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Tubal sterilization
Title:Tubal sterilization: focus on the U.S. experience
Author: C. Westhoff, et al.
Address: New York, New York
Source:Fertility and Sterility 73:913-922 (May) 2000
Summary: Researchers reviewed the frequency, effectiveness, and clinical sequelae of tubal sterilization (TS) in women seeking this procedure in order to determine its effectiveness and long-term risks and benefits. Annually there are about 700,000 tubal sterilizations performed in the U.S., half postpartum and half as ambulatory interval procedures. A prospective comparison of 365 women randomized to receive either Hulka clips or Falop rings revealed higher failure rates than expected. Pregnancy rates were 4.5% for the clips and 2.6% for rings. In 1996, the CDC published the findings of the US Collaborative Review of Sterilization (CREST). At 10 years, the most effective methods were postpartum partial salpingectomy and laparoscopic unipolar coagulation, with failure rates of 7.5 per 1,000, followed by Falope rings 17.7 per 1,000. Eleven million U.S. women aged 15-44 years rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy. Reversal is most successful after use of methods that destroy the least tube. There is very limited evidence of menstrual or hormonal disturbance after TS, but some studies reported higher rates of hysterectomy among previously sterilized women. Decreased risk of subsequent ovarian cancer has been observed among sterilized women. Researchers concluded that tubal sterilization is highly effective and safe. However, failures, although uncommon, occur at higher rates than previously thought.