The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization,☆☆,

Presented by invitation at the Fourteenth Annual Meeting of the American Gynecological and Obstetrical Society, Napa, California, September 7-9, 1995.
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Abstract

OBJECTIVE: Our purpose was to determine the risk of pregnancy after tubal sterilization for common methods of tubal occlusion. STUDY DESIGN: A multicenter, prospective cohort study was conducted in U.S. medical centers. A total of 10,685 women who underwent tubal sterilization was followed up for 8 to 14 years. The risk of pregnancy was assessed by cumulative life-table probabilities and proportional hazards models. RESULTS: A total of 143 sterilization failures was identified. Cumulative 10-year probabilities of pregnancy were highest after clip sterilization (36.5/1000 procedures) and lowest after unipolar coagulation (7.5/1000) and postpartum partial salpingectomy (7.5/1000). The cumulative risk of pregnancy was highest among women sterilized at a young age with bipolar coagulation (54.3/1000) and clip application (52.1/1000). CONCLUSIONS: Although tubal sterilization is highly effective, the risk of sterilization failure is higher than generally reported. The risk persists for years after the procedure and varies by method of tubal occlusion and age. (AM J OBSTET GYNECOL 1996;174:1161-70.)

Section snippets

MATERIAL AND METHODS

The U.S. Collaborative Review of Sterilization is a prospective study of women undergoing tubal sterilization at medical centers in Baltimore, Maryland; Buffalo, New York; Chapel Hill, North Carolina; Honolulu, Hawaii; Houston, Texas; Memphis, Tennessee; Sacramento, California; St. Louis, Missouri; and San Francisco, California. The study was approved by the institutional review board in each center. This report is based on the experiences of women who entered the study from 1978 through 1986.

RESULTS

Of the 10,863 women enrolled in the U.S. Collaborative Review of Sterilization who met the inclusion criteria for this analysis, 178 were excluded from analysis. One hundred thirty-six of these women were excluded because of loss to follow-up (n = 116), refusal to be interviewed at 1-month follow-up (n = 17), or refusal after prolonged loss to follow-up (n = 3). Eight women were excluded because of hysterectomy (n = 4), repeat tubal sterilization (n = 1), or death at 1-month follow-up (n = 3;

COMMENT

We found all methods of tubal sterilization to be highly effective in reducing the risk of pregnancy. However, the failure rates of most methods were substantially higher than those from most previous reports.4, 5, 6, 7, 8

All methods of tubal occlusion require proper application to maximize effectiveness. The higher failure rates associated with sterilization by spring clip application and bipolar coagulation highlight the need for proper technique in the use of these methods. As described by

Acknowledgements

The U.S. Collaborative Review of Sterilization Working Group: Design, Coordination, and Analysis Center, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Principal Investigator: Herbert B. Peterson, MD; Project Officer: Joyce M. Hughes; Project Associates: Zhisen Xia, PhD, Lynne S. Wilcox, MD, and Lisa Ratliff Tylor; Project Consultant: James Trussell, PhD; Data Collection Centers

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    From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention,aand the Office of Population Research, Princeton University.bA complete list of the U.S. Collaborative Review of Sterilization Working Group appears at the end of the article.

    ☆☆

    Reprint requests: Herbert B. Peterson, MD, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K-34, 4770 Buford Highway, N.E., Atlanta, GA 30341-3724.

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