This chapter discusses hysteroscopic and laparoscopic sterilization, where the technique for laparoscopic sterilization is fundamentally the same for all devices that occlude the tubal lumen. Bipolar electrosurgery electrodes are applied to the isthmic portion of the Fallopian tube and the current is applied until either visual changes indicated coagulation of the tube, or a feedback mechanism on the electrosurgical generator indicates an increase in impedance between the bipolar electrodes consistent with desiccation of the tissue. Subsequent research focused on nonelectrical nonthermal methods of hysteroscopic sterilization. Recent reports have described the potential benefit of complete salpingectomy in reducing the risk of ovarian cancer. Laparoscopic tubal ligation complications are relatively uncommon, but when they occur they are frequently severe and occasionally life threatening. The full range of contraceptive options should be discussed, along with their attendant medical or surgical risks, risk of failure, and alternatives. Vasectomy of the male partner should be addressed.