Regret in the Modern Contraceptive Landscape: Evaluating Regret in Patients Undergoing Tubal Ligation or Bilateral Salpingectomy for Contraception.

OBJECTIVE: To estimate the prevalence of regret among Canadians undergoing tubal ligation or bilateral salpingectomy for contraception in the context of widely available, highly effective, and tolerable reversible contraceptive methods including long-acting reversible contraceptives. METHODS: We performed an online cross-sectional survey of regret following tubal sterilization using Qualtrics software. A convenience sample was used to recruit Canadian residents between the ages of 18 and 60 years who had undergone tubal ligation or salpingectomy for contraception. The online survey was advertised on 3 social media platforms: Facebook, Twitter, and Instagram. RESULTS: We obtained survey results for 844 Canadian residents. Regret was reported by 15.9% of respondents. Consistent with existing literature, factors associated with regret included younger age at the time of the procedure, a change in relationship status, and having the procedure performed at the time of a pregnancy. Surprisingly, 9.5% of respondents reported an element of coercion, 4.5% were unaware the procedure was considered permanent contraception, and 33.3% did not recall their provider discussing alternative forms of contraception with them prior to surgery. CONCLUSION: We found that the prevalence of regret following tubal sterilization has not changed with the widespread availability of highly effective reversible contraceptive methods. However, most patients choosing permanent contraception will be satisfied with their decision. Shared decision-making should respect the autonomy of each patient to make their own decisions regarding the most acceptable family planning method for their circumstances.

Factores asociados a la no realización de la esterilización quirúrgica en mujeres gran multíparas de la serranía peruana, 2017 / Factors associated with not performing surgical sterilization in great multiparous women of the Peruvian highlands, 2017

RESUMEN Objetivo: Determinar las características sociodemográficas, los antecedentes gíneco-obstétricos, la percepción y los conocimientos previos asociados a no realizarse la esterilización quirúrgica en mujeres gran multíparas internadas en un hospital de la provincia de Huancayo. Materiales y Métodos: Estudio de tipo cuantitativo, prospectivo y de corte transversal, que se realizó en las mujeres gran multíparas internadas en el Hospital Regional Docente Materno Infantil "El Carmen" de Huancayo; que cumplieran con los criterios de inclusión. Se aplicó un instrumento de recolección de tipo encuesta. Se realizó una estadística descriptiva, así como, el análisis bivariado y multivariado. Resultados: Un 73% de las mujeres encuestadas no se realizaría la esterilización quirúrgica a futuro, sin embargo, a un 90% le gustaría recibir más información al respecto. Los factores estadísticamente significativos asociados a no realizase la esterilización quirúrgica fueron: No haber utilizado ningún método anticonceptivo anteriormente (RPa: 1,35; IC 95%: 1,01-1,82; p: 0,042), no saber si desea tener más hijos (RPa: 1,58; IC 95%: 1,22-2,03; p <0,001), pensar que realizarse la esterilización quirúrgica iría en contra de sus derechos (RPa: 1,24; IC 95%:1,05-1,46; p: 0,008) y pensar que la esterilización quirúrgica produce alteraciones menstruales (RPa: 1,11; IC 95%:1,17-1,34; p: 0,027). Conclusiones: Muchas mujeres encuestadas no optarían por la esterilización quirúrgica a futuro, debido a diversos factores, muchos de ellos modificables con una adecuada capacitación e intervención del personal de salud.

ABSTRACT Objective: Determine sociodemographic characteristics, gynecological-obstetric history, perception and previous knowledge associated with not performing surgical sterilization in large multiparous women admitted to a hospital in the province of Huancayo. Materials and Methods: A quantitative, prospective and cross-sectional study, was carried out on large multiparous women hospitalized in the gynecology and obstetrics services of the Regional Maternal and Child Teaching Hospital "El Carmen" of Huancayo; that met the inclusion criteria. A survey-type collection instrument was applied. A descriptive statistic was carried out, as well as the bivariate and multivariate analysis. Results: 73% of the women surveyed would not undergo surgical sterilization in the future, however, 90% would like to receive more information about it. The statistically significant factors associated with not performing surgical sterilization were: Not having used any contraceptive method previously (RPa: 1.35, 95% CI: 1.01-1.82, p: 0.042), not knowing if you want having more children (RPa: 1.58, 95% CI: 1.22-2.03, p <0.001), thinking that performing surgical sterilization would be against their rights (RPa: 1.24, 95% CI: 1.05-1.46; p: 0.008) and to think that surgical sterilization produces menstrual alterations (RPa: 1.11, 95% CI: 1.17-1.34, p: 0.027). Conclusions: Many women surveyed would not opt for surgical sterilization in the future due to various factors, many of them modifiable with adequate training and intervention of health personnel.

Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators.

OBJECTIVE: Uptake of permanent contraception among women remains low in sub-Saharan Africa compared to other regions. We aimed to synthesize available evidence on barriers to, and facilitators of permanent contraception with regards to tubal ligation among women in sub-Saharan Africa. STUDY DESIGN: We reviewed literature on tubal ligation among African women published between January 1, 2000 and October 30, 2017. We searched PubMed, Global health, EMBASE, Web of science, and Google scholar for quantitative, qualitative, and mixed methods studies which reported on barriers and/or facilitators to uptake of tubal ligation in sub-Saharan Africa. Finally, we conducted a narrative synthesis and categorized our findings using a framework based on the social ecological model. RESULTS: We included 48 articles in the review. Identified barriers to tubal ligation among women included individual-level (myths and misconceptions, fear of surgery, irreversibility of procedure, religious beliefs), interpersonal-level (male partner disapproval), and organizational-level (lack of healthcare worker expertise and equipment) factors. Facilitating factors included achievement of desired family size and perceived effectiveness (individual-level), supportive male partners and knowing other women with permanent contraception experience (interpersonal-level), and finally, subsidized cost of the procedure and task-sharing with lower cadre healthcare workers (organizational-level). CONCLUSIONS: Barriers to, and facilitators of permanent contraception among women in sub-Saharan Africa are multilevel in nature. Strategies countering these barriers should be prioritized, as effective contraception can promote women's health and economic development in sub-Saharan Africa. In addition to these strategies, more quantitative research is needed to further understand patient-level factors associated with uptake of permanent contraception among women.

Women's preferences for permanent contraception method and willingness to be randomized for a hypothetical trial.

OBJECTIVE: To understand women's preferences for permanent contraception by salpingectomy or tubal occlusion following standardized counseling and evaluate the practicality of a future randomized trial. STUDY DESIGN: We invited pregnant and non-pregnant women planning permanent contraception at the University of California, Davis (UCD) and University of Tennessee (UT) Obstetrics and Gynecology clinics to participate. We enrolled women when they received routine counseling and signed procedure consent. Participants received standardized information sheets reviewing permanent contraception options based on pregnancy status then completed an anonymous survey with questions about demographics, method preference, and willingness to participate in a hypothetical randomized trial comparing salpingectomy and tubal occlusion. We evaluated predictors for salpingectomy preference using multivariable analysis. RESULTS: From July 2015 to October 2016, we enrolled 75 women at UCD and 63 women at UT. Overall, respondents preferred salpingectomy (63.0%); among the 47 women not currently pregnant at both sites, 40 (85.1%) preferred salpingectomy, most commonly because of higher efficacy. Although population characteristics differed significantly between the sites, only UCD site (aOR 4.2; 95% CI 1.9, 9.4) and non-pregnancy status (aOR 4.2; 95% CI 1.6, 10.8) predicted preference for salpingectomy in the multivariable model. Most participants (n=84, 60.9%) would not be willing to be randomized to a theoretical trial comparing salpingectomy and tubal occlusion procedures. CONCLUSION: Among a diverse group of women from two different areas in the U.S. given a choice of permanent contraception methods, salpingectomy is preferred over tubal occlusion. Most women planning a permanent contraceptive procedure would not agree to a randomized comparison of these methods. IMPLICATIONS STATEMENT: Salpingectomy, which offers theoretically higher efficacy and potentially greater ovarian cancer protection compared to tubal occlusion, is preferred by the majority of patients and should be offered to all women seeking permanent contraception. Differences in method choices less likely reflect the patient population and more likely the counseling provided.

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.

Reasons for tubal sterilisation, regret and depressive symptoms.

OBJECTIVE: To examine the associations between sterilisation reasons, regret, and depressive symptoms. STUDY DESIGN: Black, Hispanic, and non-Hispanic White US women ages 25-45 who participated in the National Survey of Fertility Barriers (NSFB) and reported a tubal sterilisation surgery were included in the sample for this study (n=837). Logistic regression was used to examine how characteristics of the sterilisation surgery (reasons for sterilisation, time since sterilisation, and new relationship since sterilisation) are associated with the odds of sterilisation regret, and linear regression was used to examine associations between sterilisation regret, sociodemographic factors, and depressive symptoms. RESULTS: Findings revealed that 28 percent of U.S. women who have undergone tubal sterilisation report regret. Time since sterilisation and having a reason for sterilisation other than simply not wanting (more) children (e.g., situational factors, health problems, encouragement by others, and other reasons) are associated with significantly higher odds of sterilisation regret. Finally, sterilisation regret is significantly associated with depressive symptoms after controlling for sociodemographic characteristics. CONCLUSION: Sterilisation regret is relatively common among women who have undergone tubal sterilisation, and regret is linked to elevated, but not necessarily clinical depressive symptoms. The reasons for sterilisation can have important implications for women's sterilisation regret and associated depressive symptoms.

Essure microinsert hysteroscopic tubal sterilization: eight-years follow-up results.

OBJECTIVES: To evaluate the effectiveness and reliability of microinsert hysteroscopic sterilization method at short- and long-term. MATERIALS AND METHODS: In the period between January 2004 and December 2005, 34 patients who submitted to the present gynecology outpatient clinic seeking for permanent contraception and accepted tubal sterilization with microinsert method were included in this prospective, interventional study. RESULTS: Bilateral microinsert placement was successful in 28 (87.5%) of 32 patients that underwent the procedure. In all of the 30 patients (100%) in whom the placement procedure was attempted, bilateral tubal occlusion was documented by hysterosalpingogram (HSG) including the two patients in whom unilateral placement was carried out. First three procedures were performed under general anesthesia. Local or general anesthesia was not administered in any other cases (97.5%). The mean visual analogue scale score for pain felt during the procedure was 3.1. The mean procedure time was 11.5 ± 4.88 (5-22) minutes, the average time from beginning the procedure to discharge of the patients was 41.7 ± 18.5 (15-94) minutes. One intrauterine pregnancy was detected in one of the patients nine months after cessation of the alternative contraceptive period. This patient was excluded from the follow-up. At short-term all patients rated their microinsert-wearing tolerance as good or excellent. At eighth year, three patients were lost to follow-up. Mean follow-up time was 83.4 ± 15.0 (36-103) months. During 2,420 woman-months of follow-up, no other pregnancies were detected. Almost all of the patients were happy with the procedure and recommended it to a friend. CONCLUSION: Essure microinsert is a safe, effective, minimally invasive sterilization method which can be performed in outpatient settings without any anesthesia requirement. It appears to be a good alternative to laparoscopic tubal sterilization. The procedure time and the time to discharge are brief. Patient tolerance during the procedure and at long-term is very good.

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study / Repercussões clínicas e psíquicas da ligadura tubária videolaparoscópica: estudo observacional de coorte única, retrospectivo

CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation. DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital. METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used. RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001), premenstrual symptoms (P < 0.001), dysmenorrhea (P = 0.019) and noncyclic pelvic pain (P = 0.001); and reductions in the number of sexual intercourse occurrences per week (P = 0.001) and in libido (P = 0.001). Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions. CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity. .

CONTEXTO E OBJETIVO: A ligadura tubária é um dos métodos contraceptivos mais utilizados em todo o mundo. Como a controvérsia sobre seus possíveis efeitos ainda continua, o objetivo deste estudo foi avaliar as repercussões clínicas e psíquicas da laqueadura videolaparoscópica. TIPO DE ESTUDO E LOCAL: Estudo observacional de coorte único, retrospectivo, conduzido em hospital público terciário. MÉTODOS: Foi aplicado um questionário a 130 mulheres, entre 21-46 anos, submetidas à ligadura tubária videolaparoscópica, pelas técnicas de eletrocoagulação bipolar/secção ou inserção do anel tubário, entre janeiro de 1999 e dezembro de 2007. Nesse questionário avaliou-se: intervalo do ciclo menstrual, intensidade e duração do sangramento, sintomas pré-menstruais, dismenorreia, dispareunia, dor pélvica não cíclica e grau de satisfação sexual. Cada mulher serviu como seu próprio controle, foi realizada análise comparativa entre os períodos pré- e pós-cirúrgico e entre as duas técnicas utilizadas. RESULTADOS: As repercussões clínicas e psicológicas mostraram-se significativas, com aumento de sangramento (P = 0,001), de sintomas pré-menstruais (P < 0,001), dismenorreia (P = 0,019), dor pélvica não cíclica (P = 0,001), e redução no número de relações sexuais por semana (P = 0,001) e na libido (P = 0,001). Mulheres com idade ≤ 35 anos, no momento da laqueadura, mostraram-se mais propensas a desenvolverem alterações menstruais. A técnica de eletrocoagulação bipolar mostrou maiores repercussões clínicas e psíquicas. CONCLUSÃO: A ligadura tubária videolaparoscópica, independentemente da técnica, repercutiu com ...

Clinical and psychological repercussions of videolaparoscopic tubal ligation: observational, single cohort, retrospective study.

CONTEXT AND OBJECTIVE: Tubal ligation is one of the most commonly used contraceptive methods worldwide. Since the controversy over the potential effects of tubal sterilization still continues, this study aimed to evaluate the clinical and psychological repercussions of videolaparoscopic tubal ligation. DESIGN AND SETTING: Observational, single cohort, retrospective study, conducted in a tertiary public hospital. METHODS: A questionnaire was applied to 130 women aged 21-46 years who underwent videolaparoscopic tubal ligation by means of tubal ring insertion or bipolar electrocoagulation and sectioning, between January 1999 and December 2007. Menstrual cycle interval, intensity and duration of bleeding, premenstrual symptoms, dysmenorrhea, dyspareunia, noncyclic pelvic pain and degree of sexual satisfaction were assessed in this questionnaire. Each woman served as her own control, and comparisons were made between before and after the surgical procedure and between the two techniques used. RESULTS: The clinical and psychological repercussions were significant, with increases in bleeding (P = 0.001), premenstrual symptoms (P < 0.001), dysmenorrhea (P = 0.019) and noncyclic pelvic pain (P = 0.001); and reductions in the number of sexual intercourse occurrences per week (P = 0.001) and in libido (P = 0.001). Women aged ≤ 35 years at the time of sterilization were more likely to develop menstrual abnormalities. The bipolar electrocoagulation method showed greater clinical and psychological repercussions. CONCLUSION: Regardless of the technique used, videolaparoscopic tubal ligation had repercussions consisting of increased menstrual flow and premenstrual symptoms, especially in women aged ≤ 35 years, and also had a negative influence on sexual activity.

[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.

Qualitative and quantitative analysis of women's perceptions of transvaginal surgery.

BACKGROUND: Prior surveys evaluating women's perceptions of transvaginal surgery both support and refute the acceptability of transvaginal access. Most surveys employed mainly quantitative analysis, limiting the insight into the women's perspective. In this mixed-methods study, we include qualitative and quantitative methodology to assess women's perceptions of transvaginal procedures. METHODS: Women seen at the outpatient clinics of a tertiary-care center were asked to complete a survey. Demographics and preferences for appendectomy, cholecystectomy, and tubal ligation were elicited, along with open-ended questions about concerns or benefits of transvaginal access. Multivariate logistic regression models were constructed to examine the impact of age, education, parity, and prior transvaginal procedures on preferences. For the qualitative evaluation, content analysis by independent investigators identified themes, issues, and concerns raised in the comments. RESULTS: The completed survey tool was returned by 409 women (grouped mean age 53 years, mean number of 2 children, 82% ≥ some college education, and 56% with previous transvaginal procedure). The transvaginal approach was acceptable for tubal ligation to 59%, for appendectomy to 43%, and for cholecystectomy to 41% of the women. The most frequently mentioned factors that would make women prefer a vaginal approach were decreased invasiveness (14.4%), recovery time (13.9%), scarring (13.7%), pain (6%), and surgical entry location relative to organ removed (4.4%). The most frequently mentioned concerns about the vaginal approach were the possibility of complications/safety (14.7%), pain (9%), infection (5.6%), and recovery time (4.9%). A number of women voiced technical concerns about the vaginal approach. CONCLUSIONS: As in prior studies, scarring and pain were important issues to be considered, but recovery time and increased invasiveness were also in the "top five" list. The surveyed women appeared to actively participate in evaluating the technical components of the procedures.

Factors influencing physicians' advice about female sterilization in USA: a national survey.

BACKGROUND: Tubal ligation can be a controversial method of birth control, depending on the patient's circumstances and the physician's beliefs. METHODS: In a national survey of 1800 US obstetrician-gynecologist (Ob/Gyn) physicians, we examined how patients' and physicians' characteristics influence Ob/Gyns' advice about, and provision of, tubal ligation. Physicians were presented with a vignette in which a patient requests tubal ligation. The patient's age, gravida/parity and her husband's agreement/disagreement were varied in a factorial experiment. Criterion variables were whether physicians would discourage tubal ligation, and whether physicians would provide the surgery. RESULTS: The response rate was 66% (1154/1760). Most Ob/Gyns (98%) would help the patient to obtain tubal ligation, although 9-70% would attempt to dissuade her, depending on her characteristics. Forty-five percent of physicians would discourage a G2P1 (gravida/parity) woman, while 29% would discourage a G4P3 woman. Most physicians (59%) would discourage a 26-year-old whose husband disagreed, while 32% would discourage a 26-year-old whose husband agreed. For a 36-year-old patient, 47% would discourage her if her husband disagreed, while only 10% would discourage her if her husband agreed. Physicians' sex had no significant effect on advice about tubal ligation. CONCLUSIONS: Regarding patients who seek surgical sterilization, physicians' advice varies based on patient age, parity and spousal agreement but almost all Ob/Gyns are willing to provide or help patients obtain surgical sterilization if asked. An important limitation of the study is that a brief vignette, while useful for statistical analysis, is a rough approximation of an actual clinical encounter.

Sexual functions and quality of life in women with tubal sterilization.

The aim of this study was to evaluate the sexual functions and quality of life of women who have undergone tubal sterilization after tubal surgery. In all, 90 active premenopausal women, who had undergone tubal sterilization at least 1 year ago and been admitted to four different hospitals, were included in the study group. A total of 100 women at a similar age range, admitted to the same four hospitals for routine health controls, were included in the control group. To obtain sexual function assessments, the patients were asked to fill out Female Sexual Function Index (FSFI) questionnaire. The participants were also asked to fill out Medical Outcomes Study Short Form (SF-36) questionnaire. All values were found to be lower in the tubal sterilization (TS) group and the differences between groups were statistically significant in domain except for pain and lubrication. Similarly, in the analysis of SF-36 scores, there were differences in comparison with the TS group in all domains. In the evaluation of the relationship of FSFI with educational level in the TS group, it was found that, while the educational level increased, all domain scores also increased, and this increase was statistically significant in all domains except pain. The termination of fertility, which is one of the important abilities of women, with tubal sterilization, may be a risk factor for female sexual dysfunction in people with low educational levels.

Tubal ligation regret and related risk factors: findings from a case-control study in Pernambuco State, Brazil.

A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women's psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.

Tubal ligation regret and related risk factors: findings from a case-control study in Pernambuco State, Brazil / Fatores de risco para o arrependimento da laqueadura tubária: resultados de um estudo de caso-controle em Pernambuco, Brasil

A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women's psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.

Um estudo do tipo caso controle foi conduzido em um hospital público de ensino no Recife, Pernambuco, Brasil, em 1997, para investigar os fatores de risco para o arrependimento da realização da laqueadura tubária, comparando mulheres laqueadas que solicitaram ou realizaram a reversão da laqueadura tubária com mulheres também laqueadas que não solicitaram e não se submeteram a esta cirurgia. As mulheres que mostraram uma maior probabilidade de arrependimento foram as esterilizadas quando jovens, as que não foram responsáveis pela decisão da cirurgia, as que realizaram a esterilização até o 45º dia pós-parto e as que adquiriram informações sobre métodos contraceptivos depois da laqueadura tubária. Morte de filhos, parceiros sem filhos anteriores à união atual e a mudança de parceiro após a laqueadura tubária também estiveram associados com a solicitação ou realização de reversão da laqueadura. Deve-se avaliar o perfil psicológico e sócio-demográfico das mulheres e seus motivos para solicitar a laqueadura tubária e aconselhá-las para o planejamento familiar a fim de reduzir os riscos de arrependimento futuro.

Failure and regret after laparoscopic filshie clip sterilization under local anesthetic.

OBJECTIVE: To estimate the failure, regret, and reversal rates 5 or more years after laparoscopic Filshie clip sterilization using local anesthesia. METHODS: A total of 1,101 women underwent Filshie clip sterilization between 1983 and 2002. They completed follow-up questionnaires that were analyzed for the following outcomes: failed sterilization, regret after the operation, and sterilization reversal. RESULTS: Two hundred thirty-three of 968 (24%) eligible women sent the questionnaire had moved from their last known address. Of the remaining 735 women, 573 (78%) completed the questionnaire: 223 (39%) 5-6 years after the operation, 175 (30%) after 7-9 years, and 175 (30%) after 10-15 years. One pregnancy occurred 10 months after surgery, and one woman had the procedure repeated when unilateral tubal patency was identified by hysterosalpingography 3 weeks after surgery. Twenty-four (4%) women regretted having the operation; 7 (1.2%) women had a reversal operation, and all subsequently conceived. CONCLUSION: Failure after tubal sterilization using Filshie clips is less than 1:500 operations. Patient selection and surgeons' experience may have influenced these results. Regret occurred in a small proportion. LEVEL OF EVIDENCE: III.

The hysteroscopic approach to sterilization.

Permanent sterilization is the most common form of contraception in the United States today. Previously, this was accomplished via the laparoscopic method. A new less invasive method has been developed, in which the Essure microinsert is inserted through a hysteroscope into the fallopian tubes. A subsequent benign inflammatory process results in tubal occlusion within 3 months of insertion. Approved since 2002, this method offers high efficacy without incisions, general anesthesia, or a prolonged recovery period.

Prediction of post-operative pain after a laparoscopic tubal ligation procedure.

BACKGROUND: Pre-operative identification of reliable predictors of post-operative pain may lead to improved pain management strategies. We investigated the correlation between pre-operative pain, psychometric variables, response to heat stimuli and post-operative pain following a laparoscopic tubal ligation procedure. METHODS: Assessments of anxiety, mood, psychological vulnerability and pre-operative pain were made before surgery using the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety Depression Scale (HADS), a psychological vulnerability test and the Short-Form McGill Pain Questionnaire (SF-MPQ), respectively. Pre-operative assessments of thermal thresholds and pain response to randomized series of heat stimuli (1 s, 44-48 degrees C) were made with quantitative sensory testing technique. Post-operative pain intensity was evaluated daily by a visual analogue scale during rest and during standardized dynamic conditions for 10 days following surgery. Univariate and multivariate regression analyses were used to construct prediction models. RESULTS: Fifty-nine patients completed the study. Post-operative pain was significantly correlated with pre-operative pain (SF-MPQ), heat pain perception, psychological vulnerability, STAI and HADS. In the multiple regression model pre-operative pain and heat pain perception were significant predictive factors (R=0.537-0.609). CONCLUSION: The study indicates that pre-surgical pain and heat pain sensitivity are important pre-operative indicators of post-operative pain intensity, while psychological factors like vulnerability and anxiety seem to contribute to a lesser degree after laparoscopic tubal ligation. The prediction model accounted for 29-43% of the total variance in post-operative movement-related pain.

Race, insurance status, and desire for tubal sterilization reversal.

OBJECTIVE: To examine the independent effects of race/ethnicity and insurance status on desire for tubal sterilization reversal. DESIGN: Secondary analysis of cross-sectional data collected by the 2002 National Survey of Family Growth (NSFG). SETTING: Interviews were conducted in person by a trained female interviewer in the participant's home. PATIENT(S): The NSFG is designed to represent women and men 15-44 years of age in the U.S. household population. The sample consisted of 934 women who had undergone tubal sterilization at any time before being interviewed. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Desire for sterilization reversal. RESULT(S): Among women older than 30 years at time of surgery, black women were significantly more likely to desire sterilization reversal compared with white women (adjusted odds ratio, 2.6; 95% confidence interval, 1.2, 5.8). In the total cohort and in the subset of women 30 years or younger, there were no significant racial/ethnic variations in desire for sterilization reversal. CONCLUSION(S): Among women over age 30 at the time of tubal sterilization, black women were much more likely to express desire for reversal than white women.

Success rate and patient satisfaction with the Essure sterilisation in an outpatient setting: a prospective study of 857 women.

After 857 women with Essure system inserted for tubal obstruction as a method of sterilization in an outpatient setting, insertion is achieved in close to 99% of the women. Physician described the procedure as very difficult in 15% of the cases, mainly due to anatomical tubal anomalis or tubal spasm, and women felt highly satisfied in all cases.