Original Articles
Poststerilization regret: findings from the United States collaborative review of sterilization

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Abstract

Objective: To evaluate the cumulative probability of regret after tubal sterilization, and to identify risk factors for regret that are identifiable before sterilization.

Methods: We used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18–44 years who had tubal sterilizations between 1978 and 1987. Actuarial life tables and Cox proportional hazards models were used to identify those groups at greatest risk of experiencing regret.

Results: The cumulative probability of expressing regret during a follow-up interview within 14 years after tubal sterilization was 20.3% for women aged 30 or younger at the time of sterilization and 5.9% for women over age 30 at sterilization (adjusted relative risk [RR] 1.9; 95% confidence interval [CI] 1.6, 2.3). For the former group, the cumulative probability of regret was similar for women sterilized during the postpartum period (after cesarean, 20.3%, 95% CI 14.5, 26.0; after vaginal delivery, 23.7%, 95% CI 17.6, 29.8) and for women sterilized within 1 year after the birth of their youngest child (22.3%, 95% CI 16.4, 28.2). For women aged 30 or younger at sterilization, the cumulative probability of regret decreased as time since the birth of the youngest child increased (2–3 years, 16.2%, 95% CI 11.4, 21.0; 4–7 years, 11.3%, 95% CI 7.8, 14.8; 8 or more years, 8.3%, 95% CI 5.1, 11.4) and was lowest among women who had no previous births (6.3%, 95% CI 3.1, 9.4).

Conclusion: Although most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret during follow-up interviews within 14 years after the procedure. (Obstet Gynecol 1999;93:889–95.)

Section snippets

Methods

The methods for the Collaborative Review of Sterilization, a prospective multicenter study, have been described.6, 7, 8 Participating medical centers were located 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 at each center.

Women were enrolled from 1978 to 1987 and were eligible for

Results

Consideration of demographic and reproductive characteristics showed that the study population was racially diverse and that the majority of participants were married, underwent interval laparoscopic sterilization procedures, and had elected tubal sterilization for contraceptive rather than medical reasons (Table 1). Half of the participants were 30 years or younger at the time of sterilization. The mean follow-up time was 6.5 years. Among the women eligible for interview at 1, 3, 5, and 8–14

Discussion

The cumulative probability of expressing regret during follow-up interviews within 14 years after tubal sterilization was 20% for women who were aged 30 years or younger when sterilized. Young women sterilized within 1 year after the birth of their youngest child were just as likely to experience regret at some point as were women sterilized during the immediate postpartum period. Poststerilization regret decreased as the time since the birth of the youngest child increased. A large number of

References (22)

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      The irreversibility of permanent contraception calls for careful counseling. Although most women express no regret, studies show an increased risk of later regret for women under 30 years of age or who have given birth less than one year before the time of the procedure [31]. It is also noted that reasons other than simply not wanting children seem to be associated with a higher risk of later regret and depressive symptoms.

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    Supported by an interagency agreement (3-YO2-HD41075-10) with the National Institute of Child Health and Human Development.

    1

    The U.S. Collaborative Review of Sterilization Working Group: Herbert B. Peterson, MD, Joyce M. Hughes, Zhisen Xia, PhD, Lynne S. Wilcox, MD, and Lisa Ratliff Tylor, Atlanta, Georgia; James Trussell, PhD, Princeton, New Jersey; Norman G. Courey, MD, CM, Buffalo, New York; Philip D. Darney, MD, MSc, San Francisco, California; Ernst R. Friedrich, MD, St. Louis, Missouri; Ralph W. Hale, MD, Washington, DC; Roy T. Nakayama, MD, Honolulu, Hawaii; Jaroslav F. Hulka, MD, Chapel Hill, North Carolina; Alfred N. Poindexter, MD, Houston, Texas; George M. Ryan, MD and Frank Ling, MD, Memphis, Tennessee; Gary K. Stewart, MD, Sacramento, California; and Howard A. Zacur, MD, Baltimore, Maryland.

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