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Probability of pregnancy after sterilization: A comparison of hysteroscopic versus laparoscopic sterilization

Aileen Gariepy, Yale University, 2011
See also executive summary.

Project abstract

Female sterilization is one of the most commonly used methods of contraception. Of the 38.2 million U.S. women using a contraceptive from 2006-2008, 27% utilized female sterilization.

While this proportion has been stable since 1988, hysteroscopic sterilization (HS) is a newer method that is quickly gaining popularity over laparoscopic sterilization (LS). HS presents certain advantages over LS. It is a non-incisional method, avoids abdominal entry (which may be especially important in women with adhesions or co-morbidities), can be performed as an office procedure, and avoids general anesthesia.

However, unlike LS which conveys immediate reliability, HS is a multi-step process and bilateral occlusion must be proven on hysterosalpingogram (HSG) before it can be relied upon. Each step of this process introduces a chance of finding that the procedure failed, of non-compliance with use of alternative contraception, or loss to follow-up. Failed attempts at HS can subject women to multiple procedures, a delay in achieving sterilization, and increase the risk of unintended pregnancy.

Current published assessments of HS success do not adequately address these complex issues. Reported success rates often exclude women who failed initial microinsert placement, who did not return for HSG, or who became pregnant before their HSG. These omissions falsely elevate the percentages of successful sterilization and thwart informed decision making.

I have already completed an evidence-based decision analysis that examines the probability of a successful sterilization procedure after laparoscopic versus hysteroscopic approach and the manuscript is currently in revision for publication. I plan to develop this analysis further by evaluating the likelihood of pregnancy after HS or LS. I plan to expand my Markov model from one year to fourteen years and to include pregnancy rates after sterilization for both HS and LS at multiple points in time, reflective of real world experience.

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