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Surgical sterilization of women

Topic Outline

GRAPHICS

INTRODUCTION

Surgical sterilization is a safe, highly effective, permanent, and convenient form of contraception. Numerous methods for achieving permanent sterilization have been described, and subsequently modified to improve success rates, simplify surgical technique and reduce postoperative pain and length of hospital stay. Laparoscopic techniques are preferred for most patients, as they are effective, and are usually performed on an outpatient basis, and result in rapid patient recovery. In 1995, almost 30 percent of contraceptive users in the United States used tubal sterilization [1].

Female surgical sterilization via laparoscopy or laparotomy is reviewed in this topic. Hysteroscopic sterilization is reviewed separately. (See "Hysteroscopic sterilization".)

GENERAL CONSIDERATIONS

Tubal sterilization is an elective and essentially permanent procedure. There are virtually no absolute contraindications, although a patient's gynecologic disease may require sterilization by hysterectomy and bilateral oophorectomy.

Known extensive intra-abdominal adhesions increase the potential for intraoperative morbidity during laparoscopy. With the development of transcervical (or hysteroscopic) sterilization, laparotomy is now rarely necessary for sterilization. Alternatively, other forms of contraceptive can be offered. (See "Hysteroscopic sterilization" and "Overview of contraception".)

Pregnancy may pose a significant risk to women with some medical disorders; thus forming a basis for elective sterilization. However, consultation with a maternal-fetal medicine specialist is advisable to determine the current magnitude of risk to mother and offspring, since occasionally women have been told that pregnancy is contraindicated when, in fact, it is not.

                                    

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Literature review current through: Oct 2014. | This topic last updated: May 8, 2014.
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References
Top
  1. Westhoff C, Davis A. Tubal sterilization: focus on the U.S. experience. Fertil Steril 2000; 73:913.
  2. American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 133: benefits and risks of sterilization. Obstet Gynecol 2013; 121:392.
  3. Hankinson SE, Hunter DJ, Colditz GA, et al. Tubal ligation, hysterectomy, and risk of ovarian cancer. A prospective study. JAMA 1993; 270:2813.
  4. DeStefano F, Huezo CM, Peterson HB, et al. Menstrual changes after tubal sterilization. Obstet Gynecol 1983; 62:673.
  5. Bhiwandiwala PP, Mumford SD, Feldblum PJ. Menstrual pattern changes following laparoscopic sterilization with different occlusion techniques: a review of 10,004 cases. Am J Obstet Gynecol 1983; 145:684.
  6. Bhiwandiwala PP, Mumford SD, Feldblum PJ. Menstrual pattern changes following laparoscopic sterilization: a comparative study of electrocoagulation and the tubal ring in 1,025 cases. J Reprod Med 1982; 27:249.
  7. Gentile GP, Kaufman SC, Helbig DW. Is there any evidence for a post-tubal sterilization syndrome? Fertil Steril 1998; 69:179.
  8. Peterson HB, Jeng G, Folger SG, et al. The risk of menstrual abnormalities after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 2000; 343:1681.
  9. Grubb GS, Peterson HB, Layde PM, Rubin GL. Regret after decision to have a tubal sterilization. Fertil Steril 1985; 44:248.
  10. Henshaw SK, Singh S. Sterilization regret among U.S. couples. Fam Plann Perspect 1986; 18:238.
  11. Phillips JM, Hulka JF, Hulka B, Corson SL. 1979 AAGL membership survey. J Reprod Med 1981; 26:529.
  12. Allyn DP, Leton DA, Westcott NA, Hale RW. Presterilization counseling and women's regret about having been sterilized. J Reprod Med 1986; 31:1027.
  13. Trussell, J, Guilbert, E, Hedley, A. Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec. Obstet Gynecol 2003; 101; 677.
  14. Divers WA Jr. Characteristics of women requesting reversal of sterilization. Fertil Steril 1984; 41:233.
  15. Winston RM. Why 103 women asked for reversal of sterilisation. Br Med J 1977; 2:305.
  16. Jamieson DJ, Kaufman SC, Costello C, et al. A comparison of women's regret after vasectomy versus tubal sterilization. Obstet Gynecol 2002; 99:1073.
  17. Wilcox LS, Chu SY, Eaker ED, et al. Risk factors for regret after tubal sterilization: 5 years of follow-up in a prospective study. Fertil Steril 1991; 55:927.
  18. Vessey M, Huggins G, Lawless M, et al. Tubal sterilization: findings in a large prospective study. Br J Obstet Gynaecol 1983; 90:203.
  19. WHITACRE FE, LOEB WM, LOEB L. The time for postpartum sterilization; report of 150 cases; bacteriologic studies on the postpartum uterus. Am J Obstet Gynecol 1946; 52:1041.
  20. Rozier JR. Immediate postpartum tubal ligation. An intraumbilical approach. Am J Obstet Gynecol 1973; 117:226.
  21. Lu T, Chun D. A long term follow-up study of 1,055 cases of postpartum tubal ligation. J Obstet Gynaecol Br Emp 1967; 74:875.
  22. Black WP, Sclare AB. Sterilization by tubal ligation--a follow-up study. J Obstet Gynaecol Br Commonw 1968; 75:219.
  23. Green LR, Laros RK Jr. Postpartum sterilization. Clin Obstet Gynecol 1980; 23:647.
  24. MacKay AP, Kieke BA Jr, Koonin LM, Beattie K. Tubal sterilization in the United States, 1994-1996. Fam Plann Perspect 2001; 33:161.
  25. Lipscomb GH, Spellman JR, Ling FW. The effect of same-day pregnancy testing on the incidence of luteal phase pregnancy. Obstet Gynecol 1993; 82:411.
  26. Grubb GS, Peterson HB. Luteal phase pregnancy and tubal sterilization. Obstet Gynecol 1985; 66:784.
  27. Sherman PA, Burigo JA. Comparison of laparoscopic Falope-Ring and minilaparotomy sterilization. Obstet Gynecol 1984; 63:71.
  28. Kulier R, Boulvain M, Walker D, et al. Minilaparotomy and endoscopic techniques for tubal sterilisation. Cochrane Database Syst Rev 2002; :CD001328.
  29. Penfield AJ. Minilaparotomy for female sterilization. Obstet Gynecol 1979; 54:184.
  30. Lee RB, Boyd JA. Minilaparotomy under local anesthesia for outpatient sterilization: a preliminary report. Fertil Steril 1980; 33:129.
  31. Cheng MC, Wong YM, Rochat RW, Ratnam SS. Sterilization failures in Singapore: an examination of ligation techniques and failure rates. Stud Fam Plann 1977; 8:109.
  32. Peterson, HB, Pollack, AE, Warshaw, JS. Tubal sterilization. In: Telinde's Operative Gynecology, 8th ed, Rock, JA, Thompson, JD (Eds), Lippincott Williams & Wilkins, Philadelphia 1997. p.529.
  33. Irving, FC. A new method of insuring sterility following cesarean section. Am J Obstet Gynecol 1924; 8:335.
  34. Fox MD, Long CA, Meeks GR, et al. Laparoscopic Pomeroy tubal ligation as a teaching model for residents. J Reprod Med 1994; 39:862.
  35. Murray JE, Hibbert ML, Heth SR, Letterie GS. A technique for laparoscopic pomeroy tubal ligation with endoloop sutures. Obstet Gynecol 1992; 80:1053.
  36. Uchida H. Uchida tubal sterilization. Am J Obstet Gynecol 1975; 121:153.
  37. Kroener WF Jr. Surgical sterilization by fimbriectomy. Am J Obstet Gynecol 1969; 104:247.
  38. Stovall TG, Ling FW, Lipscomb GH, et al. A model for resident surgical training in laparoscopic sterilization. Obstet Gynecol 1994; 83:470.
  39. PALMER R. [Not Available]. Gynecol Obstet (Paris) 1947; 46:420.
  40. Rioux JE, Quesnel G, Blanchet J, et al. [Laparoscopy: tubal sterilization: 1000 cases and general evaluation of the method]. Union Med Can 1973; 102:1865.
  41. Yuzpe AA, Loffer FD, Pent D. Laparoscopic tubal sterilization by the "burn only" technic. Obstet Gynecol 1977; 49:106.
  42. Soderstrom, RM. Electrical safety in laparoscopy. p. 306. In Philips JM (ed): Endoscopy in Gynecology. American Association of Gynecologic Laparoscopists Downey, CA, 1967.
  43. Black WP. Sterilization by laparoscopic tubal electrocoagulation: an assessment. Am J Obstet Gynecol 1971; 111:979.
  44. Poliakoff, SR, Yoon, IB, King, TM. A four year experience with the Yoon Ring. In Phillips JM (ed): Endoscopy in Gynecology. American Association of Gynecologic Laparoscopists, Downey, CA, 1978.
  45. Penfield AJ. The Filshie clip for female sterilization: a review of world experience. Am J Obstet Gynecol 2000; 182:485.
  46. Kohaut BA, Musselman BL, Sanchez-Ramos L, Kaunitz AM. Randomized trial to compare perioperative outcomes of Filshie clip vs. Pomeroy technique for postpartum and intraoperative cesarean tubal sterilization: a pilot study. Contraception 2004; 69:267.
  47. Dominik R, Gates D, Sokal D, et al. Two randomized controlled trials comparing the Hulka and Filshie Clips for tubal sterilization. Contraception 2000; 62:169.
  48. Filshie GM, Casey D, Pogmore JR, et al. The titanium/silicone rubber clip for female sterilization. Br J Obstet Gynaecol 1981; 88:655.
  49. Sokal D, Gates D, Amatya R, Dominik R. Two randomized controlled trials comparing the tubal ring and filshie clip for tubal sterilization. Fertil Steril 2000; 74:525.
  50. Kovacs GT, Krins AJ. Female sterilisations with Filshie clips: what is the risk failure? A retrospective survey of 30,000 applications. J Fam Plann Reprod Health Care 2002; 28:34.
  51. Daucher JA, Weber AM. Chronic abdominal pain after laparoscopic sterilization clip placement. Obstet Gynecol 2006; 108:1540.
  52. Handa, VL, Berlin, M, Washington, AE. A comparison of local and general anesthesia for laparoscopic tubal sterilization. J Women Health 1994; 3:135.
  53. Mehta PV. A total of 250,136 laparoscopic sterilizations by a single operator. Br J Obstet Gynaecol 1989; 96:1024.
  54. Lipscomb GH, Stovall TG, Ramanathan JA, Ling FW. Comparison of silastic rings and electrocoagulation for laparoscopic tubal ligation under local anesthesia. Obstet Gynecol 1992; 80:645.
  55. Fishburne JI Jr. Office laparoscopic sterilization with local anesthesia. J Reprod Med 1977; 18:233.
  56. Penfield AJ. Laparoscopic sterilization under local anesthesia. 1200 cases. Obstet Gynecol 1977; 49:725.
  57. Lipscomb GH, Summitt RL Jr, McCord ML, Ling FW. The effect of nitrous oxide and carbon dioxide pneumoperitoneum on operative and postoperative pain during laparoscopic sterilization under local anesthesia. J Am Assoc Gynecol Laparosc 1994; 2:57.
  58. Lipscomb GH, Summitt RL Jr, McCord ML, Ling FW. Serum bupivacaine levels during laparoscopic sterilization using local anesthesia. J Am Assoc Gynecol Laparosc 1994; 2:27.
  59. Benhamou D, Narchi P, Mazoit JX, Fernandez H. Postoperative pain after local anesthetics for laparoscopic sterilization. Obstet Gynecol 1994; 84:877.
  60. LEE JG Jr, RANDALL JH, KEETTEL WC. Tubal sterilization; a review of 1,169 cases. Am J Obstet Gynecol 1951; 62:568.
  61. Miesfeld RR, Giarratano RC, Moyers TG. Vaginal tubal ligation--is infection a significant risk? Am J Obstet Gynecol 1980; 137:183.
  62. Smith RP, Maggi CS, Nolan TE. Morbidity and vaginal tubal cautery: a report and review. Obstet Gynecol 1991; 78:209.
  63. Hartfield VJ. Female sterilization by the vaginal route: a positive reassessment and comparison of 4 tubal occlusion methods. Aust N Z J Obstet Gynaecol 1993; 33:408.
  64. Hartfield VJ. Daycare Pomeroy sterilisation by the vaginal route. N Z Med J 1977; 85:223.
  65. Khairullah Z, Huber DH, Gonzales B. Declining mortality in international sterilization services. Int J Gynaecol Obstet 1992; 39:41.
  66. Jamieson DJ, Hillis SD, Duerr A, et al. Complications of interval laparoscopic tubal sterilization: findings from the United States Collaborative Review of Sterilization. Obstet Gynecol 2000; 96:997.
  67. Peterson HB, Xia Z, Hughes JM, et al. The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol 1996; 174:1161.
  68. Chi IC, Laufe LE, Gardner SD, Tolbert MA. An epidemiologic study of risk factors associated with pregnancy following female sterilization. Am J Obstet Gynecol 1980; 136:768.
  69. McCausland A. High rate of ectopic pregnancy following laparoscopic tubal coagulation failures. Incidence and etiology. Am J Obstet Gynecol 1980; 136:97.
  70. Peterson HB, Xia Z, Hughes JM, et al. The risk of ectopic pregnancy after tubal sterilization. U.S. Collaborative Review of Sterilization Working Group. N Engl J Med 1997; 336:762.
  71. Soderstrom RM. Sterilization failures and their causes. Am J Obstet Gynecol 1985; 152:395.
  72. Thompson BH, Wheeless CR. Failures of laparoscopy sterilization. Obstet Gynecol 1975; 45:659.
  73. Chi I, Mumford SD, Laufe LE. Technical failures in tubal ring sterilization: Incidence, perceived reasons, outcome, and risk factors. Am J Obstet Gynecol 1980; 138:307.
  74. Varma R, Gupta JK. Failed sterilisation: evidence-based review and medico-legal ramifications. BJOG 2004; 111:1322.
  75. Aubert JM, Garcia A. Improving Falope-Ring application in laparoscopy training. J Reprod Med 1987; 32:340.
  76. Lipscomb GH, Stovall TG, Summitt RL Jr, Ling FW. Chromopertubation at laparoscopic tubal occlusion. Obstet Gynecol 1994; 83:725.
  77. Cohen MM. Long-term risk of hysterectomy after tubal sterilization. Am J Epidemiol 1987; 125:410.
  78. Stergachis A, Shy KK, Grothaus LC, et al. Tubal sterilization and the long-term risk of hysterectomy. JAMA 1990; 264:2893.
  79. Goldhaber MK, Armstrong MA, Golditch IM, et al. Long-term risk of hysterectomy among 80,007 sterilized and comparison women at Kaiser Permanente, 1971-1987. Am J Epidemiol 1993; 138:508.
  80. Hillis SD, Marchbanks PA, Tylor LR, Peterson HB. Higher hysterectomy risk for sterilized than nonsterilized women: findings from the U.S. Collaborative Review of Sterilization. The U.S. Collaborative Review of Sterilization Working Group. Obstet Gynecol 1998; 91:241.
  81. Taffe J, Green A, Dudley E, Dennerstein L. Tubal ligation, hysterectomy and D&C: evidence from the Melbourne Women's Midlife Health Project. Gynecol Obstet Invest 2000; 50:117.
  82. Narod SA, Sun P, Ghadirian P, et al. Tubal ligation and risk of ovarian cancer in carriers of BRCA1 or BRCA2 mutations: a case-control study. Lancet 2001; 357:1467.
  83. Abbuhl SB, Muskin EB, Shofer FS. Pelvic inflammatory disease in patients with bilateral tubal ligation. Am J Emerg Med 1997; 15:271.
  84. Edelman DA. Pelvic inflammatory disease and contraceptive practice. Adv Contracept 1986; 2:141.
  85. Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. IV. The pathogenesis of epithelial ovarian cancer. Collaborative Ovarian Cancer Group. Am J Epidemiol 1992; 136:1212.
  86. Costello C, Hillis SD, Marchbanks PA, et al. The effect of interval tubal sterilization on sexual interest and pleasure. Obstet Gynecol 2002; 100:511.
  87. Smith A, Lyons A, Ferris J, et al. Are sexual problems more common in women who have had a tubal ligation? A population-based study of Australian women. BJOG 2010; 117:463.
  88. Visvanathan N, Wyshak G. Tubal ligation, menstrual changes, and menopausal symptoms. J Womens Health Gend Based Med 2000; 9:521.
  89. Carranza-Lira S, Murillo-Uribe A, Martínez-Trejo N, Santos-González J. Influence of previous bilateral partial tubal resection on symptoms, hormones, lipids, and bone density in postmenopausal women. Contraception 1997; 56:5.
  90. Twigg J, Evans J. Spontaneous tubal re-canalisation: a late complication of Falope ring sterilisation. J Fam Plann Reprod Health Care 2001; 27:156.
  91. Lok IH, Lo KW, Ng JS, et al. Spontaneous expulsion of a Filshie clip through the anterior abdominal wall. Gynecol Obstet Invest 2003; 55:183.
  92. Stovall TG, Ling FW, Henry GM, Ryan GM Jr. Method failures of laparoscopic tubal sterilization in a residency training program. A comparison of the tubal ring and spring-loaded clip. J Reprod Med 1991; 36:283.
  93. Stovall TG, Ling FW, O'Kelley KR, Coleman SA. Gross and histologic examination of tubal ligation failures in a residency training program. Obstet Gynecol 1990; 76:461.
  94. Lipscomb GH, Stovall TG, Ling FW. Basic laparoscopic knowledge among gynecologic laparoscopists. Am J Obstet Gynecol 1994; 171:1455.