Pregnancy after surgical sterilization five times more likely
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Pregnancy after surgical sterilization five times more likely
Pregnancy after surgical sterilization five times more likely
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.”