I was able to get a bisalp in the US at 35 pretty easily, but I also had a really good medical reason for not wanting to carry kids and a gyno who was actually cool about it. I have enough of my spine fused in a place that a pregnancy would cause some pretty severe pain (plus I just don’t want to carry a child). My gyno was really sympathetic because he knew me both before and after fusion. He still had to refer me to another doctor because the hospital he worked with wouldn’t approve it (Catholic hospitals SUCK).
I got my referral and the next gyno was also very sympathetic to my circumstances. At the initial consultation, he sincerely apologized because he had to ask questions, per hospital policy, to make sure I was sure. I even brought a friend as moral support, plus she was curious about the process of getting a bisalp. He had a list and when he got to the question of “what if your future husband wants kids”, all 3 of us laughed at it. It was really clear that I was sure.
I have heard horror stories about women trying to get sterilized, a few were from acquaintances. I honestly do not believe it would have been that easy if it hadn’t been for my fusion.
Edit: I fucked up the age, I was 35 when I had my bisalp. Best fucking decision I’ve ever made!