Female Sterilisation

Summary

A Cochrane review [Abstract] 1 included 19 studies with a total of 13 209 subjects; 3 RCTs (n=1632) concerned postpartum sterilisation. Comparisons included tubal rings vs clips, partial salpingectomy vs electrocoagulatio, tubal rings vs electrocoagulation, partial salpingectomy vs clips, clips vs electrocoagulation, and Hulka vs Filshie clips. One year after sterilisation, failure rates were low (under 5/1000) for all methods. There were no deaths reported with any method, and major morbidity related to the occlusion technique was rare.

The tubal ring had higher rate of techical failures and more minor morbidity than the clip.When tubal rings were compared with electrocoagulation, postoperative pain was reported significantly more frequently for tubal rings. Major morbidity was significantly higher with the modified Pomeroy technique than electrocoagulation, as was postoperative pain; there was no significant difference in technical failures.When partial salpingectomy was compared with clips, there were no major morbidity events in either group, minor morbidity was low, but technical failure occurred more frequently with clips.

A systematic review and meta-analysis 2 comparing salpingectomy with tubal ligation included 6 RCTs in a qualitative analysis. There were few differences between the procedures, with no differences in most important clinical outcomes (antimüllerian hormone, blood loss, length of hospital stay, pre- or postoperative complications, or wound infections). A single study reported a non-significant reduced rate of pregnancies with salpingectomy (risk ratio, 0.22; 95% CI 0.05 to 1.02; P=.05).

A retrospective cohort study 3 compared real-world effectiveness of hysteroscopic (n=5 906) to laparoscopic (n=23 965) sterilization. Poststerilization pregnancy claims were identified for 4.74% of women after hysteroscopic and 5.57% after laparoscopic sterilization. 12 months after the procedure, the crude incidence of pregnancy claims was higher for hysteroscopic than for laparoscopic sterilization (3.26 vs. 2.61 per 100 woman-years), but the propensity-weighted adjusted incidence rate ratio was 1.06 (95% CI 0.85 to 1.26). The cumulative pregnancy rates 5 years after sterilization were lower with hysteroscopic than with laparoscopic sterilization (6.26 vs. 7.22 per 100 woman-years; propensity-weighted, adjusted risk ratio, 0.76, 95% CI 0.62 to 0.90).

A observational study 4 evaluated 7-year outcomes after hysteroscopic and laparoscopic sterilizations. The propensity score-matched cohort consisted of 10 109 pairs of women. The estimated risk of undergoing an additional tubal ligation or resection within 7 years was higher after hysteroscopic sterilization than it was after laparoscopic sterilization (3.9% vs 1.6%, HR 2.89, 95% CI 2.33 to 3.57). The difference was most pronounced within the initial year after attempted sterilization (1.5% vs 0.2%; HR 6.39, 95% CI 4.16 to 9.80).