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Moon HS, Joo BS, Kim SG, Nam KI, Koo JS. Where Microsurgical Tubal Reanastomosis Stands in the In vitro Fertilization Era. Gynecol Minim Invasive Ther 2024; 13:71-78. [PMID: 38911303 PMCID: PMC11192280 DOI: 10.4103/gmit.gmit_43_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 06/25/2024] Open
Abstract
Among various options of contraception, bilateral tubal ligation (BTL) remains the most frequently used method for women worldwide even at present. However, up to 30% of those who undergo BTL eventually change their minds and wish to conceive again for a variety of reasons, such as a change in marital status or simply wanting more children. In this case, we can either approach it surgically with tubal re-anastomosis (TA) or by in vitro fertilization (IVF)-embryo transfer. Despite the many advantages of TA which lead the American Society of Reproductive Medicine Committee Opinion to recommend it as the primary choice of treatment in posttubal ligation infertility in 2012, IVF is widely being chosen as the first-line treatment nowadays. This study will review the efficacy of TA in various aspects, including pregnancy rate, cost-effectiveness, feasibility, and accessibility, based on review of the literature and our experience. Through this study, we intend to provide a basis for gynecologists to consider TA as the first option in women who wish to conceive again after BTL in this day and age of IVF.
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Affiliation(s)
- Hwa Sook Moon
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
| | - Bo Sun Joo
- Reproduction Aging Center, The Korea Institute for Public Sperm Bank, Busan, Korea
| | - Sang Gap Kim
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
| | - Kyung Il Nam
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
| | - Ja Seong Koo
- Department of Obstetrics and Gynecology, Center for Minimally Invasive Surgery and Treatment, Good Moonhwa Hospital, Busan, Korea
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Rufin KGA, do Valle HA, McAlpine JN, Elwood C, Hanley GE. Complications after opportunistic salpingectomy compared with tubal ligation at cesarean section: a retrospective cohort study. Fertil Steril 2024; 121:531-539. [PMID: 38043843 DOI: 10.1016/j.fertnstert.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To compare perioperative and postoperative complications in patients who underwent opportunistic salpingectomy (OS) (removal of the fallopian tubes for ovarian cancer risk reduction during another surgery) at the time of cesarean section (C-section) with those in patients who underwent tubal ligation. DESIGN A population-based, retrospective cohort study. SETTING British Columbia, Canada. PATIENT(S) A total of 18,184 patients were included in this study, of whom 8,440 and 9,744 underwent OS and tubal ligation, respectively. INTERVENTION(S) Patients who underwent OS during a C-section were compared with those who underwent tubal ligation during a C-section. MAIN OUTCOME MEASURE(S) We examined the perioperative outcomes, including operating room time, length of hospital stay, surgical complications such as infections, anemia, incision complications, injury to a pelvic organ, or operating room return; postoperative complications, including physician visits for a postoperative infection or visits that resulted in ultrasound or laboratory examinations and hospital readmissions in the 6 weeks after discharge; and likelihood to fill a prescription for antibiotics or analgesics. RESULT(S) The OS group had decreased odds of perioperative complications compared with the tubal ligation group (adjusted odds ratio [aOR], 0.77; 95% confidence interval [CI], 0.61-0.99). Patients who underwent OS did not have increased risks of physician visits for surgical complications, such as infection, or hospital readmissions in the 6 weeks after hospital discharge. In addition, these patients had 18% and 23% increased odds of filling prescriptions for nonsteroidal anti-inflammatory drugs (aOR, 1.18; 95% CI, 1.07-1.28) and opioids (aOR, 1.23%; 95% CI, 1.12-1.35), respectively. CONCLUSION(S) In this population-based, real-world study of OS at C-section, we report decreased perioperative complications and no difference in postoperative complications between patients who underwent OS and those who underwent tubal ligation. Patients who underwent OS had an increased likelihood of filling a prescription for nonsteroidal anti-inflammatory drugs and opioids in the 6 weeks after hospital discharge. This result should be interpreted with caution because we did not have data on over-the-counter medication use and, thus, not all prescription analgesics were captured in our data. Our data suggest that OS after C-section is a safe way to provide effective contraception and ovarian cancer risk reduction.
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Affiliation(s)
- Khaye Gerazel A Rufin
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helena Abreu do Valle
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica N McAlpine
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chelsea Elwood
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gillian E Hanley
- Department of Gynaecology and Obstetrics, Division of Gynaecologic Oncology, University of British Columbia, Vancouver, British Columbia, Canada.
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Marchand GJ, Masoud AT, King AK, Brazil GM, Ulibarri HM, Parise JE, Arroyo AL, Coriell CL, Goetz SP, Moir CJ, Govindan ML. Salpingectomy, tubal ligation and hysteroscopic occlusion for sterilization. Minerva Obstet Gynecol 2022; 74:452-461. [PMID: 35912465 DOI: 10.23736/s2724-606x.22.05134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Sterilization of females is considered one of the most prevalent contraceptive techniques among women in the United States. There are many surgical sterilization procedures including salpingectomy, tubal ligation, and hysteroscopic occlusion of the fallopian tubes. We provide an overview of these methods from the clinical data and latest studies available on this topic. EVIDENCE ACQUISITION In order to review the latest literature on the topic, we searched electronic databases including PubMed, Web of Science, Scopus, and Cochrane library for all eligible studies from May 1st 2018 until May 1st 2022 using the following strategy: ("fallopian tube removal" OR Salpingectomy OR "fallopian tube excision" OR "tubal sterilization") AND ("tubal ligation" OR "bipolar coagulation" OR "tubal clip" OR "tubal ring" OR fimbriectomy). We reviewed every study that met our criteria and subjectively considered their results and methodology into this narrative review. EVIDENCE SYNTHESIS In addition to reviewing major guidelines in the United States, 19 recent studies met our eligibility criteria and were included in this review. We grouped the findings under the following headings: anatomical and physiological considerations, sterilization, salpingectomy, tubal ligation, and hysteroscopic tubal occlusion. CONCLUSIONS Bilateral salpingectomy and techniques of tubal ligation or occlusion continue to be effective procedures with good safety profiles. All techniques have similar surgical outcomes and long-term success rates. As salpingectomy has the advantage of reducing the risk of occurrence of ovarian cancer, this is preferential when feasible. Hysteroscopic occlusion techniques may be more minimally invasive but have the disadvantages of delayed efficacy, the need for a second invasive diagnostic procedure, and limited availability.
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Affiliation(s)
- Greg J Marchand
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA -
| | - Ahmed T Masoud
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
- Faculty of Medicine, University of Fayoum, Fayoum, Egypt
| | - Alexa K King
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Giovanna M Brazil
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Hollie M Ulibarri
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Julia E Parise
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Amanda L Arroyo
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Catherine L Coriell
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Sydnee P Goetz
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Carmen J Moir
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
| | - Malini L Govindan
- Department of Minimally Invasive Surgery, Marchand Institute for Minimally Invasive Surgery, Mesa, AZ, USA
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Fang NZ, Advaney SP, Castaño PM, Davis A, Westhoff CL. Female permanent contraception trends and updates. Am J Obstet Gynecol 2022; 226:773-780. [PMID: 34973178 DOI: 10.1016/j.ajog.2021.12.261] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/02/2021] [Accepted: 12/23/2021] [Indexed: 11/23/2022]
Abstract
Permanent contraception remains one of the most popular methods of contraception worldwide. This article has reviewed recent literature related to demographic characteristics of users, prevalence of use and trends over time, surgical techniques, and barriers to obtain the procedure. We have emphasized the patient's perspective as a key element of choosing permanent contraception. This review has incorporated sections on salpingectomy, hysteroscopy, unmet need, impact of policies at religiously affiliated institutions, and reproductive coercion.
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Affiliation(s)
- Nancy Z Fang
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Center, Aurora, CO.
| | - Simone P Advaney
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Paula M Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Anne Davis
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY
| | - Carolyn L Westhoff
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
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Lacitignola L, Laricchiuta P, Imperante A, Acquafredda C, Stabile M, Staffieri F. Laparoscopic salpingectomy in Papio hamadryas for birth control in captivity. Vet Surg 2022; 51 Suppl 1:O98-O106. [PMID: 34985139 DOI: 10.1111/vsu.13760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/19/2021] [Accepted: 12/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the feasibility of laparoscopic salpingectomy in baboons (Papio hamadryas). We hypothesized that laparoscopic salpingectomy could be performed in baboon species within a reasonable amount of surgical time, with minor complications occurring at low rates. STUDY DESIGN Case series and technique description. ANIMALS Sixteen baboons (n = 16). METHODS The surgical procedures were performed using the 3-port technique, with 5 mm instruments and a telescope placed at the umbilical and hypogastric regions. A salpinx dissection was performed, using a radiofrequency bipolar vessel sealing device, from the fimbriae to the uterine attachments. We evaluated the surgical duration, learning curve, and intraoperative and early postoperative complications. RESULTS Ten adult and 6 subadult baboons with a mean weight of 9.32 kg, a range of 4-14.2 kg, and a standard deviation (SD) of 3.09 kg were included in the study. The total duration of surgery was 28.75 min (range, 16-50 min; SD, 9.60 min). The installation phase was completed in a mean time of 7.68 min (range, 3-15 min; SD, 3.43 min), and the time to complete the salpingectomy of both salpinges was 9.68 min (range, 4-20 min; SD, 3.97 min). No complications were observed in the postoperative period. CONCLUSION Laparoscopic salpingectomy in Papio hamadryas was feasible, with an acceptable surgical time, low invasiveness, and only minor technical perioperative complications. CLINICAL SIGNIFICANCE Laparoscopic salpingectomy could be a viable and safe therapeutic option in nonhuman primate birth-control programs.
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Affiliation(s)
- Luca Lacitignola
- Dipartimento Dell'Emergenze e trapianti di Organo, sez. Cliniche Veterinarie e P.A., Università degli studi di Bari, Bari, Italy
| | | | - Annarita Imperante
- Dottorato di ricerca in "Trapianti di Tessuti ed Organi e Terapie Cellulari", Università degli studi di Bari, Bari, Italy
| | - Claudia Acquafredda
- Dottorato di ricerca in "Trapianti di Tessuti ed Organi e Terapie Cellulari", Università degli studi di Bari, Bari, Italy
| | - Marzia Stabile
- Dottorato di ricerca in "Trapianti di Tessuti ed Organi e Terapie Cellulari", Università degli studi di Bari, Bari, Italy
| | - Francesco Staffieri
- Dipartimento Dell'Emergenze e trapianti di Organo, sez. Cliniche Veterinarie e P.A., Università degli studi di Bari, Bari, Italy
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Welch EK, Lindberg M, Mauney D, McLeod F. Bring back the tubal: An intervention to provide postpartum tubal ligation in the underserved population. Health Care Women Int 2020; 45:113-128. [PMID: 32897839 DOI: 10.1080/07399332.2020.1805747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/01/2020] [Indexed: 10/23/2022]
Abstract
We aimed to improve educational awareness of postpartum bilateral tubal ligation (PPBTL), which we defined as a 15% improvement between pre-/post-intervention questionnaire scores. We followed patients desiring and undergoing PPBTL and reason for unfulfilled procedures from 2017-2018. OB/GYN, Nursing, and Anesthesia participated in educational sessions with pre-/post-intervention questionnaires. Comparing the first and latter six months after study initiation, PPBTLs performed increased from 39% to 54%. Fifty-two staff participated in the interventions, with a 21% improvement in scores (OB/GYN p = 0.0117, Nursing p = 0.0001, Anesthesia p = 0.0002). We conclude multidisciplinary interventions improved educational awareness, an integral part to increasing PPBTL performance in the underserved.
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Affiliation(s)
- Eva K Welch
- Department of Obstetrics & Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
- Department of Obstetrics & Gynecology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Mary Lindberg
- Department of Obstetrics & Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Donald Mauney
- Department of Anesthesiology, Geisinger Health System, Wilkes Barre, Pennsylvania, USA
| | - Francine McLeod
- Department of Obstetrics & Gynecology, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
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Batra P, Rodriguez K, Cheney AM. Using Deliberative and Qualitative Methods to Recommend Revisions to the Medicaid Sterilization Waiting Period. Womens Health Issues 2020; 30:260-267. [PMID: 32409262 DOI: 10.1016/j.whi.2020.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/21/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Sterilization is used by one-quarter of women in the United States for contraception and is a preferred birth control method among women with Medicaid. A history of coercive sterilization practices in the United States led to federal regulation of consent for Medicaid sterilization (including a mandated waiting period); this regulation can be a barrier to sterilization in Medicaid-insured women. This study aimed to develop a revised model of Medicaid sterilization policy grounded in the experiences of women impacted by current regulations. METHODS This prospective study used in-depth interviews with 32 Medicaid-insured women who had obtained or tried to obtain sterilization to elicit recommendations regarding the Medicaid waiting period. Deliberative methods (a planning cell including 20 key community stakeholders) were used to evaluate women's recommendations and propose a revised policy for sterilization under Medicaid. RESULTS In-depth interview data demonstrated that women were often not made aware of the 30-day waiting period during informed consent before sterilization. Once informed about the policy, women described the Medicaid waiting period as "unfair," because it did not apply to all women. After deliberating women's recommendations to change the policy, key stakeholders came to a consensus around replacing the current waiting period policy with an improved consent process that would acknowledge the problematic history of coercive sterilization. Participants could not endorse removing the waiting period altogether without evidence that the health system had shifted away from coercive sterilization practices. CONCLUSIONS Using deliberative methods and the recommendations of women with Medicaid insurance, community stakeholders recommended developing a revised Medicaid sterilization consent policy that acknowledged the historical context of this procedure.
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Affiliation(s)
- Priya Batra
- Department of Social Medicine, Population, and Public Health, University of California, Riverside, Riverside, California; Inland Empire Health Plan, Rancho Cucamonga, California.
| | - Katheryn Rodriguez
- Department of Anthropology, University of California, Riverside, Riverside, California
| | - Ann M Cheney
- Department of Social Medicine, Population, and Public Health, University of California, Riverside, Riverside, California
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Ainsworth AJ, Baumgarten SC, Bakkum-Gamez JN, Vachon CM, Weaver AL, Laughlin-Tommaso SK. Tubal Ligation and Age at Natural Menopause. Obstet Gynecol 2019; 133:1247-1254. [PMID: 31135741 PMCID: PMC8543885 DOI: 10.1097/aog.0000000000003266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the effect of tubal ligation on age at natural menopause, as a marker of long-term ovarian function. METHODS Three preexisting population-based cohorts were included in this cross-sectional study. Data from each cohort was analyzed separately. The cohorts were restricted to women who never smoked and had reached natural menopause, without prior hysterectomy or oophorectomy. The following variables were collected: race, age at menarche, age at menopause, history of hysterectomy or oophorectomy, gravidity and parity, tobacco use, and ever use of hormonal contraception. The type of tubal ligation and age at tubal ligation were manually abstracted in cohort 1. For cohorts 2 and 3, history of tubal ligation was obtained from an institutional form, completed by patient report. The primary outcome, age at natural menopause, was compared between the two groups (those with and without a history of tubal ligation). RESULTS Inclusion criteria was met by 555 women from cohort 1, 1,816 women from cohort 2, and 1,534 women from cohort 3. Baseline characteristics did not differ between cohorts. The percentage with tubal ligation was the same in all cohorts: 26.0%, 25.5%, and 25.0%, respectively. Women with a tubal ligation were more likely to have had at least one pregnancy and to have used hormonal contraception compared with women without a tubal ligation. There was no significant difference in age at natural menopause in women who underwent tubal ligation (50.1, 49.9, 50.0 years, respectively) compared with those who did not (50.7, 49.6, 50.0 years, respectively). The type of tubal ligation (cohort 1 only) had no effect on age at menopause. CONCLUSIONS Tubal ligation did not affect age at natural menopause in the three large cohorts included in this study.
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Affiliation(s)
| | - Sarah C Baumgarten
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Celine M Vachon
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Amy L Weaver
- Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
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Gormley R, Vickers B, Norman WV. Comparing options for women seeking permanent contraception in high-resource countries: a protocol for a systematic review. Syst Rev 2019; 8:74. [PMID: 30914067 PMCID: PMC6434619 DOI: 10.1186/s13643-019-0987-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/13/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND For women seeking permanent contraception, there are a variety of options available including surgical techniques such as tubal ligation or bilateral salpingectomy, in-clinic procedures such as hysteroscopic techniques using micro-inserts, or the levonorgestrel-releasing intrauterine contraceptive. Despite the various methods available for women who are seeking permanent contraception, there is not a review or decision-making tool that systematically brings together outcomes related to effectiveness, tolerability, adverse effects, non-contraceptive benefits, recovery, or accessibility: all of which are important for shared decision-making between patients and health care providers. METHODS We registered our protocol [on Prospero: CRD42016038254] following PRISMA guidelines. A search strategy was created in collaboration with a librarian, and three databases (EMBASE, PubMed, Web of Science) will be searched along with secondary screening of relevant articles. A third reviewer will adjudicate any discrepancies. Data will be extracted independently according to population, intervention, comparison, outcomes (PICOS); length of follow-up; and funding. Articles will be assessed for bias using the Newcastle-Ottawa Scale and the Cochrane Collaboration tool. If appropriate, a network meta-analysis will be conducted to rank and analyze each method according to each objective. If heterogeneity between studies is too high or it is not possible to conduct a network meta-analysis, a narrative analysis of the study results will be provided. DISCUSSION Clinicians and their patients seeking permanent contraception have several options, yet we were unable to find a systematic review or decision support tool helping to facilitate shared decision-making. This systematic review can inform patients, providers, and health policy decision-makers about which options of permanent contraception will meet different reproductive goals according to various outcomes, which can lead to better health, social, economic, and mental well-being for reproductive age women. This can also aid our understanding of resulting costs to the health care system. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038254.
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Affiliation(s)
- Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- Contraception and Abortion Research Team-Groupe - de recherche sur l’avortement et la contraception (CART-GRAC), BC Women’s Hospital, Vancouver, Canada
| | - Brian Vickers
- Contraception and Abortion Research Team-Groupe - de recherche sur l’avortement et la contraception (CART-GRAC), BC Women’s Hospital, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Wendy V. Norman
- Contraception and Abortion Research Team-Groupe - de recherche sur l’avortement et la contraception (CART-GRAC), BC Women’s Hospital, Vancouver, Canada
- Department of Family Practice, University of British Columbia, Vancouver, Canada
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11
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Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery. Am J Obstet Gynecol 2019; 220:106.e1-106.e10. [PMID: 30170036 DOI: 10.1016/j.ajog.2018.08.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/06/2018] [Accepted: 08/20/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Removal of the fallopian tubes at the time of hysterectomy or interval sterilization has become routine practice to prevent ovarian cancer. While emerging as a strategy, uptake of this procedure at the time of cesarean delivery for pregnant women seeking permanent sterilization has not been widely adopted due to perceptions of increased morbidity and operative difficulty with a lack of available data in this setting. OBJECTIVE We sought to conduct a cost-effectiveness analysis comparing strategies for long-term sterilization and ovarian cancer risk reduction at the time of cesarean delivery, including bilateral tubal ligation, opportunistic salpingectomy, and long-acting reversible contraception. STUDY DESIGN A decision-analytic and cost-effectiveness model was constructed for pregnant women undergoing cesarean delivery who desired permanent sterilization in the US population, comparing 3 strategies: (1) bilateral tubal ligation, (2) bilateral opportunistic salpingectomy, and (3) postpartum long-acting reversible contraception. This theoretic cohort consisted of 110,000 pregnant women desiring permanent sterilization at the time of cesarean delivery and ovarian cancer prevention at an average of 35 years who were monitored for an additional 40 years based on an average US female life expectancy of 75 years. The primary outcome measure was the incremental cost-effectiveness ratio. Effectiveness was measured as quality-adjusted life years. Secondary outcomes included: the number of ovarian cancer cases and deaths, procedure-related complications, and unintended and ectopic pregnancies. The 1-, 2-, and 3-way and Monte Carlo probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set at $100,000. RESULTS Both bilateral tubal ligation and bilateral opportunistic salpingectomy with cesarean delivery have favorable cost-effectiveness ratios. In the base case analysis, salpingectomy was more cost-effective with an incremental cost-effectiveness ratio of $23,189 per quality-adjusted life year compared to tubal ligation. Long-acting reversible contraception after cesarean was not cost-effective (ie, dominated). Although salpingectomy and tubal ligation were both cost-effective over a wide range of cost and risk estimates, the incremental cost-effectiveness ratio analysis was highly sensitive to the uncertainty around the estimates of salpingectomy cancer risk reduction, risk of perioperative complications, and cost. Monte Carlo probabilistic sensitivity analysis estimated that tubal ligation had a 49% chance of being the preferred strategy over salpingectomy. If the true salpingectomy risk of perioperative complications is >2% higher than tubal ligation or if the cancer risk reduction of salpingectomy is <52%, then tubal ligation is the preferred, more cost-effective strategy. CONCLUSION Bilateral tubal ligation and bilateral opportunistic salpingectomy with cesarean delivery are both cost-effective strategies for permanent sterilization and ovarian cancer risk reduction. Although salpingectomy and tubal ligation are both reasonable strategies for cesarean patients seeking permanent sterilization and cancer risk reduction, threshold analyses indicate that the risks and benefits of salpingectomy with cesarean delivery need to be better defined before a preferred strategy can be determined.
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Zerden ML, Castellano T, Doll KM, Stuart GS, Munoz MC, Boggess KA. Risk-Reducing Salpingectomy Versus Standard Tubal Sterilization: Lessons From Offering Women Options for Interval Sterilization. South Med J 2018; 111:173-177. [PMID: 29505655 DOI: 10.14423/smj.0000000000000779] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In women receiving sterilization, the removal of the entire fallopian tube, a procedure referred to as a risk-reducing salpingectomy (RRS), reduces subsequent ovarian cancer risk compared with standard tubal sterilization procedures. There are limited data on which surgical procedure women will choose when educated about the benefits of an RRS. Our objective was to study the proportion of women desiring sterilization that would choose an RRS. METHODS This cohort study included women 30 years of age and older with a living biological child who requested laparoscopic sterilization at a tertiary academic hospital. Participants were given a decision aid and offered an RRS or a standard tubal sterilization procedure with titanium clips. The primary outcome was to determine the proportion of women who would choose an RRS. Other outcomes included estimated blood loss and operative time, which was compared between groups, along with complications. RESULTS Fourteen of the 18 (78%) women who participated in our study chose RRS. Estimated blood loss and operating time were similar among women who underwent RRS and standard tubal sterilizations. There were no significant complications in either group. The study was ended early based on emerging data and a change in national practice patterns. CONCLUSIONS Because of the elective nature of sterilization and the complexities of cancer risk reduction, a patient-centered approach is beneficial for sterilization counseling. Our results support offering RRS as an alternative to standard tubal sterilization.
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Affiliation(s)
- Matthew L Zerden
- From the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
| | - Tara Castellano
- From the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
| | - Kemi M Doll
- From the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
| | - Gretchen S Stuart
- From the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
| | - M Cris Munoz
- From the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
| | - Kim A Boggess
- From the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill
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Tai RWM, Choi SKY, Coyte PC. The Cost-Effectiveness of Salpingectomies for Family Planning in the Prevention of Ovarian Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:317-327. [PMID: 29054509 DOI: 10.1016/j.jogc.2017.06.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Ovarian cancer is the most lethal gynaecologic cancer. Disease prevention may be the only method to reduce the incidence of ovarian cancer. The Society of Gynecologic Oncology advised that salpingectomies may be an appropriate and feasible strategy for ovarian cancer risk reduction. This study conducted an economic evaluation from a societal perspective of bilateral salpingectomies versus conventional sterilization techniques in the prevention of ovarian cancer. STUDY DESIGN We performed a micro-cost analysis comparing laparoscopic tubal coagulation, tubal clips and bilateral salpingectomies at the Michael Garron Hospital, formerly the Toronto East General Hospital, from 2015 to 2016. A Markov model was used in the cost-effectiveness and cost-utility analyses on these surgical procedures in ovarian cancer prevention. Costs were derived for the number ovarian cancer cases observed per sterilization method, cancer treatment, and associated procedural costs over each cancer patient's lifetime. The number of bilateral salpingectomies required to prevent an additional ovarian cancer case with the recommended treatment was also estimated. RESULTS Bilateral salpingectomies performed at the Michael Garron Hospital generated savings of $7823 per life-year gained (95% CI $3248-$10 190; incremental cost [ΔC] -$907, incremental effect [ΔE] 0.11 life-years gained) compared with tubal clips and savings of $6315 per life-year gained (95% CI -$6360 to $9342; ΔC -$755, ΔE 0.11 life-years gained) compared with tubal coagulation. Most importantly, for every 150 bilateral salpingectomies performed, one case of ovarian cancer may be prevented. CONCLUSION Laparoscopic bilateral salpingectomy is the dominant, cost-effective surgical strategy when compared to tubal clips and tubal coagulation to prevent ovarian cancer. Laparoscopic bilateral salpingectomies reduce costs and enhance quality-adjusted life-years relative to the two alternative treatments.
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Affiliation(s)
- R W Melissa Tai
- Faculty of Medicine, University of Toronto, Toronto, ON; Michael Garron Hospital, Toronto, ON.
| | | | - Peter C Coyte
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON
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HIGH PREVALENCE OF VOLUNTARY STERILIZATION AMONG AMERICAN WOMEN EXPLAINED BY TRADE-OFFS RESULTING FROM MALE PARENTAL COMMITMENT. J Biosoc Sci 2017; 50:505-526. [PMID: 28879818 DOI: 10.1017/s0021932017000414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Tubal ligation is the modal form of family planning among American women aged 30 and older. As the preference for tubal ligation over cheaper, lower risk and more reliable methods, such as vasectomy, has puzzled experts, a theoretical approach that explains this preference would be useful. The present study investigates the high prevalence of voluntary sterilization among American women from the perspective of life history theory, arguing that the trade-offs between investing in current and future offspring will favour tubal ligation when women cannot obtain reliable male commitment to future parental investment. Data came from the National Survey of Fertility Barriers (NSFB), a nationally representative survey of 4712 American women aged 25-45 conducted between 2004 and 2007. Four novel predictions of the prevalence of tubal ligation, drawn from life history theory, were developed and tested: 1) it is most common among unpartnered women with children, and least common among married women with children; 2) it is negatively correlated with age at first birth; 3) it is least common among highly educated women without children, and most common among less educated women with children; and 4) among women with two or more children, it is positively correlated with lifetime number of long-term partners. These predictions were tested using multivariate regression analysis. The first prediction was not supported: women with children were more likely to be sterilized, regardless of their marital status. The other three predictions were all supported by the data. The results suggest that trade-offs influence women's decisions to undergo voluntary sterilization. Women are most likely to opt for tubal ligation when the costs of an additional child will impinge on their ability to invest in existing offspring, especially in the context of reduced male commitment.
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Abstract
OBJECTIVE To compare rates of gynecologic morbidity after laparoscopic and hysteroscopic sterilization. METHODS This retrospective cohort study used a commercial claims administrative database, 2007-2013, to compare rates of pregnancy, menstrual dysfunction, pelvic pain, hysteroscopic surgery, and intra-abdominal gynecologic surgery after laparoscopic and hysteroscopic sterilization. Women with 12 or more continuous months of data before and after their index procedure were included. Pregnancy rates after laparoscopic and hysteroscopic sterilization were compared for the entire population of women who underwent hysteroscopic sterilization and the subset who had completed postprocedure hysterosalpingograms. Cox proportional hazard models were calculated controlling for age, comorbidities, U.S. geographic region, metropolitan statistical area designation, and insurance type. RESULTS A total of 42,391 women underwent laparoscopic and 27,724 underwent hysteroscopic sterilization. The pregnancy rate was higher after hysteroscopic than laparoscopic sterilization (adjusted hazard ratio [HR] 1.20, 95% confidence interval [CI] 1.09-1.33; 2.4% compared with 2.0% risk of pregnancy at 2 years). Only 66.1% (n=18,318) of women who underwent hysteroscopic sterilization received a hysterosalpingogram. This group had similar pregnancy rates as those who underwent laparoscopic sterilization (adjusted HR 0.90, 95% CI 0.80-1.02; 1.8% compared with 2.0% at 2 years). After undergoing hysteroscopic sterilization, more women were diagnosed with menstrual dysfunction (adjusted HR 1.23, 95% CI 1.20-1.27; 26.8% compared with 22.3% at 2 years), and more women underwent hysteroscopic surgeries (adjusted HR 2.05, 95% CI 1.96-2.14; 13.8% compared with 6.4% at 2 years), but fewer women were diagnosed with pelvic pain (adjusted HR 0.83, P<.001; 21.0% compared with 25.6% at 2 years) and fewer women underwent intra-abdominal gynecologic surgeries (adjusted HR 0.95, 95% CI 0.90-0.99; 7.7% compared with 8.1% at 2 years), including hysterectomy (adjusted HR 0.65, 95% CI 0.61-0.69; 10.9% compared with 14.3% at 5 years). CONCLUSION Hysteroscopic sterilization may be associated with a higher rate of pregnancy, more menstrual dysfunction, more hysteroscopic surgeries, less pelvic pain, and fewer intra-abdominal gynecologic surgeries than laparoscopic sterilization. Pregnancy rates appear to be similar for women who completed their postprocedure hysterosalpingogram, but only 66% of women did so.
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Committee Opinion No. 695: Sterilization of Women: Ethical Issues and Considerations. Obstet Gynecol 2017; 129:e109-e116. [DOI: 10.1097/aog.0000000000002023] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Should Opportunistic Bilateral Salpingectomy (OBS) for Prevention of Ovarian Cancer Be Incorporated Into Routine Care or Offered in the Context of a Clinical Trial? Int J Gynecol Cancer 2016; 26:31-3. [DOI: 10.1097/igc.0000000000000567] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Stewart J, Breslin WJ, Beyer BK, Chadwick K, De Schaepdrijver L, Desai M, Enright B, Foster W, Hui JY, Moffat GJ, Tornesi B, Van Malderen K, Wiesner L, Chen CL. Birth Control in Clinical Trials: Industry Survey of Current Use Practices, Governance, and Monitoring. Ther Innov Regul Sci 2015; 50:155-168. [PMID: 27042398 PMCID: PMC4766962 DOI: 10.1177/2168479015608415] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/01/2015] [Indexed: 11/16/2022]
Abstract
The Health and Environmental Sciences Institute (HESI) Developmental and Reproductive Toxicology Technical Committee sponsored a pharmaceutical industry survey on current industry practices for contraception use during clinical trials. The objectives of the survey were to improve our understanding of the current industry practices for contraception requirements in clinical trials, the governance processes set up to promote consistency and/or compliance with contraception requirements, and the effectiveness of current contraception practices in preventing pregnancies during clinical trials. Opportunities for improvements in current practices were also considered. The survey results from 12 pharmaceutical companies identified significant variability among companies with regard to contraception practices and governance during clinical trials. This variability was due primarily to differences in definitions, areas of scientific uncertainty or misunderstanding, and differences in company approaches to enrollment in clinical trials. The survey also revealed that few companies collected data in a manner that would allow a retrospective understanding of the reasons for failure of birth control during clinical trials. In this article, suggestions are made for topics where regulatory guidance or scientific publications could facilitate best practice. These include provisions for a pragmatic definition of women of childbearing potential, guidance on how animal data can influence the requirements for male and female birth control, evidence-based guidance on birth control and pregnancy testing regimes suitable for low- and high-risk situations, plus practical methods to ascertain the risk of drug-drug interactions with hormonal contraceptives.
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Affiliation(s)
- J Stewart
- AstraZeneca, Macclesfield, United Kingdom
| | - W J Breslin
- Lilly Research Laboratories, Indianapolis, IN, USA
| | - B K Beyer
- Sanofi U.S. Inc, Bridgewater, NJ, USA
| | - K Chadwick
- Bristol-Myers Squibb, New Brunswick, NJ, USA
| | | | - M Desai
- AbbVie Inc, North Chicago, IL, USA
| | | | - W Foster
- McMaster University, Hamilton, Ontario, Canada
| | - J Y Hui
- Celgene Corp, Summit, NJ, USA
| | | | | | - K Van Malderen
- Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - L Wiesner
- Federal Institute for Drugs and Medical Devices, Bonn, Germany
| | - C L Chen
- ILSI-Health and Environmental Sciences Institute, Washington, DC, USA
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Tiourin E, Velasco VS, Rosales MA, Sullivan PS, Janzen DM, Memarzadeh S. Tubal Ligation Induces Quiescence in the Epithelia of the Fallopian Tube Fimbria. Reprod Sci 2015; 22:1262-71. [PMID: 25736327 PMCID: PMC5933088 DOI: 10.1177/1933719115574345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Tubal ligation keeps the fimbriated end of the fallopian tube intact while interrupting the conduit for sperm and egg between the uterus and ovary. Tubal ligation is associated with an approximately 20% decreased risk of high-grade serous ovarian cancers, which mounting evidence suggests arise from the distal fallopian tube epithelium. We postulated that biological changes at the epithelial cellular level of the distal fallopian tube may account for the surgical procedure's observed risk reduction. We compared the histology, presence of epithelial progenitors (basally located CD44-positive cells), and degree of epithelial proliferation (Ki67-positive cells) of distal fallopian tube from 10 patients with previous tubal ligation and 10 age-matched patients with uncut fallopian tubes. A significantly reduced population of proliferating epithelial progenitors (basally located CD44/Ki67 dual-positive cells) was detected in the tubal ligated specimens (P = .0002). To functionally assess the effect of tubal ligation, a murine model was utilized to compare the growth capacity of distal fallopian tube epithelial cells isolated from either ligated or sham-operated tubal epithelia. Murine fallopian tube epithelial cells isolated after tubal ligation showed a significantly reduced capacity to grow organoids in culture compared to sham-operated controls (P = .002). The findings of this study show that tubal ligation is associated with a reduced presence and decreased proliferation of progenitor cells in the distal fallopian tube epithelium. These compositional and functional changes suggest that tubal ligation induces quiescence of distal fallopian tube epithelial cells.
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Affiliation(s)
- Ekaterina Tiourin
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor S Velasco
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Miguel A Rosales
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Peggy S Sullivan
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Deanna M Janzen
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Sanaz Memarzadeh
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California Los Angeles, Los Angeles, CA, USA The VA Greater Los Angeles Health Care System, Los Angeles, CA, USA
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Abstract
OBJECTIVE To determine the cumulative incidence of live delivery in women who underwent reversal of tubal sterilization. DESIGN Population-based retrospective cohort study. SETTING Hospitals in Western Australia. PATIENT(S) All women aged 20-44 years, with a history of hospital admission for tubal sterilization, who subsequently underwent reversal of sterilization during the period 1985 to 2009 in Western Australia (n = 1,898). INTERVENTION(S) Data regarding reversal of sterilization and prior tubal sterilization were extracted from routinely collected administrative hospital separation records, until commencement of IVF treatment. MAIN OUTCOME MEASURE(S) First live-delivery rates. RESULT(S) There were 969 first live deliveries observed during the study period. The overall cumulative live-delivery rate was 20% (95% confidence interval [CI] 18-23) within the first year after reversal, 40% (95% CI 38-42) at 2 years, 51% (95% CI 48-53) at 5 years, and 52% (95% CI 50-55) at 10 years. The 5-year cumulative live-delivery rate was significantly lower in women who were aged 40-44 years (26%) compared with younger women (aged 20-29, 30-34, and 35-39 years) (50%, 56%, and 51%, respectively). CONCLUSION(S) Women undergoing reversal of sterilization before they reach age 40 years have at least a 50% chance of delivering a live baby within the next 5 years. Up to that age, there is no significant difference in live deliveries. The live-delivery rate halves after the age of 40 years.
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Moaddab A, McCullough LB, Chervenak FA, Fox KA, Aagaard KM, Salmanian B, Raine SP, Shamshirsaz AA. Health care justice and its implications for current policy of a mandatory waiting period for elective tubal sterilization. Am J Obstet Gynecol 2015; 212:736-9. [PMID: 25935572 DOI: 10.1016/j.ajog.2015.03.049] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 02/27/2015] [Accepted: 03/26/2015] [Indexed: 01/12/2023]
Abstract
Tubal sterilization during the immediate postpartum period is 1 of the most common forms of contraception in the United States. This time of the procedure has the advantage of 1-time hospitalization, which results in ease and convenience for the woman. The US Collaborative Review of Sterilization Study indicates the high efficacy and effectiveness of postpartum tubal sterilization. Oral and written informed consent is the ethical and legal standard for the performance of elective tubal sterilization for permanent contraception for all patients, regardless of source of payment. Current health care policy and practice regarding elective tubal sterilization for Medicaid beneficiaries places a unique requirement on these patients and their obstetricians: a mandatory waiting period. This requirement originates in decades-old legislation, which we briefly describe. We then introduce the concept of health care justice in professional obstetric ethics and explain how it originates in the ethical concepts of medicine as a profession and of being a patient and its deontologic and consequentialist dimensions. We next identify the implications of health care justice for the current policy of a mandatory 30-day waiting period. We conclude that Medicaid policy allocates access to elective tubal sterilization differently, based on source of payment and gender, which violates health care justice in both its deontologic and consequentialist dimensions. Obstetricians should invoke health care justice in women's health care as the basis for advocacy for needed change in law and health policy, to eliminate health care injustice in women's access to elective tubal sterilization.
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Affiliation(s)
- Amirhossein Moaddab
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Laurence B McCullough
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
| | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Weill Medical College of Cornell University/New York Presbyterian Hospital, New York, NY
| | - Karin A Fox
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | | | - Bahram Salmanian
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Susan P Raine
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
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Veersema S. Hysteroscopy and contraception. Best Pract Res Clin Obstet Gynaecol 2015; 29:940-50. [PMID: 26013880 DOI: 10.1016/j.bpobgyn.2015.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
The Essure method is the only available hysteroscopic sterilisation method. A 4-cm device is placed in the fallopian tubes, which then induces an inflammatory reaction that causes occlusion. The method has a high successful placement rate and high effectiveness, and it can be performed in an office setting without anaesthesia. Three months after the procedure, a confirmation test has to be conducted to assure a correct position of the micro-inserts and tubal occlusion. This test can be performed by hysterosalpingography (HSG), plain X-ray or ultrasound. Pregnancies reported after Essure sterilisation are, in a majority, related to non-adherence to the follow-up protocol or misreading of the confirmation test. A majority of the pregnancies occurred after HSGs that were determined to have been misinterpreted, including missed expulsion or perforation of the micro-insert. Other complications such as ectopic pregnancy and allergic reaction to the micro-inserts seem to have been described to be of low incidence.
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Affiliation(s)
- Sebastiaan Veersema
- Department of Obstetrics & Gynaecology, St Antonius Hospital, Nieuwegein, The Netherlands.
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23
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Yu PH, Weng CC, Kuo HC, Chi CH. Evaluation of endoscopic salpingectomy for sterilization of female Formosan macaques (Macaca cyclopis). Am J Primatol 2014; 77:359-67. [DOI: 10.1002/ajp.22354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 09/29/2014] [Accepted: 10/10/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Pin-Huan Yu
- National Taiwan University; Taipei City Taiwan
| | | | - Hung-Chih Kuo
- Department of Veterinary Medicine; National Chiayi University; Chiayi City Taiwan
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Effect of tubal sterilization technique on risk of serous epithelial ovarian and primary peritoneal carcinoma. Gynecol Oncol 2014; 135:423-7. [PMID: 25316178 DOI: 10.1016/j.ygyno.2014.10.005] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/26/2014] [Accepted: 10/05/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the effect of excisional tubal sterilization on subsequent development of serous epithelial ovarian cancer (EOC) or primary peritoneal cancer (PPC). METHODS We performed a population-based, nested case-control study using the Rochester Epidemiology Project. We identified all patients with a diagnosis of serous EOC or PPC from 1966 through 2009. Each case was age-matched to 2 controls without either diagnosis. Odds ratios (ORs) and corresponding 95% CIs were estimated from conditional logistic regression models. Models were adjusted for prior hysterectomy, prior salpingo-oophorectomy, oral contraceptive use, endometriosis, infertility, gravidity, and parity. RESULTS In total, we identified 194 cases of serous EOC and PPC during the study period and matched them with 388 controls (mean [SD] age, 61.4 [15.2] years). Fourteen cases (7.2%) and 46 controls (11.9%) had undergone tubal sterilization. Adjusted risk of serous EOC or PPC was slightly lower after any tubal sterilization (OR, 0.59 [95% CI, 0.29-1.17]; P=.13). The rate of excisional tubal sterilization was lower in cases than controls (2.6% vs 6.4%). Adjusted risk of serous EOC and PPC was decreased by 64% after excisional tubal sterilization (OR, 0.36 [95% CI, 0.13-1.02]; P=.054) compared with those without sterilization or with nonexcisional tubal sterilization. CONCLUSIONS We present a population-based investigation of the effects of excisional tubal sterilization on the risk of serous EOC and PPC. Excisional methods may confer greater risk reduction than other sterilization methods.
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Stulberg DB, Hoffman Y, Dahlquist IH, Freedman LR. Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns' experiences. Contraception 2014; 90:422-8. [PMID: 24912729 DOI: 10.1016/j.contraception.2014.04.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 04/22/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Tubal sterilization remains one of the most commonly requested contraceptive methods in the United States. Catholic hospital policy prohibits all sterilizations, but this ban is not uniformly enforced. We conducted this study to assess obstetrician-gynecologists' beliefs and experiences with tubal ligation in Catholic hospitals. STUDY DESIGN We interviewed 31 obstetrician-gynecologists geographically dispersed throughout the US who responded to a national survey and agreed to be contacted for a follow-up interview or who were referred by colleagues from the survey sample. Twenty-seven had experienced working in a Catholic hospital. Interviews were open ended and guided by a semistructured instrument. Transcripts were thematically analyzed. RESULTS Obstetrician-gynecologists disagreed with strict prohibition of sterilizations, especially when denying a tubal ligation placed the patient at increased medical risk. Cesarean delivery in Catholic hospitals raised frustration for obstetrician-gynecologists when the hospital prohibited a simultaneous tubal ligation and, thus, sent the patient for an unnecessary subsequent surgery. Obstetrician-gynecologists described some hospitals allowing tubal ligations in limited circumstances, but these workarounds were vulnerable to changes in enforcement. Some obstetrician-gynecologists reported that Catholic policy posed greater barriers for low-income patients and those with insurance restrictions. CONCLUSION Obstetrician-gynecologists working in Catholic hospitals in this study did not share the Church's beliefs on sterilization. Research to understand patients' experiences and knowledge of their sterilization options is warranted in order to promote women's autonomy and minimize risk of harm. IMPLICATIONS STATEMENT Tubal sterilization, even when medically indicated or in conjunction with cesarean delivery, is severely restricted for women delivering in Catholic hospitals. For women whose only access to hospital care is at a Catholic institution, religious policies can prevent them from receiving a desired sterilization and place them at risk for future undesired pregnancy.
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Affiliation(s)
- Debra B Stulberg
- Department of Family Medicine, University of Chicago, Chicago, IL; MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL; Department of Obstetrics & Gynecology, University of Chicago, Chicago, IL.
| | - Yael Hoffman
- Department of Family Medicine, University of Chicago, Chicago, IL
| | | | - Lori R Freedman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA
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26
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Gizzo S, Bertocco A, Saccardi C, Di Gangi S, Litta PS, D'antona D, Nardelli GB. Female sterilization: Update on clinical efficacy, side effects and contraindications. MINIM INVASIV THER 2014; 23:261-70. [DOI: 10.3109/13645706.2014.901975] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Robot-assisted laparoscopy for infertility treatment: current views. Fertil Steril 2014; 101:621-6. [DOI: 10.1016/j.fertnstert.2014.01.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/10/2014] [Accepted: 01/15/2014] [Indexed: 12/22/2022]
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Comparison of tubal sterilization procedures performed by keyless abdominal rope-lifting surgery and conventional CO2 laparoscopy: a case controlled clinical study. ScientificWorldJournal 2013; 2013:963615. [PMID: 24453932 PMCID: PMC3886610 DOI: 10.1155/2013/963615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 10/08/2013] [Indexed: 12/12/2022] Open
Abstract
Objective. To evaluate the safety and efficacy of Keyless Abdominal Rope-Lifting Surgery (KARS), for tubal sterilization procedures in comparison with the conventional CO2 laparoscopy. Material and Methods. During a one-year period, 71 women underwent tubal ligation surgery. Conventional laparoscopy (N = 38) and KARS (N = 33) were used for tubal sterilization. In KARS, an abdominal access pathway through a single intra-abdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intraumbilical entry without the use of trocars. In CO2 laparoscopy, following the creation of the CO2 pneumoperitoneum a 10 mm trocar and two 5 mm trocars were introduced into the abdominal cavity. Tubal sterilizations were performed following the creation of the abdominal access pathways in both groups. The groups were compared with each other. Results. All operations could be performed by KARS without conversion to CO2 laparoscopy or laparotomy. The mean operative time of the two groups was not significantly different (P > 0.05). Intra- and postoperative findings including complications, bleeding, and hospital stay time did not differ between groups (P > 0.05). Conclusion. KARS for tubal sterilization seems safe and effective in terms of cosmesis, postoperative pain, and early hospital discharge.
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Risk-reducing salpingectomy as preventative strategy for pelvic serous cancer. Int J Gynecol Cancer 2013; 23:417-21. [PMID: 23385282 DOI: 10.1097/igc.0b013e3182849dba] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The systemic failure to detect early-stage ovarian cancer may be attributed to a significant amount of pelvic serous cancers arising from the fallopian tube rather than the ovarian surface epithelium. This article reviews the possibility of applying risk-reducing salpingectomy as a new paradigm for the prevention of pelvic serous cancer in both high- and low-risk women.
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Hirshfeld-Cytron J, Winter J. Laparoscopic tubal reanastomosis versus in vitro fertilization: cost-based decision analysis. Am J Obstet Gynecol 2013; 209:56.e1-6. [PMID: 23583214 DOI: 10.1016/j.ajog.2013.04.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 03/17/2013] [Accepted: 04/08/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Regret after tubal ligation continues to be a problem. After tubal ligation, couples have the option of tubal surgery or in vitro fertilization (IVF). STUDY DESIGN Using decision analysis techniques, we compared cost-effectiveness of tubal reanastomosis by tubal type vs tubal surgery or in vitro fertilization (IVF) for 3 separate age groups of women: <35 years of age, 35 to 40 years of age and >40 years of age. Tubal techniques was divided into type A, those with more favorable prognosis because of the likelihood of having a more significant length tube at time of reanastomosis and type B, those with a worse prognosis of success. We incorporated delivery costs to address the impact of high order multiples in IVF. Data were extracted by studies available in the literature. All costs were adjusted to 2012 US dollars. One-way and 2-way sensitivity analyses were performed. RESULTS The laparoscopic reanastomosis of type A dominated the other groups, because it was more effective and less costly then type B and IVF. However, when women were >40 years old with a history of type B, IVF was favored when its costs were at the lower limit. CONCLUSION The most cost-effective choice for a woman desiring pregnancy after tubal ligation is laparoscopic reanastomosis after a prior clip or ring tubal ligation for women ≤40 years old. It is also the most cost-effective for the oldest cohort, assuming IVF costs are greater than $4500.
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Gilks CB, Miller D. Opportunistic salpingectomy for women at low risk for development of ovarian carcinoma: The time has come. Gynecol Oncol 2013; 129:443-4. [DOI: 10.1016/j.ygyno.2013.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sieh W, Salvador S, McGuire V, Weber RP, Terry KL, Rossing MA, Risch H, Wu AH, Webb PM, Moysich K, Doherty JA, Felberg A, Miller D, Jordan SJ, Goodman MT, Lurie G, Chang-Claude J, Rudolph A, Kjær SK, Jensen A, Høgdall E, Bandera EV, Olson SH, King MG, Rodriguez-Rodriguez L, Kiemeney LA, Marees T, Massuger LF, van Altena AM, Ness RB, Cramer DW, Pike MC, Pearce CL, Berchuck A, Schildkraut JM, Whittemore AS. Tubal ligation and risk of ovarian cancer subtypes: a pooled analysis of case-control studies. Int J Epidemiol 2013; 42:579-89. [PMID: 23569193 PMCID: PMC3619957 DOI: 10.1093/ije/dyt042] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2013] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Tubal ligation is a protective factor for ovarian cancer, but it is unknown whether this protection extends to all invasive histological subtypes or borderline tumors. We undertook an international collaborative study to examine the association between tubal ligation and ovarian cancer subtypes. METHODS We pooled primary data from 13 population-based case-control studies, including 10,157 patients with ovarian cancer (7942 invasive; 2215 borderline) and 13,904 control women. Invasive cases were analysed by histological type, grade and stage, and borderline cases were analysed by histological type. Pooled odds ratios were estimated using conditional logistic regression to match on site, race/ethnicity and age categories, and to adjust for age, oral contraceptive use duration and number of full-term births. RESULTS Tubal ligation was associated with significantly reduced risks of invasive serous (OR, 0.81; 95% CI, 0.74-0.89; P < 0.001), endometrioid (OR, 0.48; 95% CI, 0.40-0.59; P < 0.001), clear cell (OR, 0.52; 95% CI, 0.40-0.67; P < 0.001) and mucinous (OR, 0.68; 95% CI, 0.52-0.89; P = 0.005) cancers. The magnitude of risk reduction was significantly greater for invasive endometrioid (P < 0.0001) and clear cell (P = 0.0018) than for serous cancer. No significant associations were found with borderline serous or mucinous tumours. CONCLUSIONS We found that the protective effects of tubal ligation on ovarian cancer risk were subtype-specific. These findings provide insights into distinct aetiologies of ovarian cancer subtypes and mechanisms underlying the protective effects of tubal ligation.
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Affiliation(s)
- Weiva Sieh
- Department of Health Research and Policy, Stanford University, Stanford, CA 94305-5405, USA.
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Ercan CM, Sakinci M, Coksuer H, Keskin U, Tapan S, Ergun A. Ovarian reserve testing before and after laparoscopic tubal bipolar electrodesiccation and transection. Eur J Obstet Gynecol Reprod Biol 2012; 166:56-60. [PMID: 23036487 DOI: 10.1016/j.ejogrb.2012.09.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 07/25/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To find out whether tubal sterilization leads to loss of ovarian reserve, we assessed the hormonal and ultrasonographic parameters of ovarian reserve in women who underwent laparoscopic tubal sterilization by bipolar electrodesiccation and transection. STUDY DESIGN In this preliminary study, laparoscopic tubal sterilization was performed on 49 healthy women who had voluntarily requested elective surgical sterilization. Among the current ovarian reserve indicators, in the early proliferative phases, preoperative (baseline) and postoperative (third month) serum follicle-stimulating hormone (FSH), estradiol (E2), and anti-Mullerian hormone (AMH) levels, ovarian volume, and antral follicle counts (AFCs) were determined. Analysis of these hormonal and ultrasonographic parameters of ovarian reserve preoperatively and postoperatively was the main outcome measure. RESULTS Preoperative and third-month postoperative FSH, LH, E2, and AMH levels did not reveal statistically significant differences (p=0.101, p=0.180, p=0.254, and p=0.079; respectively). The ultrasonographic indicators of ovarian reserve did not change in terms of total ovarian volume and total AFC (p=0.793 and p=0.098, respectively). CONCLUSIONS Short-term follow-up study results revealed a slight but non-significant change in the current ovarian reserve markers, especially in the AMH levels.
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Affiliation(s)
- Cihangir Mutlu Ercan
- Gulhane Military Medical Academy, Obstetrics and Gynecology Department, 06018 Etlik, Ankara, Turkey.
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[Robot-assisted coelioscopic proximal tubal reanastomosis]. ACTA ACUST UNITED AC 2012; 41:54-7. [PMID: 22521989 DOI: 10.1016/j.gyobfe.2012.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 10/26/2011] [Indexed: 11/21/2022]
Abstract
We report two cases of robot-assisted coelioscopic proximal tubal reanastomosis after proximal tubal ligature. Patients were aged 43 and 34 years respectively and had previously undergone proximal tubal ligation by coagulation section at 37 years of age for the first patient, and by Filshie clip at 24 years for the second one. Both had regular menstrual cycles and their ovarian reserve was good. Their partners were presenting with normal sperm criteria. Proximal tubal reanastomosis was carried out in September 2010 by robotic coelioscopy with five extramucous vicryl 5-0 stitches on each tube and positive blue testing. Total durations of the interventions were 200 and 220minutes respectively. Postoperative outcomes were simple and patients had spontaneous pregnancy at 4 and 2.5 months respectively. Both pregnancies show normal progress currently. This is a contribution to literature data meant to determine the role of robotics in proximal tubal reanastomosis.
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Chapa HO, Venegas G. Preprocedure patient preferences and attitudes toward permanent contraceptive options. Patient Prefer Adherence 2012; 6:331-6. [PMID: 22563241 PMCID: PMC3340118 DOI: 10.2147/ppa.s30247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine patient preference for laparoscopic tubal occlusion or hysteroscopic tubal occlusion, two common sterilization interventions, and the acceptability of a postprocedure confirmation test for a hysteroscopic approach. PARTICIPANTS AND METHODS A total of 100 patients were offered two procedures. A description of each procedure was developed and read to each patient by a research nurse on site. Patients were then asked to respond to a questionnaire concerning options. Final informed consent, procedure review, and procedural date determination were provided by a physician upon completion of the questionnaire. Patients were not allowed to change their questionnaire responses after completion. No interviewer or physician input was allowed during the questionnaire. The study was completed in English or Spanish, as per patient request, by a bilingual/fluent speaker. Physicians completing informed consent were unaware of the questionnaire responses. Patients were not financially incentivized. RESULTS Of 100 participants, 93 (93%) preferred hysteroscopic sterilization to laparoscopy. The reasons were as follows: fear of general anesthesia (24/93 [26%]), fear of incision (25/93 [27%]), cost (32/93 [34%]), and time (12/93 [13%]) to return to routine activity. All 93 viewed "office-based location" as the main advantage over laparoscopy; 88/93 (94.6%) considered a confirmation test to be a benefit of the procedure. After informed consent was obtained, one additional patient switched from a laparoscopic decision to hysteroscopy (total = 94/100); 89/94 (95%) hysteroscopic decisions underwent hysteroscopic sterilization; 4/6 (67%) laparoscopic decisions proceeded to that surgery. The remainder (N = 7) cancelled due to lack of financial resources. CONCLUSION A nonincisional, office-based approach to sterilization has high patient acceptability. Patients viewed a confirmatory test for tubal occlusion as a benefit after sterilization.
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Affiliation(s)
- Hector O Chapa
- Department of Obstetrics and Gynecology, Women’s Specialty Center Dallas, Methodist Medical Center, Dallas, TX, USA
| | - Gonzalo Venegas
- Department of Obstetrics and Gynecology, Women’s Specialty Center Dallas, Methodist Medical Center, Dallas, TX, USA
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Soweid A, Yaghi S, Kobeissy A, El Majzoub N, Khreiss M, Alaeddine M, Ayoub C, Seoud M, Matar G, Jamali F. Natural orifice transluminal endoscopic surgery (NOTES): assessment of peritoneal bacterial load after intraperitoneal antimicrobial wash and evaluation of hemodynamic changes in a porcine model. MINIM INVASIV THER 2011; 21:265-70. [PMID: 21919809 DOI: 10.3109/13645706.2011.607828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Natural orifice transluminal endoscopic surgery (NOTES) is a promising newly developed procedure; however, it is associated with many complications. The main aim of our study is to assess whether peritoneal wash with antibiotics decreases the bacterial load contamination related to the transgastric approach. METHODS Ten female farm pigs underwent transgastric peritoneoscopy with fallopian tubal ligation. Five pigs were randomized to antibiotic wash of the peritoneal cavity and five to placebo. All animals were given one intravenous dose of antibiotic before the procedure. Hemodynamic variables were continuously monitored throughout the procedure. The next day, peritoneal cultures were taken. The fallopian tubes were inspected to determine the success of ligation and the gastric incision sites were assessed for leakage. RESULTS No significant difference was noted between the antibiotic peritoneal wash group and the placebo group in terms of peritoneal bacterial load with respective median colony-forming units per ml (CFU/ml) of 0 [0; 1] vs. 0 [0; 4], p = 0.637. No clinically significant hemodynamic changes were noted during the procedure. CONCLUSIONS The results of our study indicate that NOTES carries minimal risk of peritoneal bacterial contamination, regardless of the use of intraperitoneal antibiotics, and is not associated with hemodynamic compromise.
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Affiliation(s)
- Assaad Soweid
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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A comparison of novice and experienced physicians performing hysteroscopic sterilization: an analysis of an FDA-mandated trial. Fertil Steril 2011; 96:643-648.e1. [DOI: 10.1016/j.fertnstert.2011.06.047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/15/2011] [Accepted: 06/16/2011] [Indexed: 11/22/2022]
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Rudzik AEF, Leonard SH, Sievert LL. Determinants of Tubal Ligation in Puebla, Mexico. Women Health 2011; 51:365-82. [DOI: 10.1080/03630242.2011.574793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lessard CR, Hopkins MR. Efficacy, safety, and patient acceptability of the Essure™ procedure. Patient Prefer Adherence 2011; 5:207-12. [PMID: 21573052 PMCID: PMC3090382 DOI: 10.2147/ppa.s12400] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Indexed: 11/23/2022] Open
Abstract
The Essure™ system for permanent contraception was developed as a less invasive method of female sterilization. Placement of the Essure™ coil involves a hysteroscopic transcervical technique. This procedure can be done in a variety of settings and with a range of anesthetic options. More than eight years have passed since the US Food and Drug Administration approval of Essure™. Much research has been done to evaluate placement success, adverse outcomes, satisfaction, pain, and the contraceptive efficacy of the Essure™. The purpose of this review is to summarize the available literature regarding the efficacy, safety, and patient satisfaction with this new sterilization technique.
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Affiliation(s)
| | - Matthew R Hopkins
- Correspondence: Matthew R Hopkins, Mayo Clinic, Department of Obstetrics and Gynecology, 200 First Street SW, Rochester, MN 55905, USA, Tel +1 507 266 3717, Fax +1 507 266 7953, Email
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Serfaty D. Stérilisation. Contraception 2011. [DOI: 10.1016/b978-2-294-70921-0.00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Eisenberg ML, Lipshultz LI. Estimating the number of vasectomies performed annually in the United States: data from the National Survey of Family Growth. J Urol 2010; 184:2068-72. [PMID: 20850832 DOI: 10.1016/j.juro.2010.06.117] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE While hospital discharge and ambulatory surgery registries provide accurate estimates of female sterilization procedures, current estimates of male sterilization rates are lacking since these procedures are done in many settings. Population based data are used to estimate annual sterilization numbers. MATERIALS AND METHODS We analyzed data on 4,928 men and 7,643 women from the 2002 National Survey of Family Growth. We determined the year of vasectomy in men and the year of tubal ligation in women who reported a history of surgical sterilization. After accounting for the complex survey design of the National Survey of Family Growth we calculated the estimated number of individuals who underwent surgical sterilization in the United States. RESULTS A total of 141 men reported vasectomy, representing an overall 6% prevalence in National Survey of Family Growth survey population, while 1,173 women (16%) reported tubal ligation. Using National Survey of Family Growth data an estimated 175,000 to 354,000 vasectomies were done yearly from 1998 to 2002. In the same period the National Survey of Family Growth estimated that 546,000 to 789,000 tubal ligations were done annually in the United States. This compares closely to the 596,000 to 687,000 tubal ligations calculated using ambulatory surgery and hospital discharge data from a similar period. CONCLUSIONS The estimated annual number of tubal ligations from the National Survey of Family Growth is in line with the current literature using hospital discharge and ambulatory surgery registries, suggesting the accuracy of the method of estimating surgical sterilization numbers. This suggests that the National Survey of Family Growth may be used to provide an estimate of vasectomy use in the United States.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, University of California-San Francisco, San Francisco, California, USA.
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Tubal sterilization trends in the United States. Fertil Steril 2010; 94:1-6. [DOI: 10.1016/j.fertnstert.2010.03.029] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 03/09/2010] [Indexed: 11/24/2022]
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Chang WH, Liu JY, Yeh YC, Wu GJ, Chiang YJ, Yu MH, Chen CH. Tubal ligation via colpotomy or laparoscopy: a retrospective comparative study. Arch Gynecol Obstet 2010; 283:805-8. [PMID: 20339859 DOI: 10.1007/s00404-010-1435-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 03/09/2010] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare transvaginal with laparoscopic tubal sterilization with respect to invasiveness and outcomes. METHOD The outcomes of 103 patients who received interval tubal sterilization were compared. Group A (n = 38) underwent the transvaginal approach, group B (n = 38) a laparoscopic approach, and group C (n = 27) underwent mini-laparotomy due to difficulties encountered in one of the other procedures. RESULTS There were no significant differences in patient age between the groups. There was no significant difference in operative time or blood loss between groups A and B. Operative time was significantly longer in group C (120 ± 35 min) than group A (40 ± 5 min) or group B (45 ± 9 min) (p < 0.05). Blood loss was significantly greater in group C (120 ± 30 ml) than in group A (10 ± 2 ml) or group B (10 ± 1 ml) (p < 0.05). The cost of transvaginal tubal sterilization was the lowest, and that of mini-laparotomy was the highest. There was no contraception failure in any group. CONCLUSIONS Transvaginal tubal sterilization is technically more difficult, but when correctly performed it is not associated with an increased complication rate, and is less costly than laparoscopic sterilization.
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Affiliation(s)
- Wei-Hsi Chang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Centre, 325, Section 2, Cheng-Kung Road, Nei-Hu, Taipei 114, Taiwan, ROC
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Okunlola MA, Oyugbo IA, Owonikoko KM. Knowledge, attitude and concerns about voluntary surgical conception among healthcare workers in Ibadan, Nigeria. J OBSTET GYNAECOL 2009; 27:608-11. [PMID: 17896262 DOI: 10.1080/01443610701497694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
A multicentre study was conducted among healthcare workers in three major hospitals in Ibadan, south-west Nigeria. Structured questionnaires were self-administered to different cadres of healthcare workers in these hospitals with the objective of evaluating their knowledge, attitude and concerns about voluntary surgical contraception. The study revealed that though they had a generally good knowledge of voluntary surgical contraception, their attitude and concerns about the procedure was not encouraging and were largely biased. Such beliefs among healthcare workers tend to negatively influence the uptake of the procedure in the general population, further depleting the low contraceptive use in Nigeria, which has only recently attained a percentage in double figures. Strategies and means to improve on this are discussed to encourage better uptake and acceptability of the procedure among the general population.
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Affiliation(s)
- M A Okunlola
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Nigeria.
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Franchini M, Cianferoni L, Lippi G, Calonaci F, Calzolari S, Mazzini M, Florio P. Tubal sterilization by laparoscopy or hysteroscopy: which is the most cost-effective procedure? Fertil Steril 2009; 91:1499-502. [DOI: 10.1016/j.fertnstert.2008.08.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2008] [Revised: 07/26/2008] [Accepted: 08/07/2008] [Indexed: 10/21/2022]
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Rackow BW, Rhee MC, Taylor HS. Training of residents in laparoscopic tubal sterilization: long-term failure rates. EUR J CONTRACEP REPR 2008; 13:148-52. [PMID: 18465476 DOI: 10.1080/13625180801920180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Laparoscopic tubal sterilization with bipolar coagulation is a common and effective method of contraception, and a procedure much used to teach laparoscopic surgical skills to Obstetrics and Gynaecology residents (trainees); but it has an inherent risk of failure. This study investigated the long-term failure rate of this procedure when performed by Obstetrics and Gynaecology residents on women treated in their teaching clinics. METHODS From 1991 to 1994, Obstetrics and Gynaecology residents carried out 386 laparoscopic tubal sterilizations with bipolar coagulation at Yale-New Haven Hospital. Six to nine years after the procedure, the women concerned were contacted by telephone and data were collected about sterilization failure. RESULTS Two failures of laparoscopic tubal sterilization with bipolar coagulation were identified: an ectopic pregnancy and a spontaneous abortion. For this time period, the long-term sterilization failure rate was 1.9% (0-4.4%). CONCLUSIONS The long-term sterilization failure rate for laparoscopic tubal sterilization with bipolar coagulation performed by residents is comparable to the results of prior studies. These findings can be used to properly counsel women at a teaching clinic about the risks of sterilization failure with this procedure, and attest to the adequacy of residents' training and supervision.
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Affiliation(s)
- Beth W Rackow
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
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Abstract
BACKGROUND Tubal sterilization is a common method of contraception used worldwide. The Filshie clip is a device designed to occlude the fallopian tubes. It is common practice to apply the clips across the isthmus using laparoscopy. It is often suggested that failures occur due to problems with the technique used to occlude the fallopian tubes. CASE After insertion of an intrauterine device, a patient experienced an unplanned pregnancy and subsequent abortion. The intrauterine device was removed, and bilateral Filshie clips were applied by an experienced surgeon. After this procedure, the patient experienced a second unplanned pregnancy and subsequent abortion. A partial salpingectomy was performed after the fallopian tubes were examined, and it was confirmed that the Filshie clips were applied appropriately. CONCLUSION It is important to understand why sterilization clips lead to contraceptive failure and to inform patients of this risk. Contraceptive failure after female sterilization remains a medical issue.
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