Surgical method: Fallopian tubes are "occluded by cautery, crushing, clamping, or blocking. -99.5% effectiveness rate -most common to achieve tubal ligation= laparoscopy -After a menstrual flow and before ovulation, an incision as small as 1 cm is made just under the woman's umbilicus with the woman under general or local anesthesia. -A lighted laparoscope is inserted through the incision. -Carbon dioxide is then pumped into the incision -An electrical current to coagulate tissue is then passed through the instrument for 3 to 5 seconds, or the tubes are clamped by plastic, metal, or rubber rings, then cut or filled with a silicone gel to seal them. -A new system, essure, consists of a spring-loaded mechanism that, when inserted through the vagina and uterus into the outer end of a fallopian tube ( a hysteroscopy procedure), releases a soft micro-insert into the tube that effectively seals the tube. -may return coitus 2 to 3 days after the procedure. -will still have a monthly menstrual flow -If a silicone gel has been instilled into the tubes as a blocking agent, it can be removed at a later date to reverse the procedure. -May go home on the same day of the procedure