In females, sterilization can be achieved by hysterectomy or tubal occlusion. In the USA, female sterilization is the second commonest method of contraception overall, and the most common method used by married women and women aged over 30. Prior to deciding on a sterilization operation, the woman or preferably the couple should be given information about alternatives, especially long-acting reversible method of contraception (LARC) and also vasectomy. They should understand that vasectomy has a lower failure rate and fewer complications than tubal sterilization. Various approaches to tubal occlusion described in this chapter are laparoscopic filshie clips, and hysteroscopic approach. Women choosing laparoscopic sterilization are more likely to have a successful procedure. Approximately 5% of women who have a failed hysteroscopic attempt declined further sterilization. The options for women who have been sterilized and wish to restore fertility are to undergo sterilization reversal or to attempt in vitro fertilization (IVF).