Tubal sterilization: focus on the US experience

Objective: To review the frequency, effectiveness, and clinical sequelae of tubal sterilization with a focus on the U.S. experience. Design: A review of U.S. health care statistics and English-language litera ture using a MEDLINE search, bibliographies of key references, and U.S. gov ernment publications. Patient(s): Women seeking tubal sterilization. Intervention: Tubal sterilization. Main Outcome Measure(s): Effectiveness and long-term risks and benefits. Result(s): Half of the 700,000 annual bilateral tubal sterilizations (TS) a re performed postpartum and half as ambulatory interval procedures. Eleven million U.S. women 15-44 years of age rely on TS for contraception. Failure rates vary by method with one third or more resulting in ectopic pregnancy . Reversal is most successful after use of methods that destroy the least t ube. Evidence of menstrual or hormonal disturbance after TS is weak, althou gh some studies find higher rates of hysterectomy among previously steriliz ed women. Decreased risk of subsequent ovarian cancer has been observed amo ng sterilized women. Conclusion(s): Tubal sterilization is highly effective and safe. Failures, although uncommon, occur at higher rates than previously appreciated. Evide nce for hormonal or menstrual changes due to TS is weak. Tubal sterilizatio n is associated with decreased risk of ovarian cancer. (Fertil Steril(R) 20 00;73:913-22. (C) 2000 by American Society for Reproductive Medicine).