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.

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.

Profile of Indian women requesting reversal of sterilisation.

This is a prospective clinical study carried out on 96 tubectomised women referred for microsurgical reversal to the Pandit BDS Postgraduate Institute of Medical Sciences, Rohtak and LHMC and SSKH, New Delhi. It was concluded that in developing countries high perinatal and child mortality rates are responsible for increased demands for reversal of sterilisation. Proper pre-operative counselling, age of the women, assessment of marital stability, family size and age of children are important before advocating sterilisation as a method of contraception.

Robot-assisted laparoscopy for infertility treatment: current views.

To determine the interest of using robotic laparoscopic surgery in the management of female infertility, we reviewed our own activity and searched the Medline database for publications on robotic technology in infertility surgery, with the use of the following search words: robotic laparoscopy, tubal anastomosis, myomectomy, deep infiltrating endometriosis, and adnexal surgery. Robot-assisted laparoscopic surgery has seen rapid progression over the past few years. It has been mostly used for myomectomy, proximal tubal reanastomosis, and deep endometriosis surgery. Despite its increased range of indications, no randomized control studies are available. The place of robotic surgery in the management of infertility remains undetermined.

The status of vasectomy reversals.

Vasectomy reversals are being requested in increasing numbers. Non-urologists are often the first physicians consulted about such procedures. In some instances, these physicians know very little about the procedures, and the consultation leads to confusion and frustration. In this report, current facts on vasectomy reversals will be provided for the benefit of non-urologists.

PIP: This report provides current facts about vasectomy reversal, hoping to inform non-urologists, who are often the first physicians consulted by patients seeking the procedure. The author explain that an increasing number of men are requesting vasectomy reversals, and unless non-urologists are informed about the subtleties involved in the procedure, they may provide patients with confusing and frustrating information. The article begins by discussing patient selection, operative choices, scheduling and anesthesia. Since all men continue to produce sperm in the testes after a vasectomy, they are all potential candidates for reversal. The procedure, however, involves thoughtful intraoperative evaluation, as well as the use of improved microsurgical techniques in some cases. The old vasectomy site may not be the only place of obstruction, since over time there may be engorgement, leaking, or scarring in the epididymis. The 2 operative procedures available are vasovasostomy and vasoepididymostomy. The decision of which procedure is required is made only at the time of the surgery, based upon certain intraoperative findings. The article goes on to explain the intraoperative findings that influence the operative choice, and discusses the success ratios of reversals. In 61 vasovasostomies performed by the author, more than 80% were considered successful, with 31 (50.8%) pregnancies reported. And in 16 vasoepididymostomies performed, 62.5% achieved patency and resulted in a pregnancy rate of 25%. The author then addresses the possible causes of postoperative failure, including sperm antibodies. Finally, the author briefly mentions options other than reconstructive microsurgery, such as intraoperative sperm aspiration and micromanipulation.

The choice of sterilization: voluntarily childless couples, mothers of one child by choice, and males seeking reversal of vasectomy.

PIP: The voluntarily childless and parents of 1 child by choice might be expected to make strong use of sterilization. This Australian study examines the reasons given by couples, whether early articulators or postponers of voluntary childlessness, and mothers of a single child for selecting or avoiding sterilization. Throughout 1982, 50 voluntarily childless couples were located and interviewed in their homes. According to the timing of the childless decision, 27 couples were identified as early articulators of childlessness (early, explicit decisions were made not to have children), while 23 were 'postponers', (childlessness resulted from successive postponements of childbearing which increasingly made children an impediment to a well established, adult-centered lifestyle). In the former group, husbands averaged 34 years of age, wives 32. In the latter group, husbands were on average 35 years old and wives 33. In both groups, the majority of couples were well educated, employed in professional or managerial positions, and likely to report low religiosity. Besides questions about contraceptive experiences, couples were asked about the reactions of others to their chidlessness, factors influencing their decision, and general perceptions of their marital relations. 34 mothers with 1 child by choice, averaging 33 years of age, formed the 2nd sample. All mothers completed a self-administered questionnaire which they were to return by mail and in which they were asked about reactions to their decision, their perceptions of the value and cost of children, their contraceptive history and choice. The 3rd sample was based on a doctor's record of interviews with 112 males who sought reversals of vasectomies. Willingness to consider sterilization varied markedly between early articulators of voluntary childlessness and postponers. Postponers were less likely to be sterilized, and less certain about future sterilization because of its finality and saw the operation as an explicit rather than implicit decision not to bear children. Early articulators were more likely to be sterilized; they were unwilling to cope with the anxieties of using effective but not permanent contraception. Among the voluntarily childless and mothers of a single child who were not sterilized, respondents cited its finality, aversion to nonessential surgery, and satisfaction with present methods. Clinic data on requests for reversals of previous vasectomies revealed that neither the intentionally childless nor the single child parents were overrepresented among men seeking reversals.^ieng

Laqueadura e reversäo: análise de 21 casos / Tubal sterilization and reversal: analysis of 21 cases

A laqueadura tornou-se um dos mais populares métodos contraceptivos. Como conseqüência, o arrependimento e a solicitação de reversão desta cirurgia vêm crescendo significativamente. Os autores verificaram que a idade média em que foi realizada a laqueadura foi de 24 ñ 3,6 anos, e que 81 por cento das pacientes tinham mais de três filhos. Na maioria dos casos a esterilização aconteceu na cesariana (47,6 por cento), e em cerca de 42,9 por cento, algum tempo após o parto normal. O principal motivo que levou a esta cirurgia foi o desejo de não ter mais filhos (28,6 por cento), associado a maus-tratos, dificuldade financeira, efeito colateral da pílula e incentivo do parceiro, perfazendo 66,7 por cento. O perfil epidemiológico da maioria destas pacientes caracterizou-se por idade superior à do seu parceiro (47,6 por cento) e igualdade quanto ao grau de escolaridade (47,6 por cento). A combinação de esterilização em pacientes muito jovens com a ocorrência de novo matrimônio tornou-se a principal razão que levou à procura pela reversão da ligação tubária. O estudo visa mostrar os motivos que levaram 21 pacientes a solicitarem a laqueadura e posteriormente a buscarem a salpingoplastia, para a sua reversão