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.

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.

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.

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.

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.

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.

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.

Pregnancy success after hysteroscopic sterilization reversal.

OBJECTIVE: To evaluate the effectiveness of hysteroscopic sterilization reversal by assessing pregnancy rates and identifying surgical complications. METHODS: All patients at a single center undergoing elective reversal of hysteroscopic sterilization for fertility were followed from January 2009 to May 2014. Eligible patients met prespecified criteria for outpatient surgery. Patients underwent outpatient reversal using a transverse suprapubic abdominal incision with tubouterine implantation performed with either bilateral cornual or single transverse posterior-fundal uterine incisions. Patients were evaluated on postoperative day 1, called the following day, and e-mailed at 2 weeks and 12 months. Pregnancy outcomes were assessed through a 12-month questionnaire and self-reporting using an Internet-based patient portal. Univariate analysis of patient and operative characteristics was performed. RESULTS: Seventy patients underwent bilateral tubouterine implantation and completed at least 12 months of follow-up. All surgeries were outpatient without any immediate operative complications. Four patients had complications between 2 and 30 days, none requiring extended hospitalization. Women who became pregnant were younger (mean age 34 years) than those who did not become pregnant (mean age 38 years). Twenty-five patients (36%, 95% confidence interval [CI] 25-47%) reported a total of 31 naturally conceived pregnancies. Twenty-seven percent (19/70, 95% CI 17-37%) of those undergoing surgery subsequently reported live births. A single pregnancy complication of postpartum hemorrhage after cesarean delivery requiring transfusion was reported; no ectopic pregnancies were reported. CONCLUSION: Hysteroscopic sterilization can be reversed using tubouterine implantation and both pregnancy and live birth rates are promising.

Female sterilization and refertilization.

OBJECTIVE: To analyze data on sterilization and refertilization procedures that took place at Orbis Medical Center in Sittard, a hospital in the south of the Netherlands. STUDY DESIGN: Retrospective cohort study of surgical tubal sterilizations performed on 966 patients for contraception between 2002 and 2011, and of 19 patients who underwent refertilization between 2002 and 2012. The main outcome measures were complications and failure rates of sterilization, motives for refertilization and pregnancy rates after refertilization. The t test and nonparametric tests were used to determine differences between groups and proportions. RESULTS: Between 2002 and 2011, the number of sterilizations declined. Almost all the patients (99.8%) underwent laparoscopic sterilization. The most common method of sterilization used Filshie clips, and was used in 99.7% of the women. The median age at the time of sterilization was 37 years. The failure rate was 0.3%. All procedures were uneventful. The number of refertilizations during this time period also declined. The median time between sterilization and refertilization was 65 months. Patients who underwent refertilization were significantly younger at time of sterilization than patients who did not (p<0.001). After refertilization, 12 patients (63.2%) became pregnant. CONCLUSIONS: The complication and failure rates of laparoscopic sterilization are low. The number of laparoscopic sterilizations and the number of refertilizations are both declining. Still, refertilization is a safe procedure and gives a significant chance of becoming pregnant.

[Regret following hysteroscopic tubal sterilization]. / Regret après stérilisation tubaire hystéroscopique par technique Essure(®)

INTRODUCTION: The definitive contraception techniques are irreversible. Women opting for this type of contraception may therefore regret their decision later. Since 2002, the number of tubal sterilizations performed by the Essure(®) technique has steadily increased to more than 100,000 procedures to date. Due to the simplicity of the technique, the low operative risk and the absence of anesthesia, in most cases hysteroscopic sterilization is now the first tubal sterilization technique in France. The rate of regret after hysteroscopic tubal sterilization has never been evaluated. The purpose of this study is to evaluate the regret after hysteroscopic sterilization with Essure(®). METHODS: All patients who benefited hysteroscopic sterilization by Essure(®), in two teaching departments of obstetrics and gynecology of the same university, between June 2005 and December 2011 were included in this study. Patients with a medical indication for tubal sterilization or patients with an obturation of hydrosalpinx before in vitro fertilization were excluded. A specific questionnaire to assess patients regret was sent by post to all patients. RESULTS: During the study period, 452 hysteroscopic sterilizations were performed. Three hundred and six patients (67%) completed and returned the questionnaire. The average age of patients at the procedure was 41.4 [39.1, 43.7]. Mean follow after sterilization was 43 months [40.1, 45.9]. Seventeen of 306 patients (5.5%) expressed a sense of regret after sterilization. Seven women out of 306 (2.3%) consulted to discuss the possibility of a new pregnancy. None of these patients has finally resorted either to adopt or to medically assisted procreation. CONCLUSION: The regret after tubal sterilization by hysteroscopy is a rare event. All patients asking for a permanent contraception technique should be informed of the irreversible nature of the technique.

Does a history of unintended pregnancy lessen the likelihood of desire for sterilization reversal?

BACKGROUND: Unintended pregnancy has been significantly associated with subsequent female sterilization. Whether women who are sterilized after experiencing an unintended pregnancy are less likely to express desire for sterilization reversal is unknown. METHODS: This study used national, cross-sectional data collected by the 2006-2010 National Survey of Family Growth. The study sample included women ages 15-44 who were surgically sterile from a tubal sterilization at the time of interview. Multivariable logistic regression was used to examine the relationship between a history of unintended pregnancy and desire for sterilization reversal while controlling for potential confounders. RESULTS: In this nationally representative sample of 1,418 women who were sterile from a tubal sterilization, 78% had a history of at least one unintended pregnancy and 28% expressed a desire to have their sterilization reversed. In unadjusted analysis, having a prior unintended pregnancy was associated with higher odds of expressing desire for sterilization reversal (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.15-2.79). In adjusted analysis controlling for sociodemographic factors, unintended pregnancy was no longer significantly associated with desire for reversal (OR: 1.46; 95% CI: 0.91-2.34). CONCLUSION: Among women who had undergone tubal sterilization, a prior history of unintended pregnancy did not decrease desire for sterilization reversal.

Reconstrução cirúrgica tubária e condições de realização das laqueaduras / Reconstrucción quirúrgica tubaria y condiciones de realización de las ligaduras / Tubal reconstructive surgery and conditions for implementation of ligation

Objetivou-se verificar idade materna, número de filhos, tipo de parto concomitante à laqueadura e prática anticoncepcional que a antecedeu; e identificar as razões que motivaram essas mulheres à laqueadura e à reconstrução cirúrgica tubária. Estudo transversal, de campo, realizado em ambulatório público de infertilidade de Fortaleza, Ceará, com 13 mulheres. Os dados foram coletados por meio de entrevista, de janeiro a abril de 2009. Laqueaduras foram realizadas em mulheres com menos de 25 anos, menos de dois filhos, sem conhecimento e acesso aos métodos anticoncepcionais e na ocasião do parto. As mulheres apresentaram a negligência masculina com o exercício da paternidade, o desejo de não querer ter mais filhos e a pressão da patroa ou familiares como razões para laquearem. Para 11 mulheres, a mudança de cônjuge foi decisiva na busca pela reconstrução cirúrgica tubária, uma perpetuação do poder masculino à tomada de decisão das mulheres no campo reprodutivo.

El objetivo fue verificar edad materna, número de hijos, tipo de parto concomitante a la ligadura de trompas y a la práctica anticonceptiva que la precedió; e identificar las razones motivaron estas mujeres a la ligadura y reconstrucción quirúrgica de trompas. Estudio transversal, de campo, llevado a cabo en un ambulatorio público de esterilidad de Fortaleza, Ceará, Brasil, con 13 mujeres. Los datos fueran colectados con entrevista, de enero a abril de 2009. Esterilizaciones fueran hechas en mujeres menores de 25 años, con menos de dos niños, sin conocimiento y acceso a los métodos contraceptivos y en el momento siguiente al parto. Las mujeres presentaron la negligencia masculina con el ejercicio de la paternidad, el deseo de no tener más hijos y la presión del jefe y de la familia como razones para hacer la ligación de trompas. A 11 mujeres, el cambio del cónyuge fue decisivo para la búsqueda por la reconstrucción quirúrgica, fuerte influencia masculina sobre las mujeres en el campo reproductivo.

It was aimed to verify 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 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 foneticamenteTubal ligations were made on 25-year-old women or less, right after childbirth, mothers of two children or less, unaware of the 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 the sterilizations. For 11 of these women, the change of male companion was decisive for looking for surgical reversion, the strong influence that partners have on women's decisions on the reproductive area.

[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.

Clinical factors determining pregnancy outcome after microsurgical tubal reanastomosis.

OBJECTIVE: To evaluate pregnancy rates after tubal microsurgical anastomosis. DESIGN: Retrospective study. SETTING: Private tertiary care center. PATIENT(S): Two hundred sixty-one women undergoing tubal microsurgical anastomosis. INTERVENTION(S): Tubal anastomoses were performed by minilaparotomy using microsurgical principles and approximating proximal and distal tubal ends in a two-layer technique with 8-0 ethylon. MAIN OUTCOME MEASURE(S): Pregnancy outcome was analyzed for the technique of sterilization, location of anastomosis, tubal length, age, and semen parameters. RESULT(S): After exclusion of 89 patients lost to follow-up (34%) and 8 who did not attempt to conceive, 164 of the 261 patients were analyzed.The overall intrauterine pregnancy rate was 72.5%, with a miscarriage rate of 18% and a tubal pregnancy rate of 7.7%. Related to age, the cumulative intrauterine pregnancy rate was, respectively, 81%, 67%, 50%, and 12.5% for patients <36, 36-40, 40-43, and >43 years. Mean time to pregnancy was respectively 6.9, 6.2, and 12.7 months, respectively, for patients aged <36, 36-39, and 40-43 years According to the type of sterilization, intrauterine pregnancies occurred in 72% after ring sterilization, 78% after clip sterilization, 68% after coagulation, and 67% after Pomeroy sterilization. Intrauterine pregnancies and ectopic pregnancies, respectively, occurred in 80% and 3.4% in the isthmo-isthmic, 63% and 18% in the isthmo-ampullar, 75% and 8.3% in the isthmo-cornual, 100% and 0% in the ampullo-ampullar, and 60% and 0% in the ampullo-cornual anastomosis groups. Tubal length after anastomosis did not influence the pregnancy rate. In case of fertile sperm, the pregnancy rate was found to be 80%, and it decreased to 50% in case of subfertile semen. CONCLUSION(S): Our results clearly demonstrate the validity of tubal microsurgical anastomosis, establishing a quasinormalization of the fertility potential and offering the opportunity for a spontaneous conception.

Surgical competence of obstetrics and gynecology residents performing microsurgical tubal anastamoses.

OBJECTIVE: To assess tubal patency rates after microsurgical tubal anastamosis in a residency program. STUDY DESIGN: Retrospective cohort analysis. Primary outcome measurement was tubal patency rates. RESULTS: Twenty-seven of the forty-nine patients (55.1%) had bilateral tubal patency and twenty-one of the forty-nine (42.9%) had only one tube open after surgery. No statistical difference in tubal patency rate was noted between the REI staff (85.7%) and the resident (71.4%) (p=0.09). No statistical difference was noted when comparing the patency rate of the residents' first procedure (68.6%) to subsequent procedures (72.8%) (p=0.99). CONCLUSIONS: These data suggest that with appropriate guidance, residents without prior experience are able to perform microsurgical procedures under direct supervision. Residents completed the procedure with patency rates similar to the REI staff. Additionally, tubal patency rates were not significant different in comparing the residents' first or subsequent procedures.

[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.

Laqueadura intraparto e de intervalo / Intrapartum and interval tubal sterilization: characteristics correlated with the procedure and regret in a sample of women from a public hospital

O Brasil é um dos países com alta prevalência de laqueadura tubária, sendo freqüente sua realização durante o parto. Nos últimos anos, tem-se notado aumento da busca por reversão, principalmente entre mulheres jovens. OBJETIVOS: Estudar, em amostra de mulheres laqueadas, as características relacionadas ao procedimento, determinar a freqüência de execução intraparto, medir as taxas de satisfação e arrependimento com o método. MÉTODOS: Foram entrevistadas 335 mulheres laqueadas. As variáveis estudadas foram as relacionadas ao procedimento: idade na laqueadura, se intraparto (vaginal ou cesárea) ou de intervalo (fora do período de parto e puerpério), serviço no qual foi realizada, pagamento pelo procedimento, motivo declarado para a opção pelo método, e as relacionadas à satisfação/arrependimento: desejo de gravidez após esterilização, procura por tratamento e realização da cirurgia de reversão. As mulheres foram divididas em dois grupos, laqueadas intraparto e intervalo, avaliando-se associação das variáveis pelo teste Exato de Fisher e Qui-quadrado com correção de Yates. O estudo obteve aprovação do Comitê de Ética. RESULTADOS: Predominaram mulheres brancas, com mais de 35 anos, unidas, com baixa escolaridade e 43,5 por cento esterilizadas antes dos 30 anos. Haviam realizado laqueadura intraparto 245 mulheres, 91,2 por cento daquelas com parto cesárea e 44,6 por cento com parto vaginal. Nos dois grupos, laqueadas intraparto e de intervalo, estavam satisfeitas com o método 82 por cento e 80,8 por cento das mulheres respectivamente. Apesar de 14,6 por cento terem referido desejo de engravidar alguma vez após esterilização, consultaram por esterilidade 3,4 por cento e 2,3 por cento, respectivamente, e uma mulher submeteu-se à cirurgia de reversão. Os motivos mais freqüentes para a escolha do método foram a satisfação com a prole (35,5 por cento e 46,7 por cento) e a indicação médica (41,6 por cento e 32,2 por cento), respectivamente. CONCLUSÃO: A laqueadura intraparto...

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 percent had undergone sterilization before 30 years of age. Two hundred and forty-five women underwent intrapartum tubal ligation, 91.2 percent of them had cesarean delivery and 44.6 percent vaginal delivery. In both groups undergoing intrapartum tubal ligation and ligation after an interval, 82.0 percent and 80.8 percent reported satisfaction with the method. Although 14.6 percent expressed a desire to become pregnant at some time after sterilization, consultation regarding sterility occurred in 3.4 percent...