Laparoscopic Essure® Device Removal by En Bloc Salpingectomy-Cornuectomy with Intraoperative X-Ray Checking: A Retrospective Cohort Study.

STUDY OBJECTIVE: To evaluate the feasibility, efficacy, and morbidity of Essure® device removal via laparoscopic en bloc salpingectomy-cornuectomy resection (LSC) and the utility of confirmation of complete removal with an intraoperative X-ray of the removed specimen (IX-S). DESIGN: Retrospective observational cohort study. SETTING: Academic hospitals of La Conception, Marseille, and Arnaud-de-Villeneuve, Montpellier, France. PATIENTS: Women who were not seeking future fertility seeking Essure® device removal by salpingectomy, between February 2017 and August 2018. INTERVENTIONS: All women underwent LSC. An IX-S was performed to confirm complete Essure® device removal. In the case of an unsatisfactory IX-S, an intraoperative pelvic X-ray control of the patient (IX-P) was performed. If IX-P diagnosed residual Essure® fragments, an additional resection was performed, and the removed tissue was checked by IX-S. MEASUREMENTS AND MAIN RESULTS: We included 72 women, and a total of 140 Essure® devices were removed. The IX-S confirmed complete Essure® device removal in 131 of 140 cases (93.6%) in 63 of 72 women (87.5%). Out of the 9 women with unsatisfactory IX-S, 6 had no residual Essure® fragments at IX-P, and Essure® device removal was considered complete. Three women had a persistent Essure® fragment at IX-P: an additional resection allowed complete removal in 2 cases and resulted in failure in 1 of 140 case (0.7%). There were 2 of 72 women (2.8%) intraoperative complications and 4 of 72 women (5.6%) postoperative grade 1 complications according to the Clavien-Dindo classification. CONCLUSION: Essure® device removal by LSC appears to be an effective and safe procedure. IX-S is a useful method to evaluate whether the removal of Essure® device is complete during an LSC procedure.

Declining rates of sterilisation reversal procedures in western Australian women from 1990 to 2008: the relationship with age, hospital type and government policy changes.

BACKGROUND: Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown. METHODS: Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures). RESULTS: From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions. CONCLUSION: Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.

The role of anticipated decision regret and the patient's best interest in sterilisation and medically assisted reproduction.

There is a clear discrepancy in the way those who request medical assistance in pursuit of their reproductive choices are treated. On the one hand, women who request a sterilisation are urged to consider possible future regrets and are sometimes refused treatment in anticipation of such regrets. This is despite the fact that for all age ranges, the majority of women undergoing a sterilisation do not regret the decision. Moreover, women who are voluntarily childless are likely to have a happier and more gratifying life than parents. On the other hand, women who request fertility treatment are not urged to second guess their desire for parenthood. Although the fact that the probability of regret is expected to be higher in the former case than in the latter justifies this difference in treatment to a certain extent, the gap between the two different approaches is wider than it ought to be if we also take future well-being into consideration, instead of focussing exclusively on anticipated decision regret.

Fertility outcome in laparoscopic single tube reanastomosis.

OBJECTIVE: To evaluate the fertility outcome in laparoscopic unilateral tubal reanastomosis. STUDY DESIGN: This was a retrospective observational study. The medical records of all patients who underwent laparoscopic unilateral tubal reanastomosis from October 2003 to October 2010 at the Center for Advanced Endoscopy and Infertility Treatment, Paul's Hospital, Cochin, Kerala, India, were analyzed. RESULTS: A total of 71 patients out of 81 could be followed up. Of those 71 women 39 (54.9%) conceived, and most of them within 1 year (36/39). Overall intra-uterine pregnancy rate was 52.11%. Thirty delivered a live infant (delivery rate 42.25%), 7 had abortions, 1 ectopic pregnancy was noted in the operated tube and 1 in the contralateral tube. Final tubal length of ≥ 5 cm showed statistically significant association with pregnancy rate (p = 0.0056). There was no significant difference in mean age, duration between sterilization and reanastomosis, or type of sterilization between the 2 groups. CONCLUSION: Though bilateral tubal reanastomosis is an ideal procedure, unilateral laparoscopic tubal reanastomosis gives an acceptable pregnancy rate. Unilateral laparoscopic reanastomosis is feasible in most of the cases, as most of the time only 1 tube is suitable for reanastomosis. Also, the surgical team can perform the unilateral procedure more efficiently, and the patient receives less anesthesia since the duration of surgery is shorter when compared to the bilateral procedure. Bilateral anastomosis is better when both tubes are accessible, especially in older women.

[Tubal reconstructive surgery and conditions for implementation of tubal ligation]. / Reconstrução cirúrgica tubária e condições de realização das laqueaduras.

We verified maternal age, parity, mode of delivery concurrent to tubal ligation and the contraceptive practice that preceded it; and to identify the reasons that motivated these women to have tubal ligation and tubal reconstructive surgery. This is a cross-sectional field study, carried out in a public laboratory for infertility in Fortaleza, Ceará, Brazil, with 13 women. Data were collected through interviews from January to April, 2009. Ler foneticamente Tubal ligations were made on 25-year-old women or less, right after childbirth, mothers of two children or less, unaware of contraceptive methods and/or how to obtain them. These women alleged male carelessness with fatherhood, the lack of desire for more children and pressure from families and employers as the reasons for sterilization. For 11 of these women, the change of male companion was decisive in looking for surgical reversion, showing the continuity of the strong influence that male partners have on women's decisions on reproduction.

Desire for Sterilization Reversal Among U.S. Females: Increasing Inequalities by Educational Level.

CONTEXT: For decades, high reliance on female sterilization in the United States has been accompanied by a high level of desire for sterilization reversal, and less-educated women have been more likely than better educated women to use the method and desire a reversal. Little is known about how levels of and educational differentials in such desire have changed in recent decades. METHODS: Data from 4,147 women who reported being sterile from a tubal sterilization in the 1995, 2002 and 2006-2010 waves of the National Survey of Family Growth were analyzed using chi-square and Wald tests and binary logistic regression analyses. Predicted probabilities were calculated to determine the likelihood of desire for procedure reversal by wave and educational level. RESULTS: The prevalence of desire for sterilization reversal rose by 41%, from 18% in 1995 to 23% in 2002 and 25% in 2006-2010. Overall, women with a bachelor's degree were less likely than those who had not finished high school to desire a reversal (odds ratio, 0.2), and this educational differential was larger in 2006-2010 than in earlier waves. Predicted probabilities indicate that 9% of sterilized women with less than a high school education and 8% of those with a bachelor's degree expressed a desire for procedure reversal in 1995, as did 15% and 3%, respectively, in 2006-2010. CONCLUSION: Future research should consider how insurance coverage of all methods under the Affordable Care Act may affect use of sterilization and desire for reversal.

Tubal anastomosis after previous sterilization: a systematic review.

BACKGROUND: Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location. OBJECTIVE AND RATIONALE: We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success. SEARCH METHODS: Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness. OUTCOMES: We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated. WIDER IMPLICATIONS: In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.

Regret following female sterilization at a young age: a systematic review.

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.

[Intrapartum and interval tubal sterilization]. / Laqueadura intraparto e de intervalo.

BACKGROUND: Brazil is a country with a high prevalence of tubal ligation, which is frequently performed at the time of delivery. In recent years, an increase in tubal reversal has been noticed, primarily among young women. OBJECTIVES: To study characteristics correlated with the procedure, determine frequency of intrapartum tubal ligation, measure patient satisfaction rates and tubal sterilization regret, in a sample of post-tubal patients. METHODS: Three hundred and thirty-five women underwent tubal ligation. The variables studied were related to the procedure: age at tubal ligation, whether ligation was performed intrapartum (vaginal or cesarean section) or after an interval (other than the intrapartum and puerperal period), health service performing the sterilization, medical expenses paid for the procedure, reason stated for choosing the method and causes related to satisfaction/regret: desire to become pregnant after sterilization, search for treatment and performance of tubal ligation reversal. The women were divided into two groups, a group undergoing ligation in the intrapartum period and a second group ligated after an interval, to evaluate the association between variables by using Fisher's exact test and chi-squared calculation with Yates' correction. The study was approved by the Ethics Committee of the institution. RESULTS: There was a predominance of Caucasian women over 35 years of age, married, and with a low level of education of which 43.5% had undergone sterilization before 30 years of age. Two hundred and forty-five women underwent intrapartum tubal ligation, 91.2% of them had cesarean delivery and 44.6% vaginal delivery. In both groups undergoing intrapartum tubal ligation and ligation after an interval, 82.0% and 80.8% reported satisfaction with the method. Although 14.6% expressed a desire to become pregnant at some time after sterilization, consultation regarding sterility occurred in 3.4% and 2.3%, respectively, and one woman underwent tubal reversal. The most frequent reasons for choosing the method were satisfaction with the number of offspring (35.5% and 46.7%) and medical indication (41.6% and 32.2%), respectively. CONCLUSION: The incidence of intrapartum tubal ligation was higher when the last delivery had been a cesarean section. No difference was detected among the groups regarding rates of satisfaction and regret after performance of the sterilization procedure.

Changes in family structure and regret following tubal sterilization.

Tubal sterilization is one of the contraceptive methods whose use has increased the most in Brazil, but a growing number of women have expressed regret after the procedure. A case-control study was conducted at the Centro Integrado de Saúde Amaury de Medeiros (CISAM), Recife, Pernambuco, Brazil, in 1997 to investigate the association between changes in family structure and request for or submittal to surgical reversal of tubal sterilization, comparing 304 sterilized women who had requested or submitted to reversal of tubal sterilization and 304 women who were also sterilized but had not requested, had not submitted to, and who did not wish to submit to reversal. The simple and adjusted odds ratios were estimated using logistic regression. The results of the current study showed that death of children, partners without children prior to the current union, and partner change after tubal sterilization were associated with the request for or submittal to reversal of tubal sterilization. More strict criteria are suggested in the indication of tubal sterilization, including an in-depth profile of the woman requesting tubal sterilization and identification of risk factors for future regret.

Effectiveness of in vitro fertilization in women with previous tubal sterilization.

OBJECTIVE: The objective was to determine the effectiveness of in vitro fertilization (IVF) on live-delivery rates in women who had previously undergone tubal sterilization. STUDY DESIGN: We examined first IVF live deliveries for women aged 20-44 years at their first embryo transfer (ET) with history of hospital admission for tubal sterilization in Western Australia (WA). The ET cycles (n=178) were ascertained over the period of 1996 to 2010 using WA hospital records. A control group of subfertile women matched by age was randomly selected (n=178). We used Kaplan-Meier curves and life-table analysis to evaluate the cumulative live-delivery rates. RESULTS: An overall cumulative live-delivery rate in women who had undergone previous tubal sterilization (31%) was comparable to that of subfertile controls (34%) within the first 24 months. Younger women (aged 20-34 years) with previous sterilization (34%) were slightly more likely to deliver an IVF live baby than older women (aged 35-39 and 40-44 years) (33% and 22%, respectively), although this difference was not statistically significant (p=.449). CONCLUSION: Women who desire fertility after a tubal sterilization procedure and undergo IVF have rates of pregnancy similar to age-matched subfertile IVF control patients. IMPLICATIONS: In vitro fertilization success in women who had undergone previous tubal sterilization is similar to that of the subfertile controls and thus does not depend on past fertility. Age is the most important predictive factor in achieving pregnancy.

Live delivery outcome after tubal sterilization reversal: a population-based study.

OBJECTIVE: To determine the cumulative incidence of live delivery in women who underwent reversal of tubal sterilization. DESIGN: Population-based retrospective cohort study. SETTING: Hospitals in Western Australia. PATIENT(S): All women aged 20-44 years, with a history of hospital admission for tubal sterilization, who subsequently underwent reversal of sterilization during the period 1985 to 2009 in Western Australia (n = 1,898). INTERVENTION(S): Data regarding reversal of sterilization and prior tubal sterilization were extracted from routinely collected administrative hospital separation records, until commencement of IVF treatment. MAIN OUTCOME MEASURE(S): First live-delivery rates. RESULT(S): There were 969 first live deliveries observed during the study period. The overall cumulative live-delivery rate was 20% (95% confidence interval [CI] 18-23) within the first year after reversal, 40% (95% CI 38-42) at 2 years, 51% (95% CI 48-53) at 5 years, and 52% (95% CI 50-55) at 10 years. The 5-year cumulative live-delivery rate was significantly lower in women who were aged 40-44 years (26%) compared with younger women (aged 20-29, 30-34, and 35-39 years) (50%, 56%, and 51%, respectively). CONCLUSION(S): Women undergoing reversal of sterilization before they reach age 40 years have at least a 50% chance of delivering a live baby within the next 5 years. Up to that age, there is no significant difference in live deliveries. The live-delivery rate halves after the age of 40 years.

Surgical sterilization in the United States: prevalence and characteristics, 1965-95.

OBJECTIVES: This report presents national data on the prevalence of surgical sterilization from 1965 to 1995 among women 15-44 years of age. Data are shown by type of sterilizing operation and demographic characteristics of the women. For the 1995 survey data, reasons for the three most common sterilizing operations (tubal ligation, vasectomy, and hysterectomy) are shown, as well as the desire for reversal among those with potentially reversible operations. METHODS: Data are based on nationally representative samples of women 15-44 years of age: the 1965 National Fertility Study (NFS), and the 1973, 1982, 1988, and 1995 cycles of the National Survey of Family Growth (NSFG). RESULTS: After rising from 16 to 42 percent between 1965 and 1988, the prevalence of surgical sterilization among married women 15-44 years old remained stable at 41 percent in 1995. Age, parity, religious affiliation, and education continued to be strongly associated with overall surgical sterilization levels. Tubal ligation and vasectomy were equally prevalent in the 1965 and 1973 surveys, but since 1962, tubal ligation has been more prevalent than vasectomy. CONCLUSIONS: Several factors contributed to the rise in reliance upon surgical sterilization among women 15-44 years old over the last 3 decades: (a) aging of the post-World War II Baby Boom women (and their partners) through the primary reproductive years; (b) relatively high contraceptive failure rates, particularly among socioeconomically less advantaged women; and (c) higher expectations for contraceptive effectiveness, safety, and convenience. Overall sterilization prevalence may be leveling off among women 15-44 years old, in part due to greater delay of first and subsequent births, thus making sterilization less of a concern while women are in this age range.

Sterilization failure, sterilization reversal, and pregnancy after sterilization reversal in Quebec.

OBJECTIVE: 1). To determine the likelihood of sterilization reversal and of subsequent sterilization after sterilization reversal among men and women and 2). to examine the likelihood of pregnancy after sterilization (contraceptive failure) and of pregnancy after sterilization reversal. METHODS: Payment data from the Quebec provincial health insurance system were obtained for each person undergoing vasectomy or female sterilization from January 1, 1980 to December 31, 1999 and linked through a unique identifying number for each person. Using standard techniques of survival analysis, we computed the cumulative probability of experiencing each of six events. RESULTS: Among women, 0.9% (of 311960) experienced a pregnancy after sterilization, 1.8% (of 321929) obtained a reversal after sterilization, 61% (of 4369) achieved a pregnancy after sterilization reversal and 48% achieved a delivery; 23% (of 4677) obtained a subsequent sterilization after reversal. Among men, 2.4% (of 310827) obtained a reversal after vasectomy and 18% (of 6694) obtained a subsequent vasectomy after reversal. All of these risks were much higher among those in the youngest age groups. CONCLUSION: Sterilization reversal and pregnancy after sterilization are not rare. Relatively high rates of reversal among the youngest age groups suggest a need for better counseling about alternative contraceptive strategies.

Reversal of sterilization in women over 40 years of age: a multicenter survey in The Netherlands.

Microscopic reversal of sterilization in women is successful. Most infertility treatments, however, are bound to an age limit, which in the individual case is sometimes overstepped. To determine if reversal of sterilization in women greater than 40 years of age is justifiable, the data of nine centers of tubal surgery in the Netherlands were analyzed. In 78 women between 40 and 45 years, an intrauterine pregnancy rate of 45% and an ectopic pregnancy rate of 4% was reported. Whereas 26% of first pregnancies ended in a spontaneous abortion, the live birth rate (all healthy children) still amounted to 44%. The mean duration between operation and first pregnancy was 5.5 months. It is concluded that microscopical reversal of sterilization in women between 40 and 45 years is an acceptable infertility treatment.

PIP: Cases of all women over 40 attending 9 Dutch centers offering microsurgical tubal surgery for reversal of sterilization from 1987- 1988 were reviewed. 78 cases met the criteria of minimum 4 cm of healthy tube, and normal basal body temperature, semen analysis and postcoital testing. The patients' ages ranged from 40-45, mean 41. There were 38 pregnancies after surgery: 35 intrauterine and 3 ectopic, an initial pregnancy rate of 45% intrauterine pregnancy. 26 normal term births and 9 spontaneous abortion resulted. 7 of the women who miscarried and 1 of those with ectopic pregnancy subsequently bore term babies. Thus the overall live birth rate was 44%, in comparison to 66% among the total population of reanastomosis cases in these 9 centers. The total abortion rate, 26%, is similar to that seen in women over 40 from the general population. The mean duration to 1st pregnancy was 5.5 months. Best results were seen with women sterilized with rings or clips. A trend in successful pregnancy appeared in younger women.

Requesting information about and obtaining reversal after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization.

OBJECTIVE: To determine the cumulative probabilities over 14 y of requesting information on sterilization reversal and of obtaining a reversal and to identify risk factors observable at sterilization for both measures of regret. DESIGN: The U.S. Collaborative Review of Sterilization, a prospective cohort study. SETTING: Fifteen medical centers in 9 cities. PATIENT(S): 11,232 women. MAIN OUTCOME MEASURE(S): Cumulative probabilities of requesting information on reversal and undergoing reversal. RESULT(S): The 14-y cumulative probability of requesting reversal information was 14.3% (95% confidence interval [CI], 12.4%-16.3%). Among women aged 18 to 24 y at sterilization, the cumulative probability was 40.4% (95% CI, 31.6%-49.2%). Women aged 18 to 24 y were almost 4 times as likely to request reversal information as were women > or = 30 years of age (adjusted rate ratio [RR], 3.5; 95% CI, 2.8-4.4). Number of living children was not associated with requesting reversal information. The overall cumulative probability of obtaining reversal was 1.1% (95% CI, 0.5-1.6). Younger women (18 to 30 y) were more likely to obtain reversal (RR, 7.6; 95% CI, 3.2-18.3). CONCLUSION(S): Women who were sterilized at a young age had a high chance of later requesting information about reversal, regardless of their number of living children.

Incidence, risk factors, and prevention of poststerilization regret in women: an updated international review from an epidemiological perspective.

Tubal sterilization is the world's most commonly used contraceptive method. Even a small proportion of women incurring poststerilization regret would translate into a large number of sufferers. In this review, we examine recent reports on the incidence of, and the risk factors for, posttubal sterilization regret in women and requests for sterilization reversal in both developed countries and less-developed countries. We also consider the implications of our findings in the practical prevention of poststerilization regret and requests for sterilization reversal, and discuss methodological issues.

PIP: Used by approximately 138 million women of reproductive age, tubal sterilization is the world's most popular contraceptive method. Some women, however, regret having undergone the procedure. Curious about the incidence of, and the risk factors for post-tubal sterilization regret in women, as well as requests for sterilization reversal in both developed and developing countries, the authors searched literature through the Popline and Medline databases published on the subject since 1980. Review of studies' findings indicate that poststerilization regret is limited to a small number of women, regardless of their cultural backgrounds or the development stage of the country in which they reside. Young age at sterilization is an universally strong risk factor for regret, while remarriage is a strong risk factor for request of reversal, especially in developed countries and some African countries where remarriage is common. The death of an infant or child is an important risk factor for regret and desire for reversal in less-developed countries. Careful and thorough counseling by service providers is the key to preventing poststerilization regret and request for the reversal of sterilization. It is recommended that service providers avoid making the sterilization decision for women, avoid performing sterilizations immediately after delivery and concurrently with other surgical procedures in "high risk" women, and when practical, use a tubal occlusion technique for sterilization such as clips or rings which causes the least damage to fallopian tubes. The authors close in affirming that sterilization clients should regard the sterilization procedure as irreversible, yet physicians should perform it as if the procedure may one day need to be reversed.

Risk factors for tubal sterilization regret, detectable before surgery.

Brazil has one of the highest prevalence rates of female surgical sterilization in the world. At the same time there is an increased demand for sterilization reversal. In order to understand which women tend to later request reversal of the procedure, a case-control study was carried out comparing 216 women who requested reversal with sterilized women who did not, paired by year of surgery. The relative risk of requesting reversal for women sterilized before age 25 was 18 times that of women sterilized after age 29. The elevated risk remained even after controlling for a number of variables present at the time of surgery. Multiple regression analysis showed that request for reversal was associated with younger age, less information about the procedure, and fewer contraceptive methods known before sterilization. These results support the recommendation that women should be fully informed about the tubal ligation procedure and have access to other contraceptive options before being sterilized.

Experience of reversal of sterilisation at Glasgow Royal Infirmary.

OBJECTIVE: To review experience at the Glasgow Royal Infirmary with regard to women who underwent reversal of sterilisation, to obtain a profile of these women and to evaluate the procedure itself in terms of safety and restoration of fertility. DESIGN: A retrospective study based on case records from the Glasgow Royal Infirmary and from the Glasgow Royal Maternity Hospital, both of which share the same catchment area. PARTICIPANTS: Eighty-five women underwent reversal of sterilisation between 1 January 1994 and 31 December 1998 at the Glasgow Royal Infirmary. Follow-up at the Glasgow Royal Maternity identified 43/85 women. METHODS: Patients were identified from relevant theatre log books and from records at the maternity hospital until December 2000 and their case notes reviewed. RESULTS: Having a new partner was responsible for 90% of requests. Median age at request for reversal was 34 years and most had been sterilised before the age of 30 years. There were few postoperative complications. Pregnancy occurred in at least 43% of women. CONCLUSION: Reversal of sterilisation is a safe and effective method of restoring fertility. The actual incidence of pregnancy after reversal is likely to be higher than the 43.5% recorded due to difficulties in achieving 100% follow-up.