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Gormley R, Vickers B, Cheng B, Norman WV. Comparing options for females seeking permanent contraception in high resource countries: a systematic review. Reprod Health 2021; 18:154. [PMID: 34284794 PMCID: PMC8290533 DOI: 10.1186/s12978-021-01201-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception. METHODS We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle-Ottawa Scale to assess risk of bias and excluded studies with medium-high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis. RESULTS Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium-high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC. CONCLUSIONS Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making. SYSTEMATIC REVIEW REGISTRATION PROSPERO [CRD42016038254].
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Affiliation(s)
- Rebecca Gormley
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Brian Vickers
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Brooke Cheng
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Wendy V Norman
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Contraception & Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada. .,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK. .,Department of Family Practice, University of British Columbia, 320-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
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Schueler KE, Hebert LE, Wingo EE, Freedman LR, Stulberg DB. Denial of tubal ligation in religious hospitals: Consumer attitudes when insurance limits hospital choice. Contraception 2021; 104:194-201. [PMID: 33657425 DOI: 10.1016/j.contraception.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/17/2021] [Accepted: 02/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Postpartum tubal ligation provides demonstrated benefits to women, but access to this procedure is threatened by restrictions at Catholic healthcare institutions. We aimed to understand how insured employees assign responsibility for postpartum sterilization denial and how it impacts their view of the quality of care provided. STUDY DESIGN We conducted a nationally representative, cross-sectional survey of employees at Standard and Poor's (S&P) 500 companies utilizing a dual panel drawn from Amerispeak, a probability-based research panel, and a non-probability panel. Respondents answered questions about a scenario of a woman denied a tubal ligation due to Catholic hospital policy when her employer-sponsored insurance provided no other hospital choices. Of 1113 eligible panel members, 1001 (90%) completed the survey. Weighted analysis accounted for complex survey design. RESULTS In response to the tubal ligation denial scenario, 42% of respondents rated hospital quality-of-care as poor or very poor. Sixty percent felt that something should have been done differently, with about half assigning responsibility to the religiously-affiliated hospital for not providing the procedure and half to the insurance company for not including secular hospitals in its network. Finding employers/insurance companies responsible was more common with higher education (RRR = 3.17; 95% CI: 1.58-6.33 some college; RRR = 4.26; 95% CI: 2.10-8.62 bachelor's or more) and less common among non-white respondents (RRR = 0.54; 95% CI: 0.31-0.97). Three quarters of respondents thought the employer should have intervened. CONCLUSIONS The majority of insured employees do not think women should be denied postpartum tubal ligation. They assign hospitals, insurers, and employers responsibility to remove barriers to care. IMPLICATIONS Most people who receive health insurance through a large employer disapprove of Catholic hospital restrictions when the patient's insurance restricts her hospital choice. To improve access to comprehensive reproductive care, employers and insurers should assure employees have in-network coverage of hospitals without religious restrictions.
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Affiliation(s)
- Kellie E Schueler
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Luciana E Hebert
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, WA, USA
| | - Erin E Wingo
- Department of Family and Community Medicine, University of California San Francisco, San Francisco General Hospital, San Francisco, CA, USA
| | - Lori R Freedman
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA; Advancing New Standards in Reproductive Health (ANSIRH), University of California San Francisco, Oakland, CA, USA
| | - Debra B Stulberg
- Department of Family Medicine, University of Chicago, Chicago, IL, USA.
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Salam Ansari A, Sevliya K, Badar A, Lohiya NK. Reversible inhibition of sperm under guidance as an intratubular and reversible contraception in female rats: An experimental study. Int J Reprod Biomed 2021; 19:47-56. [PMID: 33554002 PMCID: PMC7851472 DOI: 10.18502/ijrm.v19i1.8179] [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: 04/27/2019] [Revised: 08/31/2019] [Accepted: 06/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reversible inhibition of sperm under guidance (“RISUGⓇ”) is a promising intravasal male contraceptive. Objective An exploratory study was conducted with a concept of non-invasive, transcervical, single-intervention and reversible contraception using RISUGⓇ in females. Materials and Methods In this experimental study, 60 adult Wistar albino female rats weighing 150-155 g, 3-4 months old were divided into four groups: group I: sham-operated control; group II: tubal occlusion with RISUG for 90 days; group III: tubal occlusion with RISUGⓇ for 90 days and reversal with dimethyl sulphoxide and group IV: tubal occlusion with RISUGⓇ for 90 days and reversal with 5% NaHCO. Animals were subjected to bilateral fallopian tube occlusion with RISUGⓇ and reversal with DMSO and NaHCO3. The estrous cycle, fertility and histology of fallopian tube were evaluated. Results Group I showed 100% fertility during all mating schedules. Animals of experimental groups indicated positive mating, but 0% fertility was evident following 30, 60, and 90 days of tubal occlusion. However, after reversal, fertility steadily increased to normalcy in groups III (50% at 45 days, 80% at 105 days, 100% at 150 and 195 days) and IV (70% at 45 and 105 days, 100% at 150 and 195 days) animals. Group II illustrated disorganized inner cell linings and eosinated RISUGⓇimplant-filled lumen. Reversal groups (III and IV) revealed complete restoration of cellular histo-architecture. Regular estrous cycle was noticed in all experimental groups.
Conclusion RISUGⓇ is suitable for single intervention, intratubular, reversible contraception in female rats.
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Affiliation(s)
- Abdul Salam Ansari
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
| | - Kiran Sevliya
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
| | - Ayesha Badar
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
| | - Nirmal Kumar Lohiya
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
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Hariswamy S, Isaacs K. Migrating Filshie clip: a possible rare cause of appendicitis. ANZ J Surg 2020; 90:2097-2098. [PMID: 32187835 DOI: 10.1111/ans.15831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/05/2020] [Accepted: 03/05/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Soumya Hariswamy
- General Surgery, The Tweed Heads Hospital, Tweed Heads, New South Wales, Australia
| | - Kim Isaacs
- General Surgery, The Tweed Heads Hospital, Tweed Heads, New South Wales, Australia
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Effect of simethicone on reducing operative difficulty associated with bowel interference during minilaparotomy for modified Pomeroy salpingectomy: A randomized controlled trial .. Contraception 2020; 101:178-182. [PMID: 31927026 DOI: 10.1016/j.contraception.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/27/2019] [Accepted: 12/01/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To examine the effect of simethicone on reducing operative difficulty associated with bowel interference during minilaparotomy for postpartum modified Pomeroy partial salpingectomy. STUDY DESIGN We enrolled 20-45-year-old women planning the procedure from March 2018 to February 2019. We randomized participants to chew simethicone 160 mg with water 50 mL 2-8 h before surgery or no treatment. The participants were not blinded; however, surgeons, care providers, and outcome assessors were blinded to the study allocation. We measured surgeon-rated operative difficulty using a 10-cm visual analog scale that represented the difficulty perceived to be resulting from bowel interference. Secondary outcomes included operative time and intraoperative and postoperative complications. RESULTS We enrolled 60 women in each group; baseline characteristics and procedural profiles were comparable. Women in the intervention group used simethicone a median of 157 min (interquartile range 127-192) before the procedure. Surgeons rated the procedure difficulty score as 4.8 in the simethicone group and 4.5 in the control group (p = 0.57). Operative time in the two groups were 26 and 24 min, respectively (p = 0.14). We found no difference in intraoperative adverse events including blood loss and mesosalpinx tear, postoperative morbidities, hospital stay, and patient-rated satisfaction scores. CONCLUSION Preprocedural simethicone has no demonstrable benefit in reducing operative difficulty caused by bowel interference during minilaparotomy for postpartum tubal sterilization. IMPLICATIONS Preprocedural simethicone as given in this study did not result in reduced bowel interference and improved procedure difficulty. Further research examining simethicone in this setting would not be worthwhile as clinically meaningful benefit is unlikely.
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Jokinen E, Heino A, Karipohja T, Gissler M, Hurskainen R. Authors' reply re: Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy or laparotomy: a register-based study. BJOG 2018; 125:764-765. [PMID: 29411498 DOI: 10.1111/1471-0528.15117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ewa Jokinen
- Obstetrics and Gynaecology, Hyvinkää Hospital, Hyvinkää, Finland.,Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - Anna Heino
- National Institute for Health and Welfare, Helsinki, Finland
| | - Tuula Karipohja
- Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Helsinki, Finland
| | - Ritva Hurskainen
- Obstetrics and Gynaecology, Hyvinkää Hospital, Hyvinkää, Finland.,Obstetrics and Gynaecology, Helsinki University Hospital, Helsinki, Finland
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Wright E, Leung V, Bhansali A, Chaudhry M, Mahran M. Re: Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy or laparotomy: a register-based study. BJOG 2018; 125:764. [PMID: 29405606 DOI: 10.1111/1471-0528.15116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 11/28/2022]
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Espey E, Hofler LG. Evaluating the Long-term Safety of Hysteroscopic Sterilization. JAMA 2018; 319:2670235. [PMID: 29362776 DOI: 10.1001/jama.2017.21268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eve Espey
- Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
| | - Lisa G Hofler
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque
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