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).

Both patency and normal anatomy of the fallopian tube are essential for reproduction. There are many pathological conditions that affect the fallopian tube and consequently affect human reproduction. During the past 28 years, the introduction of in vitro fertilization helped many infertile couples to achieve successes, despite tubal pathology. Salpingitis isthmica nodosa is now believed to be a proliferative process of the endosalpinx into the myosalpinx, leading to hypertropic process and fibrosis in the wall of the fallopian tube and the isthmus. Tubal sterilization is performed for women who have a disease that contraindicates pregnancy. The fallopian tube could be affected with endometriosis directly or indirectly. Surgical management of endometriosis of the fallopian tube follows the same principles of dealing with endometriosis of the pelvic cavity, and this could be accomplished by the use of CO2 laser or harmonic scalpel or microcautery.

The need for reliable, safe, and reversible contraception has become more evident, and the duration of their use has increased as many women opt to delay childbearing into the late third and fourth decades. Many psychosocial and economic factors will continue to affect women's contraceptive decision-making and undoubtedly will continue to influence rates of tubal sterilization. Vasectomy, like tubal sterilization, should be considered an irreversible sterilization procedure. The oral contraceptive pill is a common form of contraception in the USA. Numerous societal, biological, psychological, and legal factors must be considered when counseling women about their reproductive health. As with any physician-patient encounter, careful documentation must accompany any discussion regarding reproduction and contraceptive choices. Discussions regarding reproductive health, contraception, and sterilization must make the clear distinction between contraception and protection from sexually transmitted disease (STDs). Broad categories of assisted fertilization include hormonal assistance designed to induce ovulation and in vitro fertilization.