The rate of pregnancy 5 years after either hysteroscopic or laparoscopic sterilization was five times greater than previously thought, according to a retrospective cohort study in Fertility and Sterility.

“Current guidance from ACOG reports the chance of pregnancy after sterilization as less than 1%,” Aileen M. Gariepy, MD, MPH, currently the director of complex family planning in the department of OB/GYN at Weill Cornell Medicine, told Healio. “At 5 years after the procedure, the cumulative rate of pregnancy was over 6% regardless of the procedure 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 colleagues examined California Medicaid pregnancy claims made between Jan. 1, 2008, and Aug. 31, 2014, by women aged 18 to 50 years who underwent either hysteroscopic (n = 5,906) or laparoscopic (n = 23,965) sterilization. They excluded women with postpartum sterilization procedures and those who had claims for conditions within the 2 years before their procedure that would preclude hysteroscopic or laparoscopic sterilization.

Pregnancy rates with sterilization:

Over the study period, 4.74% of women who underwent hysteroscopic sterilization and 5.57% of those who underwent laparoscopic sterilization made pregnancy claims. As time passed after sterilization, pregnancy claims became less frequent.

Pregnancy claims within the first 12 months after sterilization were more common in hysteroscopic sterilization compared with laparoscopy (RR = 1.25; 95% CI, 1.05-1.46). However, the difference was not statistically significant and was not maintained upon adjustment.

Within the next year following sterilization, there were fewer pregnancy claims among women with hysterectomies compared with laparoscopies (adjusted incidence rate ratio [IRR] = 0.63; 95% CI, 0.45-0.88). After 24 months, there were no statistically significant differences between the two procedures.

At 5 years, the cumulative rate of pregnancy was significantly lower with hysteroscopic sterilization compared with laparoscopic sterilization (adjusted RR = 0.76; 95% CI, 0.62-0.9). Adjusted racial/ethnic analyses 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 have a pregnancy with hysteroscopic sterilization compared with those who underwent laparoscopic sterilization.

“For sterilization overall, this study is a loud and concerning signal that the risk of pregnancy after sterilization is closer to 6%, not 1%,” Gariepy said. “Patients considering sterilization and physicians performing sterilization procedures need to know and understand this risk of sterilization failure.”

Gariepy added that Bayer stopped selling its hysteroscopic sterilization device (Essure) after the data cut-off date, although the researchers determined it was not less effective than laparoscopy in preventing pregnancy.

Future steps

Moving forward, Gariepy said further study of current female sterilization practices is needed.

“Over 219 million women and their partners rely on female sterilization to prevent pregnancy,” she said. “We need rigorous evaluation evaluating all current methods of laparoscopic sterilization methods currently available (blocking the fallopian tubes with mechanical rings or clips, burning the tubes, and removal of all or part of the tube) to better understand the risk of pregnancy after sterilization, and we need the robust evaluation of any new methods of hysteroscopic sterilization that may be in development.”

Surgical sterilization is a commonly used method of contraception that is intended to be permanent. However, it is not always 100% effective, and some women who have undergone surgical sterilization may become pregnant. Recent studies have shown that the risk of pregnancy after surgical sterilization may be higher than previously thought, with some studies suggesting that the risk is up to five times higher than previously estimated. The purpose of this essay is to explore the risk of pregnancy after surgical sterilization and the factors that may contribute to this risk.

Background

Surgical sterilization is a permanent form of contraception that involves blocking or cutting the fallopian tubes or the vas deferens in men. This prevents sperm from reaching the egg, thereby preventing pregnancy. The procedure is intended to be permanent, and the risk of pregnancy after surgical sterilization is believed to be very low.

However, recent studies have suggested that the risk of pregnancy after surgical sterilization may be higher than previously thought. A study published in the journal Obstetrics and Gynecology in 2011 found that the risk of pregnancy after tubal ligation was 7.5 per 1,000 procedures. Another study published in the same journal in 2013 found that the risk of pregnancy after vasectomy was 1.4 per 1,000 procedures.

Factors Contributing to the Risk of Pregnancy after Surgical Sterilization

Several factors may contribute to the risk of pregnancy after surgical sterilization. These include:

Age

Age is a significant factor in the risk of pregnancy after surgical sterilization. Women who undergo tubal ligation or other forms of surgical sterilization at a younger age may be at a higher risk of pregnancy, as they have a longer reproductive lifespan.

Type of procedure

The type of procedure used for surgical sterilization may also affect the risk of pregnancy. Tubal ligation procedures that involve the use of clips or rings are associated with a higher risk of pregnancy compared to procedures that involve cutting or burning the fallopian tubes.

Timing of the procedure

The timing of the procedure may also be a factor in the risk of pregnancy. Women who undergo surgical sterilization shortly after giving birth may be at a higher risk of pregnancy, as the procedure may not be fully effective immediately after delivery.

Surgeon experience

The experience of the surgeon performing the procedure may also be a factor in the risk of pregnancy. Surgeons who have performed a large number of sterilization procedures may be more skilled at ensuring that the procedure is fully effective.

Reversal of the procedure

Finally, the decision to have a reversal of the sterilization procedure may also affect the risk of pregnancy. Women who undergo a reversal procedure may be at a higher risk of pregnancy, as the procedure may not be fully effective in restoring fertility.

Conclusion

Surgical sterilization is a commonly used method of contraception that is intended to be permanent. However, recent studies have suggested that the risk of pregnancy after surgical sterilization may be higher than previously thought. Several factors may contribute to the risk of pregnancy after surgical sterilization, including age, type of procedure, timing of the procedure, surgeon experience, and reversal of the procedure.

It is important for women who have undergone surgical sterilization to be aware of the potential risk of pregnancy and to take steps to prevent unintended pregnancy, such as using additional forms of contraception. Women who experience symptoms of pregnancy after surgical sterilization should seek medical attention to rule out the possibility of a pregnancy. As the field of sterilization technology continues to evolve, it is likely that new methods will be developed that are more effective at preventing pregnancy, and the risk of unintended pregnancy after surgical sterilization will continue to decrease.