in menstrual bleeding patterns.
The Procedure
An obstetrician-gynecologist usually performs the surgery in a hospital or an ambulatory surgical center (ASC) using either general anesthesia or local anesthesia and sedation. Two techniques are commonly used:
- A laparoscopy involves pumping gas into the abdomen (for inspection/viewing), making one or two small cuts near her belly button, inserting a laparoscope (a lighted tube with a lens) to locate the fallopian tubes, and then cutting, clipping, cauterizing, or removing them.
- A mini-laparotomy, which also involves making a cut into the abdomen and then removing a portion or all of the fallopian tubes, is often done soon after childbirth. “The ideal time would be during a cesarean section, since the abdomen is already opened and the tubes are exposed for cauterization/excision or tying,” says UCLA’s Weiss.
These procedures generally take no more than 30 minutes, and risks are generally low for both (though anesthesia increases the risk of laparoscopic surgery).
Afterward
After a tubal ligation patients may feel tired, and their tummy may be sore for a short time. They may also feel dizzy or nauseous or experience cramping. Those who have fever, excessive bleeding at the incision, severe belly pain, trouble breathing, or unusual vaginal discharge should call a doctor immediately. Complications are rare, but they may include bleeding, infection, and ectopic pregnancy. Sterilization works immediately to prevent pregnancy, but patients should be sure they feel healed before having sex.
“In my practice, when a woman requests tubal sterilization, I recommend three alternatives that I believe are superior: vasectomy, a levonorgestrel intrauterine device (IUD), or a copper IUD. All have excellent outcomes (including very low rates of post-procedure pregnancy) and require fewer resources than tubal sterilization,” says Dr. Robert L. Barbieri, consulting editor, women’s health, in NEJM Journal Watch.
Average Costs Compared
Research shows that compared with tubal ligation, a vasectomy is not only simpler, safer, and more effective; it’s also a lot less expensive. The average cost lands in a range of $350 to $1,000. By comparison, median costs for a tubal ligation are $2,880 to $5,163, according to a 2021 study in Reproductive Health. The Reproductive Health Access Project estimates tubal sterilization costs at $1,500 to $6,000.
Keep in mind that these costs are for the procedure itself, which doesn’t include possible additional fees. According to the FAIRHealth consumer database of national healthcare costs, removing the fallopian tubes via an endoscope costs $2,835 in zip code 05058 (southern Vermont), but there may be added costs for anesthesia ($2,187) and either an ASC (ambulatory surgery center/$24,141) or a hospital outpatient facility ($15,307). The cost of a vasectomy in the same zip code is $1,419, with added costs for anesthesia ($897), pathology to examine tissue ($137), and either an ASC ($4,326) or a hospital outpatient facility ($3,929). These are out-of-network/uninsured costs; in-network and insured costs are substantially lower, but it’s clear that a vasectomy costs less than having the tubes tied.
Where a vasectomy is performed can also significantly impact the price tag. A 2019 study published in Urology that analyzed vasectomy costs for 453,492 patients covered by private health insurance between 2009 and 2015 found that those who had the procedure in a doctor’s office paid a total cost of roughly $707, whereas those who had it in an ASC paid $1,851. Out-of-pocket costs for the in-office surgeries were lower as well: $173 vs. $356. Also, sending vas tissue out to be evaluated by a pathologist, which American Urological Association guidelines deem unnecessary, upped the average payments for the procedure by 55%.
Insurance Coverage Compared
Health insurance plans that are compliant with the Affordable Care Act (ACA) are required to cover women’s contraceptive costs, including sterilization, as part of their preventive care, with no out-of-pocket costs for plan participants. However, 20 states plus the District of Columbia allow certain employers and insurers, such as religious organizations and churches, to refuse to comply with the federal mandate to cover contraceptives.
Male sterilization is not considered a preventive service under the ACA, so insurance plans are not required by federal law to cover vasectomies. Still, many plans cover some or all of the costs of a vasectomy. And in eight states—Illinois, Maryland, New Jersey, New Mexico, New York, Oregon, Vermont, and Washington—state-regulated health insurance plans are required to cover a vasectomy at no cost to the person seeking it. Find out more from the National Association of Insurance Commissioners (NAIC), which has links to state health insurance departments.
People with low incomes may be able to have a sterilization fully covered by Medicaid, which is financed and run by both the federal and state governments. States that have fully expanded Medicaid under the ACA must cover female sterilization along with other forms of contraception for new enrollees. (The law prohibits federal funds from being used to sterilize any woman under age 21.) Although states with expanded Medicaid aren’t required to cover vasectomies, many do. Even if you’re uninsured, you may be able to get coverage under Medicaid’s family planning services.
Alternatives to Vasectomy or Tubal Ligation
If you’re looking for a “get it and forget it” type of birth control, two long-acting reversible methods approach the effectiveness of surgical sterilization at preventing pregnancy and are low cost if you rely on them for several years. They are:
- Copper Intrauterine Device (IUD) – This small, flexible, T-shaped piece of plastic is inserted through the cervix into the uterus, where it prevents sperm from reaching an egg. It is designed to last up to 10 years.
- Levonorgestrel Intrauterine System (LVN-IUS) – This type of IUD relies on the hormone progestin to prevent pregnancy. Depending on which brand is inserted, it will last up to seven years.
“These are excellent alternatives,” says Weiss.
Although you have to pay more up front to have an IUD inserted, these two types of IUDs were found to be the least expensive options over five years of use when compared with short-term contraceptive methods, according to a 2015 study in Contraception. Annualized costs were $304 and $308 for the copper IUD and LVN-IUS, respectively, and those for short-term methods ranged from $432 for injections to $730 for a patch. Birth control pills were $452.
How Much Does a Vasectomy Cost vs. a Tubal Ligation?
A vasectomy generally costs between $350 and $1,000, depending on where you live and where you have the procedure—a doctor’s office is the least expensive option. A tubal ligation can cost between $1,500 and $6,000. On a side note, both procedures are tax deductible.
Does Insurance Cover the Cost of Sterilization?
The Affordable Care Act (ACA) mandates that compliant health insurance plans must cover women’s contraceptive costs, including sterilization, as part of their preventive care, with no co-payments or other out-of-pocket costs. Vasectomies, however, are not considered preventive care, and insurance plans may therefore exclude them from coverage.
Can a Vasectomy or Tubal Ligation Be Reversed?
Both types of sterilization procedures are considered permanent. While it’s possible to undergo surgery to reverse them, there’s no guarantee that it will work. It’s also costly and may be complicated.
The Bottom Line
Vasectomies are less expensive, safer, and more effective than tubal ligations. It’s important to understand that these procedures are considered permanent. But for people whose families are complete—or who do not wish to pass on genetic mutations—both are excellent birth control options.