April 21, 2022
2 minutes to read
Source / Disclosures
Disclosures: Gariepy reports that he is an author for UpToDate and has served on the Planned Parenthood Association’s board of directors. Please see the study for all relevant financial disclosures by other authors.
The pregnancy rate 5 years after sterilization with hysteroscopy or laparoscopy was five times greater than previously thought, according to a retrospective cohort study in Fertility and Sterility.
“Current guidance from ACOG indicates that the chance of pregnancy after sterilization is less than 1%,” Aileen M. Gariepy, MD, MPH, Currently, director of complex family planning in the department of obstetrics and gynecology at Weill Cornell Medicine, Helio told. “At 5 years after the procedure, the cumulative pregnancy rate was more than 6% regardless of which procedure was performed.”
Gariepy, who was an assistant professor of obstetrics, gynecology and reproductive sciences at Yale New Haven Hospital in New Haven, Connecticut, at the time of the study, and her colleagues examined pregnancy claims on California Medicaid between January 1, 2008 and August. 31, 2014, by women aged 18–50 who underwent either endoscopic (n = 5906) or laparoscopic (n = 23,965) sterilization. They excluded women undergoing postpartum sterilization procedures and those who had claims for conditions within two years prior to their procedure that would preclude hysteroscopic or laparoscopic sterilization.
Pregnancy rates with sterilization
During the study period, 4.74% of women who underwent hysteroscopic sterilization and 5.57% of those who underwent laparoscopic sterilization claimed pregnancy. Over time after sterilization, pregnancy claims became less frequent.
Allegations of pregnancy within the first 12 months after sterilization were more common with hysteroscopic sterilization than laparoscopy (RR = 1.25; 95% CI, 1.05-1.46). However, the difference was not statistically significant and was not maintained when adjusted.
During the year following sterilization, there were fewer pregnancy claims among women with hysterectomy compared to laparoscopy (adjusted incidence rate). [IRR] = 0.63; 95% CI, 0.45-0.88). After 24 months, there were no significant differences between the two procedures.
At 5 years, the cumulative pregnancy rate was significantly lower with hysteroscopic sterilization than with laparoscopic sterilization (adjusted RR = 0.76; 95% CI, 0.62-0.9). Adjusted racial/ethnic analyzes revealed that white women (aRR = 0.62; 95% CI, 0.4-0.84) and Asian women (aRR = 0.35; 95% CI, 0.03-0.68) were less likely to become pregnant with hysteroscopy. Those who have undergone endoscopic sterilization.
“For sterilization in general, this study is a loud and troubling indication that the risk of pregnancy after sterilization is closer to 6%, not 1%,” Garibi said. “Patients considering sterilization and clinicians performing sterilization procedures need to know and understand the risk of sterilization failure.”
Gariby added that Bayer stopped selling the Essure hysteresis device after the data deadline, although the researchers decided it was no less effective than laparoscopy at preventing pregnancy.
Going forward, Garibi said more study of current female sterilization practices is needed.
“More than 219 million women and their partners rely on female sterilization to prevent pregnancy,” she said. “We need a rigorous evaluation of all existing methods of laparoscopic sterilization currently available (blocking the fallopian tubes with mechanical rings or clamps, burning the tubes and removing all or part of the tube) to better understand the risks of pregnancy after sterilization, and we need a robust evaluation of any new methods of endoscopic sterilization. The uterus may be under development.”