How tubal ligation fits into our family planning

June 24 2011 | Guest post by Olivia
Normal Fallopian Tube, Human
Cross-section of a Fallopian Tube. Triiiippy. Photo by Ed Uthman, used with Creative Commons license.

As I sat down in the exam room in a new gynecologist's office, I prepared to have my blood pressure taken and to answer a few simple questions: When was my last period, how often do I drink alcohol, when was my past pap? Instead, the nurse looked at me incredulously and said, "You're here for a tubal consult? Really?! …She's not going to do it, you know."

I bit back my irritation , gave the nurse a big smile, and calmly replied, "I'd prefer to let the doctor make that decision. Do you need me to take my hoodie off to take my blood pressure?"

I'd expected a bit of a struggle during this appointment, but it surprised me that it came so early, and from the nurse. However, her remark was not completely off-base. Here I was, ready to talk to a doctor about getting a tubal ligation at twenty-three and with no children. Many doctors will not even consider doing a tubal on a woman unless she is over 30 and/or already has children; they worry that she will one day change her mind. Yet my husband and I had known for months that this was what we wanted.

I wrote a post on this site last fall about my struggles with bipolar disorder and the realization that though I had thought I wanted to have one biological child before adopting children, that it was not in my or my family's best interest. Since then, I have more than come to terms with that decision. In fact, turning my attention to a future of adopted children truly feels like coming home.

Growing up and into womanhood, I always felt strongly about adopting children — I knew that it was important to me to give homes to children already in this world, rather than creating new ones. Making the decision once and for all to not have biological children simply feels right to me. I am actually happy that I went through that trying time last year, because it forced me to get back to my core values. (I want to make sure to say that I don't judge those who do choose to have biological children — just that this isn't what I feel is right for me.)

After making this decision once and for all, my husband and I talked extensively about our birth control options. We knew I needed to get off hormonal birth control, since my bipolar meds reduce their effectiveness (and can seriously harm a fetus if I do get pregnant, which I covered in my other post). I thought about getting an IUD and for a host of reasons decided against it. So we were down to surgical sterilization. We determined I should be the one to have the procedure done, primarily because I have better insurance than he does and it would be fully covered. We decided to sit with this decision for several months to make sure it continued to feel right.

Fast forward to present day, with little old me sitting in that doctor's exam room, waiting to fight for what I wanted. The discussion with the gynecologist went mostly as I expected — we talked about all my options, she asked me why I wanted the procedure, she tried to direct me to other options. Then the discussion took a turn I didn't expect.

I was happily chatting away about why it was important to me to adopt and she interrupts me, saying, "You know those kids in foster care aren't your responsibility, don't you?"

I could only stare at her blankly; I was so surprised at what she had just said. After some deep cleansing breaths I simply told her that yes, it IS my responsibility to give permanent homes to children in foster care, that I knew I wouldn't change my mind about the surgery. I then asked if she would do the procedure or if I needed to find someone else. She said she would do it.

I left without saying much else to her, but this is what I wanted to say: my children are out there somewhere right now. They are about to be born, or they are babies, or they are small children. I can feel them in my soul and I can honestly say I want them and love them already. What does the decision to have a tubal ligation mean to me? It is a promise to those children that I will choose them over any biological urge I might feel to procreate. It is a promise that they will have a forever home with people who love them, that the spot they are to occupy in my family won't be taken by a biological child, that they won't grow up neglected or abused or unwanted.

I know this choice may seem extreme and a lot of people — like my doctor — won't completely understand it. For most people, it seems counterintuitive to get a tubal done as a family planning measure BEFORE having children. For me, though, putting this plan into action has made me feel more like an expectant mother than I've ever felt before. And really, once the children are here, who will care about how my husband and I got them, or the choices we made along the way to ensure things went according to plan? All anyone will see is a family, just as beautiful and loving as anyone else's.

  1. You are a much better person than I. I would have told that doctor to go fuck herself and kept looking for a new doctor. It's one thing to explain your options to you, but to say things like that? That's insane.

    33 agree
  2. Good for you! I had mine done at 26, after two children. My dr really didn't want to do it because he said they he KNEW I would change my mind (he has 5 kids himself). I told him that I WAS going to get it done, and he agreed to do it. I don't regret that decision at all.

    My husband and I start foster care training/classes in August! ๐Ÿ™‚

    1 agrees
  3. Hmm. I don't think my comment went through. Anyway, the gist of it was: Congratulations for starting your path to family-building!

    1 agrees
  4. Thank you for sharing your story. You will be a great credit to the children who share their lives with you.

    As a Canadian it blew my mind to read that health insurance reasons played a part in your decision to have a medical procedure which is far more risky to you than a vasectomy would have been to your partner. It just shows me how much I have to be grateful for.

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    • That is exactly what I thought. I mean, go for it if you're sure that you're not going to change your mind, but if you're also sure you're not going to cheat on your husband it seems insane for you to be sterilized rather than him based on "insurance". So glad to have universal health care…

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      • Hey guys..let's not let this spiral into a health care discussion, ok? It's a valid discussion, but not necessarily the best one for this post.

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        • Sorry, it just bothers me so much that money can play such a huge role in medical decisions like this. And it really does remind me how well off I am. Nothing wrong with appreciating what you have ๐Ÿ™‚

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  5. I just wanted to say you are awesome. Not only have you made a decision that important to you, you didn't back down when confronted either.

    When I was younger, I always wanted to adopt rather than biologically having children. I wanted to give a home to those who didn't have one. I ended up with an unplanned pregnancy and a fantastic kiddo of my own.

    There are people out there who will support your decision, and even call you a hero. Thank you so much for caring about those lost kids out there and I am sure you will find your children.

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  6. It sounds like you and your husband have a strong foundation, understand the challenges of foster parenting and adoption, and are committed to facing them as a team. Kudos for sticking by your convictions and following the path that's best for *you*!

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  7. I'm rather impressed that both the nurse and the doctor found it appropriate to express their opinions so frankly. I suppose we do pay them for their opinions but … those comments seemed highly unprofessional to me. Good for YOU for keeping your cool so spectacularly. What a great example of how to deal with such a situation in a very adult way.

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    • I believe that part of the consult for an irreversible procedure like this is to challenge your stance in as many ways as possible just to make sure you've thought through everything and really are committed. Sometimes it may be about a doctor expressing their own beliefs, but I imagine a lot of times (especially when they agree to do it anyway), it's just about making sure that you're sound in yours.

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      • This isn't even rare, take it from a childfree woman. The worst I ever had was a GYN that sighed and said "What's the point of being a woman if you don't have babies?" pretty nasty.
        But my online friend takes the cake when a nurse said to her "What if your husband died and your new husband wanted kids? What would you do then?" C'mon!

      • This is how I would try to read her comment, even though to you (and me, and the people commenting) it sounded ignorant and unprofessional. In her mind she was probably just trying to gauge your certainty. Also, from my own experience: since you are at the right-out-of-college age, many (unimaginative) people will assume that you are full of youthful idealism which you will eventually "outgrow". Something like coming out in college and being unable to convince people that you aren't just going through a "phase". Infuriating, yeah, but unfortunately common.

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  8. I have known several families that have adopted and it brought their family CLOSER. Just a little FYI ๐Ÿ˜‰

    You are an amazing person to recognize your heart-felt mission to rescue babies and give them a home. But even more so for standing up for what is right for YOU. Everyone is different and has a different purpose in life. Most of us forget this. (or we are un-taught it)THANKS FOR THE INSPIRATON.

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  9. You are beautiful women! your post for sure made me tear up. I love the line about this procedure being a promise to your kids who are out there.

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  10. If children in foster care aren't our responsibility, then who's responsibility are they? Chances are good that their biological family has already failed them. Thank you for caring!!

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  11. To be very charitable, your doctor has a point. Kids who end up in foster care have had a lot of trauma. More likely than not, they will come with a lot of bagage. It takes a lot of very bad behavior for a birthparent to lose all parential rights. That you're willing to take on such a challenge and recognize that all kids deserve a loving home makes what you're doing all the more wonderful. Still, the recommendation to seek out and talk with parents who have been through what you plan to do would be a great resource.

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    • As a former foster kid who was adopted at 17, I am so happy for those people who decide "those" kids are their responsibility. The fact that kids like myself experienced a lot of trauma should only be one piece of the foster/adoption puzzle. Did I have emotional problems and baggage that complicated my relationships? Yes, but I also had/have parents who were and are willing to work with me and help resolve those issues.

      Frankly, the doctor had no right saying that to a potential adoptive/foster parent — he or she would never have thought to question someone having a child in a "traditional" way, and certainly kids born to biological parents can endure significant trauma of their own, yet you don't see people questioning that decision. Most potential adoptive/foster parents are made well-aware of any issues their kiddos might come with. Better that a loving family works with those kids than allow them to not receive the love and attention they deserve, then have them kicked out on their own at 18. That is a vicious cycle.

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  12. I am a former foster kid who would have given anything for a mother who cared half as much as you do. What an amazing decision you've made. I'd call it a self sacrifice but I don't think you see it that way. I'd say its more like a small step to the bigger leap of becoming a mother.

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  13. I have PCOS and as much as i want to have a child(ren) that are biologically related to me that may never happen. At the same time i don't believe in biology, as crazy as it sounds, there is a small tribe of indigenous people somewhere in the world that believes that every child has several mothers and fathers in the tribe and the most important one wasn't the birth parent it depended on the relationship to the child.
    Its the perfect senerio for foster care. Ive seen my little brother and sister fit perfectly into my family. My little sister has the exact skin color that i have, you can tell how she feels by looking at her eyes,just like you could do with me, and her hair is the same color as my moms, and my little bro is the boy child my dad has always wanted and is just like my cousin in every thing from looks to personality. They are in no way biologically related to my family but some how they are now.
    I'm so glad you said the line about you can feel your future children out there. Me too. I can't wait for them to find their way home.

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  14. this is awesome!

    i mean, guh to the unprofessional commentary, but *this* is awesome. i hadn't thought about it before (seeing as birth control is built into my relationship), but i can see myself in your exact position were pregnancy a concern!

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  15. Good for you, you're taking the measures necessary to make sure that you are healthy and happy and you're willing to do a wonderful thing that most people don't even consider. I think your future children are going to be very lucky to have a Mom who put so much thought, effort and love into them before she even knew them.

  16. You made me tear up! Do you know how hard that is to do?! I think it was the line about knowing your kids out there waiting for you. You are probably right about your decision seeming extreme to some but it makes perfect sense to me (though maybe not FOR me). Know that there are some of us out here on the interwebs that totally support your decision, and congratulate you on it, and honor you for it!

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  17. Hi there. I loved the post! Does Olivia have a regular blog somewhere, and can someone direct me to it? I'd love to know more about her family and her journey ๐Ÿ™‚

  18. Congrats for standing up for your decision. I think more people need to be very honest if they don't want biological children and not feel like they have to have them because of societal pressure. Many of the children in foster care do need loving homes with loving, thoughtful people. Every child should be a wanted child and that doesn't always mean you have to give birth!

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  19. I think it's wonderful that you have made such a well thought-out decision regarding your future family. I wish everyone went into this process with as much forethought.

    It's perfectly reasonable to want to remove the possibility of an accidental pregnancy, especially given the risks to a fetus and your mental state.

    I'm sorry the doctor treated you that way. It's unfortunate that you are doubted because of the people who have regretted a tubal ligation.

  20. Have some respect for nurses! What she said was not appropriate, but she is a professional with skills and training that goes beyond merely taking your blood pressure. I am a nurse that does family planning and about 50% of young couples I counsel on early BTL or vasectomy who don't have kids change their minds. It's my job to ask all the questions, just like its my job to ask all the questions of other women making important reproductive choices. I don't know new patients and therefore I can't know what their decision-making process is like.

    Secondly, I grew up with a bipolar mother (pretty uncontrolled until recently–the highs are FUN; the lows suck) in a home with a revolving door of foster kids and foreign exchange students. Our family, and what it taught my siblings and I about love, is an indelible part of who we are as adults– most of us have chosen social service careers and plan to have similarly open homes. It is not a choice to be taken lightly at all as it has plenty of pitfalls and challenges. As a permanent youngster in an ever evolving situation, I am also grateful for the times when my parents had the presence of mind to give our family a break and let us regroup after a long term sibling moved back in with their birth family and when we chose to take breaks all together and focus on us.

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    • I think the OP was very respectful to the nurse by staying calm. The nurse was not asking questions, she was making an opinionated statement that the doctor would not do the procedure. She was not qualified to make that statement, regardless of her skills and training, because it was the doctor's decision not hers, which is all Olivia said, respectfully. As it turns out the nurse was wrong, causing unnecessary stress.

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      • You're right– it does sound like the author was respectful to the nurse when addressing her in the clinic. I don't want to start a debate on the role of nursing (there are plenty of other websites for that) but this sentence "I'd expected a bit of a struggle during this appointment, but it surprised me that it came so early, and from the nurse" implies the author doesn't think nurses play a role in pt. decision-making, which is simply not true. Nurses "care" is a frequent description of the profession, but, if we want to be accurate, nurses are charged with being patient advocates. And that goes well beyond blood pressure readings. If the "nurse" was actually a medical assistant, that is a different story.

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        • I'm so sorry to have implied that. I have great respect for nurses. In that sentence, I was trying to convey simply that in my experience with doctor's offices and nurses, I had never had a nurse make such an opinionated statement about what decision the doctor would make. I truly didn't mean to imply that she was out of line or that she shouldn't have an opinion, just that it took me by surprise since it had never happened before.

  21. You have really thought out your family planning and have found a way to commit fully to your future family without compromising your personal health(which of course only contributes to your families well being). You are such a bright young woman and your future family will be so very lucky to have you as a Mom. This is a lovely post! Wishing you all the best with your future kidlets! ๐Ÿ™‚

  22. This is lovely, and I'm so glad that you were able to stay strong in your convictions. Congrats on this next step, and good luck finding your children!

    (This made me tear up too, I won't lie.)

  23. I was wondering, if they aren't too private, what are the "host of reasons" that you chose not to get a non-hormonal IUD? I don't mean this in any way, shape, or form as a challenge to your decision or an attempt to make you "justify" it – I think it's awesome that you have obviously thought it through so thoroughly and I'm sure you have come to the right decision for you. I just think that you rightly point it out as a sometimes-appropriate alternative to sterilization, and I'd like to know a little more about how you came to your final decision.

    • Sure! My primary reasons are as follows. I decided against the hormonal IUD (Morena) because there is insufficient evidence about whether my primary bipolar medication would interact with it and render it less effective. I decided against the copper IUD because I have severe metal allergies and sometimes (rarely, but sometimes) people with those allergies do not do well with copper IUDs. Also I've read about women with no prior pregnancies experiencing chronic pain or discomfort after the iud is placed.

      And again, unfortunate as it is, money also had to play a role. The surgical sterilization is covered fully; the iuds are not at all. Also, to be honest… getting an IUD doesn't feel right to me, and I'm the type of person who believes it's important to follow those from-the-pit-of-your-stomach feelings.

  24. This is so beautiful! Thank you for sharing so honestly. I loved what you said about your children being out there somewhere. It really made me think of adoption in a different way. Good luck in your journey!

    1 agrees
  25. Good luck with your journey. I was inspired by your desire to adopt and the way you are dealing with a difficult situation calmly and confidently.

    I want to adopt before having biological children and I was worried that not having my own children although I can would count against me. But I also feel a sense of responsibility towards children in foster care.

  26. I'm in a similar situation and made the same decision. I have a heart condition that makes pregnancy possible but very risky for me and the fetus, and I have always felt it was silly for me to go through all the risks when there are plenty of kids out there that need homes. When I was actually ready to have kids, I went to doctors and asked questions-mostly just to say I had done a thorough check. We decided to go with an open adoption, and 5 months ago my son was born. I have never ever, even before he was born, doubted or regretted this decision. You know in your heart what is the best path to parenting for you. And know that for all the rude doctors you encountered, there are a dozen who think you are wise for being so thoughtful about having kids.
    I highly recommend the agency we used if you are interested in open adoption:

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  27. Props to you, not just for making the monumental decision to adopt or for sticking up for that decision, but also for being brave enough to recognize that you have a condition that in one way or another could have negative effects on your family if you were to have biological children. My own mother had 3 children to 3 different men, long story short, by the time I was 15 she had proven over and over again that she was just not suited to being a mother. She had lost my older brother when he was 7, so my entire life he had always lived with his dad. When I was 15 and my younger bro was 13 we were removed from the home and placed with step-family. Their hearts were in the right place for the wRong reasons so after a year in their home social services finally found my father for me(my mom had nevEr told him about me) and let me live with him. The younger bros dad was mia by choice, my older bro had to step up at 23 and finish raising our brother. We found out through all this that our mom is bi-polar. Had she chosen to go on medication a large part of our story would be different. 13 years later she still refuses to accept she has an issue. None of us our able to keep her in our lives, it is just to stressful and creates to many issues now that we have our own families. My point in sharing this is two-fold: you are a hero in my mind for accepting your disorder and protecting yourself and your family from any negative problems associated with it. And also, in your quest for children, please don't forget about the teenagers out there. So many have not experienced what it feels like to be loved or included in a family and many truely are good kids that just need some guidance and understanding, just because they will soon "age out" should not disclude them from feeling the love of parents. So from the bottom of my heart, THANK YOU.

    • Thank you so much for sharing your story. I fully intend on adopting teenagers in the future! Our plans are to adopt one sibling group of two or three younger children (anywhere from toddler to grade school age) in a few years when the husband is finished with his master's. Then several years later we'd like to add another sibling group of older children and teenagers to our family. At this point right now I feel I am too young to parent a teenager, but I absolutely want to provide a home for some in the future!

  28. Why don't your husband and you have the same insurance–especially if you're covered better? How would it work for when you have kids? Best of luck in finding your future children!

    • My insurance is expensive but necessary due to my need for continual prescriptions and mental health coverage. My husband gets his (incredibly cheaply) through his university, but it is very basic. Once he's out of school, he will hopefully get a job with good benefits for the entire family.

  29. When I had a non-hormonal IUD put in my first OBGYN said "don't you want kids that look like you" when I expressed my want to adopt. I was floored and walked out. You have a plan run with it.

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  30. I love this! I wish we were in a financial position to adopt. The sad truth is that it is much cheaper to have bio children than to adopt. My dad and husband were both adopted though and I really admire your choice!

    • Agreed. My husband's mother and her sister were both adopted, and I love the idea of adopting — but by the time we're financially stable enough to adopt (and I'm talking like, 5 years minimum; we've still got about three years of college left here) I don't know that we'll really want more children.

    • Hi! I was actually concerned about this when we started thinking about it, but I found out it's not always true. Yes, if you wan to adopt internationally, or if you want a private adoption (especially of a newborn), it can cost a lot of money in agency fees. However, if you choose to adopt through the foster care system, as we have, the only costs are the costs associated with changing the child's last name. Also, at least in Ohio, many counties provide monthly money to foster parents before the child legally becomes yours. Our plan is to use this money to pay the legal fees, and then put the rest into college funds! No money out of our pockets! ๐Ÿ™‚

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  31. This is very inspiring and I fully support your dreams of adoption! I was wondering though, it you've done any research about restrictions on fostering/adopting as a result of your bipolar disorder? I only ask because where I'm from, being diagnosed with a mental disorder excludes people from public adoptions (my cousin tried).

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    • Great question! In my county, and the counties surrounding, there are either no such restrictions, or the county simply requires documentation from your psychiatrist that you are medicated and stable. That's too bad for your cousin ๐Ÿ™

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  32. I just want to thank everyone for their words of support and encouragement. You all are beautiful and wonderful and make me so happy to be a part of the offbeatmama community.

  33. Thank you for posting this.I have postural orthostatic tachycardia syndrome, premature atrial contractions, and 2 congential heart defects. While those defects occur "naturally" in 1 of 100 babies, if YOU have one, the chances of giving it to your children is 1 in 20. My FH and I have discussed having this procedure done as well. I'll have to show it to him later.

  34. Thank you so much for sharing your story. I can relate when you say, "my children are out there somewhere right now. They are about to be born, or they are babies, or they are small children. I can feel them in my soul and I can honestly say I want them and love them already." I felt the same way before I conceived. I knew somewhere inside me was the ovum that would become my child. I wanted that child and loved them already. I hope you find your babies soon. They will be lucky to have a mama like you. ๐Ÿ™‚

    1 agrees
  35. What a beautiful Mama you already are. Your future children are so lucky and I believe in loving them before you've met them (in person). I felt the same way about my husband and son I didn't know I'd have. I don't think many people can grasp that concept but it makes your heart huge and receptive.

    Such a wonderful article. Thanks for sharing!

  36. I have never read this sentiment put so logically or so perfectly before. Most people wouldn't bat an eyelash if someone who wanted bio children said they already love their future children. SO why should it be any different for a future adoptive parent to say it? And yeah, that does make your future children your responsibility, just like my once future child was my responsibility when I was someone trying to conceive. Insensitive doctor, ugh.

    1 agrees
  37. I don't usually comment here but I had to say what a beautiful post this is. Well done for choosing the path that's right for your family and I wish you all every happiness.

  38. Your words were so amazing. I am so happy that you stood up for yourself and you were able to actually decide without the pressures of others. I fostered to kids when I was 23. Sadly, I was unable to adopt them. One day I plan to do it again and become a forever mommy to someone. I say go with your gut congratualations on your decision.

  39. This realllly struck a cord with me. I also had a tubal ligation at the age of 23 with no kids. When I was diagnosed with a genetic disease for which there is no cure or treatment, I started looking at my options. Its not fatal or anything (except in rare cases) but it is disabling, even though I don't "look sick" whatever that means. I use a wheelchair part time, and a pregnancy might push that part-time status into full time even after birth. There is also a higher chance of miscarriage and complications, and (and this is the kicker) a whopping 50% chance to pass it down. There is also no genetic test for it, so I would be that overprotective crazy Mom looking at every bump and bruise my kids had and wondering if it might be my disease. We might get a surrogate, but because I don't want to use my DNA we would also have to get a donor egg, and it is hella expensive…why not just adopt kids that are already made? Anyway, those are my reasons.

    My experience was a little different than yours. I went into my OBGYN and presented my case, expecting to argue and prepared for the worst. Instead, my wonderful doctor asked me a few basic questions, then told me she though I was making a very responsible, wise, and mature decision, then started telling me my options. I was shocked, but I found out she herself actually has a medical condition that made her decide also to not have biological children, so she completely understood. However, the day of the procedure the nurse doing my pre-op asked me what I was in for (which they have to do for security reasons, to make sure they don't remove the wrong appendix or something) then started asking me random judgmental questions about why I was having it. My Mom was back with me and heard the exchange and was furious, so she told my doctor and my doctor yelled at the nurse. I mean, come on, my doctor obviously approved it and it is an emotional decision, don't make me second guess it while you are starting my IV!

    3 years later and engaged, I don't regret my decision at all. My fiance' now was my boyfriend at the time of the procedure and he was completely on board the whole time, so that was not an issue. I did, however, go through a grieving process in the few months after the procedure. It didn't help that I was taking 2 classes that semester: in one of them the teacher was pregnant, and the other one was medical ethics where we literally discussed the ethics of situations exactly like my own. I grieved for the children that never were and the loss of a chance of a normal pregnancy I never would have been able to have. I just wanted to tell anyone who is considering having a procedure like this done to prepare yourself for a period of mourning. I still get a little upset sometimes when people ask me, knowing I am about to get married, when I will start popping out babies. It is pretty daunting to think that in order to have kids I will have to fill out a bunch of paperwork, talk to lawyers, probably fork over a lot of money, etc. to convince someone that I am fit to be a mother, rather than just having sex and getting pregnant. But it is nice to not ever have to worry about buying maternity clothes or remembering to take my birth control pill.

    1 agrees

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