Elsevier

Contraception

Volume 73, Issue 2, February 2006, Pages 205-210
Contraception

Review article
Regret following female sterilization at a young age: a systematic review

https://doi.org/10.1016/j.contraception.2005.08.006Get rights and content

Abstract

Women who undergo sterilization may later regret this decision. This systematic review examines whether age at sterilization is associated with poststerilization regret. Using MEDLINE and EMBASE, we identified 19 articles that examined associations between women's age at sterilization and later regret, requests for sterilization reversal and undergoing sterilization reversal or requesting in vitro fertilization (IVF) procedures. Study results showed that the younger women were at the time of sterilization, the more likely they were to report regretting that decision. Women undergoing sterilization at the age 30 years or younger were about twice as likely as those over 30 to express regret. They were also from 3.5 to 18 times as likely to request information about reversing the procedure and about 8 times as likely to actually undergo reversal or an evaluation for IVF. Results of studies that examined risk by continuous age showed a consistent inverse relationship between women's age at sterilization and their likelihood of regretting having had the procedure.

Introduction

Female sterilization is the most widely used method of contraception around the world, with over 200 million married women of reproductive age having been sterilized as of 2003 [1]. In the United States, more than 10 million women have undergone tubal sterilization, and in 2002, 27% of women aged 15 to 44 who were using contraception had undergone tubal sterilization [2]. Although female sterilization is a safe and highly effective method of contraception, it is intended to be permanent, and surgical procedures to reverse sterilization, as well as alternatives such as in vitro fertilization (IVF), are expensive and often unsuccessful. Although most women who undergo sterilization remain satisfied with their choice of a permanent method of contraception, some later regret that decision. In particular, young age at the time of sterilization has been associated with later regret. If factors that lead to regret could be identified prior to sterilization, some of this regret may be prevented.

We conducted this systematic review in preparation for an Expert Working Group of international family planning experts convened by the World Health Organization (WHO) in October 2003 to develop and revise medical eligibility criteria for contraceptive use. In this report, we describe the evidence obtained through our systematic review regarding whether age at the time of female sterilization is associated with later regret, as well as provide the WHO recommendations that were derived in part from this evidence.

Section snippets

Materials and methods

We searched the MEDLINE and EMBASE databases for all articles published in any language from 1966 through May 2005 using the following search terms: sterilization, sexual/ and female/; sterilization, tubal.mp.; regret.mp.; reversal.mp.contraceptives. We also searched reference lists of identified articles and relevant review articles for additional citations of interest. We did not consider abstracts of conference presentations, dissertations, or unpublished studies, nor did we contact the

Regret

Ten articles reported on eight studies examining women's poststerilization regret [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Of these, four studies reported either mean age at sterilization or proportions by age groups at sterilization for women who experienced regret and for those who did not [5], [6], [7], [8]. The results of these studies showed that women who were younger at the time of sterilization were more likely to experience regret and that the mean age of those

Discussion

Overall, evidence suggests that the younger the women are when they undergo sterilization, the more likely they are to regret the decision, to request information about sterilization reversal, or to obtain a reversal or undergo evaluation for IVF procedures. Although the studies we examined consistently showed a negative correlation between women's age at the time their sterilization and their risk of regretting their decision, none of them identified an age threshold at which the risk of

Acknowledgments

This review was supported by resources from the World Health Organization, the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Agency for International Development (USAID) and the US National Institute of Child Health and Human Development (NICHD).

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