An economic comparison of female sterilization of hysteroscopic tubal occlusion with laparoscopic bilateral tubal ligation

Background

This study compares the expected 5-year costs for permanent sterilization in women between nonincisional hysteroscopic tubal occlusion with the Essure® system performed in an office setting and laparoscopic bilateral tubal ligation (LBTL).

Study Design

An economic decision tree is used to predict outcomes and costs to compare these two procedures from a US Medicaid perspective over a 5-year time horizon.

Results

Expected costs are $2367 for Essure® and $3545 for LBTL (Essure® saves $1178 or 33% of LBTL costs). Sensitivity analyses show Essure® has lower expected costs across all values considered. If the cost for a LBTL procedure were to decrease by 20% and the cost for Essure® to increase by 20%, Essure® would have still have lower expected costs.

Conclusion

Office-based sterilization for women using Essure® can lead to substantial cost savings over 5 years compared to LBTL. This conclusion is robust to varying analytic inputs.     

Identifying women who will request sterilization reversal in a military population

OBJECTIVE: We sought to identify the characteristics of women in a military population who are likely to seek a tubal anastomosis after a previous bilateral tubal ligation (BTL). METHOD: A written investigational review board-approved questionnaire was administered to 56 women, ages 18-40 years, requesting evaluation for a reversal of a prior BTL and 52 women of the same age range not seeking reversal. The questionnaire identified demographics and relationship characteristics of volunteers at the time of their decision to have a BTL and at the present time. RESULTS: Age 25 years or younger, sterilization due to pressure from a partner, poor marital relationship at the time of the BTL and a new marriage are highly predictive of tubal sterilization regret and a request for sterilization reversal in a military population. In addition, women requesting a tubal anastomosis reported less preoperative counseling on the permanence of a BTL and of the male alternative for permanent female sterilization, vasectomy. CONCLUSION: Women with these characteristics should have extensive counseling before undergoing tubal sterilization.     

Improving hysterosalpingogram confirmatory test follow-up after Essure hysteroscopic sterilization

Background

Given the need for a 90-day post-Essure hysterosalpingogram (HSG) to confirm proper tubal placement and occlusion, we examined the impact of dedicating a staff nurse to schedule HSG appointments, call with appointment reminders and track HSG compliance for patients who had Essure.

Study Design

We performed a retrospective chart review for patients who underwent Essure sterilization between October 2003 and January 2009. We compared rates of HSG compliance and confirmed tubal occlusion for patients before February 2008 with rates after the protocol change occurred.

Results

Seventy-eight percent of preintervention patients were compliant with at least one HSG following Essure placement compared to 90.9% in the post-intervention group (p value=.033). Tubal occlusion was confirmed by postprocedure HSGs for 123/173 patients (71.1%) in the preintervention group and 48/55 patients (87.3%) in the postintervention group. Patients followed by our staff after our protocol change were more likely to undergo post-Essure compliance (Odds ratio= 2.7, confidence interval = 1.2–7.1, p=.01).

Conclusion

Dedicating a staff nurse to track patients' HSG follow-up as a multicheck system resulted in an improvement in HSG compliance and rates of confirmed tubal placement and occlusion.     

阿司匹林对宫腔镜下宫腔粘连分离术后妊娠影响的Meta分析

目的 系统评价阿司匹林对宫腔镜下宫腔粘连分离术后妊娠的影响.方法 计算机检索PubMed、Cochrane Library、EMbase、中国知网、CBM及万方数据库,检索时间为2020年10月1日前,检索词为"阿司匹林"或"乙酰水杨酸""宫内粘连"或"Asherman综合征"或"IUA".收集宫腔镜下宫腔粘连分离术后...     

The safety,efficacy and acceptability of task sharing tubal sterilization to midlevel providers: a systematic review

Background

Task sharing is an important strategy for increasing access to modern, effective contraception for women and reducing unmet need for family planning.

Objective

The objective was to identify evidence for the safety, efficacy or acceptability of task sharing tubal sterilization to midlevel providers.

Search strategy

We searched PubMed, Cochrane and Popline for articles in all languages using the following key words: task sharing, tubal sterilization, midlevel providers, task shifting.

Selection criteria

All studies reporting on any measure of safety, efficacy or acceptability of tubal sterilization performed by any cadre of midlevel providers.

Data collection and analysis

Data were independently abstracted by two authors and graded using the United States Preventive Services Task Force rating for evidence quality. Heterogeneity of outcome measures precluded a meta-analysis.

Main results

Nine studies of fair to poor quality reported on safety and acceptability outcomes. Generalizability of findings is limited by inadequate sample size and lack of statistical comparisons. No study reported on long-term efficacy outcomes.

Conclusions

Well-designed clinical trials, of adequate sample size, are urgently needed to establish the safety, efficacy and acceptability of task sharing tubal sterilization to midlevel providers.     

Contraceptive sterilization use among married men in the United States: results from the male sample of the National Survey of Family Growth

Background

Surgical sterilization has many advantages. Previous information on prevalence and correlates was based on surveys of women.

Study Design

We estimated the prevalence of vasectomy and tubal ligation of partners for male participants in the 2002 National Survey of Family Growth, a nationally representative survey of US residents aged 15-44 years. We identified factors associated with sterilizations using bivariate and multivariate techniques.

Results

The findings revealed that 13.3% of married men reported having had a vasectomy and 13.8% reported tubal sterilization in their partners. Vasectomy increased with older age and greater number of biological children, non-Hispanic white ethnicity, having ever gone to a family planning clinic. Tubal sterilization use was more likely among men who had not attended college, those of older age and those with live births.

Discussion

One in eight married men reported having vasectomies. Men who rely on vasectomies have a somewhat different profile than those whose partners have had tubal sterilizations.     

Use of erythromycin for nonsurgical female sterilization in West Bengal, India: a study of 790 cases

OBJECTIVE: Determine if erythromycin is an effective agent for achieving occlusion of the Fallopian tube for nonsurgical female sterilization. METHODS: Two studies of 100 healthy volunteers requesting sterilization were planned, one in Julpia Andhermanik and the other in Kolkata (Calcutta). A readily available marketed tablet preparation containing 500 mg of the estolate salt of erythromycin was used for the trial. In one study (Bishnupur), the tablet was crushed before placing in a copper-T IUD inserter for placement at the fundus. In the other study (Kolkata), crushed tablets were processed into 50 mg pellets of the same diameter as standard quinacrine pellets and 10 pellets were inserted at the fundus using aseptic precautions. Procedures in each study were repeated at 30 days. Oral contraceptives were prescribed for three cycles following first insertion. No incentive was offered for participation in the trial. Follow-up treatment, including first-trimester abortion for pregnancy due to failure of the sterilization procedure, was assured without charge. Due to extraordinary patient demand, one study (Bishnupur) was expanded to 690 cases for reasons of compassion. RESULTS: At 12 months of use, the failure rate of the sterilization procedure for the crushed 500 mg tablets was 35.8% (SE = 1.8) with 417 women at risk. At 12 months of use, the failure rate for the erythromycin pellets was 28.6% (SE = 5.0) with 43 women at risk. There were no serious complications reported in either trial. All pregnancies resulting from failure of the sterilization procedure were terminated by menstrual regulation within 10 weeks gestation. CONCLUSIONS: The failure rate in this study is unacceptably high for erythromycin to be used as a sterilization method.     

Barriers to obtaining a desired postpartum tubal sterilization

OBJECTIVE: To determine why women do not undergo postpartum sterilization despite expressing desire during antepartum care. METHODS: In a retrospective chart review, we identified all women between March 2002 and November 2003 who requested postpartum sterilization during antepartum care but did not undergo the procedure. We report the reasons why sterilizations were not performed. RESULTS: We reviewed 6,589 prenatal care and delivery records identifying 324 women meeting inclusion criteria. One hundred and four women changed their mind. Of women still desiring sterilization at discharge, the most common reasons for not undergoing the procedure were lack of valid Medicaid sterilization consent forms [n=121; 37.3%, 95% confidence interval (CI) 32.0-42.6%]; a medical condition precluding the procedure (n=47; 14.5%, 95% CI 10.7-18.3%); lack of availability of an operating room (n=2; 6.5%, 95% CI 3.8-9.2%). CONCLUSION: We found that the Medicaid consent process, medical conditions and insufficient operating room space prevented women from having the desired surgery.     

Vasectomy: the other (better) form of sterilization

Male sterilization (vasectomy) is the most effective form and only long-acting form of contraception available to men in the United States. Compared to female sterilization, it is more efficacious, more cost-effective, and has lower rates of complications. Despite these advantages, in the United States, vasectomy is utilized at less than half the rate of female sterilization. In addition, vasectomy is least utilized among black and Latino populations, groups with the highest rates of female sterilization. This review provides an overview of vasectomy use and techniques, and explores reasons for the disparity in vasectomy utilization in the United States.     

影响输卵管吻合术后妊娠效果的相关因素

目的:探讨输卵管吻合术后妊娠率与原绝育方法、部位、绝育年限及吻合术后输卵管长度的关系。方法:回顾性分析了2006年6月～2011年4月施行输卵管吻合术216例妇女的妊娠情况。结果:216例受术者中,妊娠184例,其中异位妊娠7例,自然流产16例,总妊娠率85.19%。吻合术后1年内妊娠率达79.30%。银夹和抽芯包埋法绝育吻合后妊娠率显著高于潘氏法(P<0.05);输卵管端端吻合,以峡-峡部妊娠率显著高于其它几个部位(P<0.05),吻合术后妊娠率与绝育年限长短无统计学相关性(P>0.05),吻合术后输卵管长度<5 cm者妊娠率明显低于>5 cm者(P<0.05)。结论:输卵管吻合术后妊娠率与原绝育方法、部位及吻合术后输卵管长度密切相关。     

Hormonal and ovarian stromal blood supply changes after laparoscopic tubal sterilization: a prospective controlled study

OBJECTIVES: The purpose of this study is to determine if the effects of tubal sterilization (TS) by laparoscopy have any risk of a subsequent significant decrease in ovarian reserve and vascular support within the ovary by means of stromal artery Doppler study, and to compare the results with matched paired controls. DESIGN: Between February 2002 and January 2005, 148 healthy volunteers were enrolled sequentially, 74 undergoing laparoscopic TS (study group) and 74 age-, parity-, body mass index-matched women were recruited as a control group. The main outcome measurements were blood levels of follicle-stimulating hormone (FSH), luteinizing hormone and E2, ovarian volume, number of antral follicles and Doppler study of ovarian stromal artery pulsatile index (PI) and maximum velocity (Vmax) on the third day of the cycle immediately before, and 1 and 12 months after the surgical intervention. RESULTS: There were significant elevations in both serum FSH levels and PI values observed 1 month after TS, compared to the preoperative levels (p < .05), and also when compared to controls. However, there were no significant elevations at 12 months postoperation in both study and control groups. The other outcome measurements did not show any significant differences between the two groups. CONCLUSIONS: Tubal sterilization by laparoscopic electrocoagulation does not cause any decrease in ovarian reserve or ovarian stromal blood supply, except an early postoperative increase in FSH and PI.     

Uptake of permanent contraception among women in sub-Saharan Africa: a literature review of barriers and facilitators

Objective

Uptake of permanent contraception among women remains low in sub-Saharan Africa compared to other regions. We aimed to synthesize available evidence on barriers to, and facilitators of permanent contraception with regards to tubal ligation among women in sub-Saharan Africa.

腹腔镜两种术式及输卵管粘连评估对输卵管妊娠腹腔镜术后再次妊娠结局的影响

目的:探讨腹腔镜治疗输卵管妊娠手术方式及输卵管周围粘连等因素对术后再次妊娠结局的影响。方法:回顾性分析输卵管妊娠102例,根据手术方式分为输卵管切开组和切除组,随访48个月,观察术式对术后再次妊娠结局的影响;根据前次手术中输卵管粘连情况进行评分,评估输卵管粘连对再次妊娠结局的影响。结果:输卵管切开取胚术组再次妊娠54例(76.1%),其中宫内妊娠28例(39.4%),重复性异位妊娠26例(36.6%),继发不孕17例(23.9%)。输卵管切除术组术后再次妊娠23例(74.2%),其中宫内妊娠13例(41.9%),重复异位妊娠10例(32.3%),继发不孕8例(25.8%)。输卵管切开组与切除术组再次妊娠率,宫内妊娠率,重复异位妊娠率和继发不孕率差异均无统计学意义。重复异位妊娠组前次腹腔镜术中输卵管粘连评分明显高于宫内妊娠组,差异有统计学意义。结论:输卵管妊娠腹腔镜手术方式对再次妊娠的结局没有影响。前次异位妊娠手术中输卵管粘连评分可以作为预测术后重复异位妊娠的重要指标。     

Ovarian morphology of rats after fallopian tube sterilization

This study was conducted to study poststerilization menstrual changes. For this purpose, 60 rats were divided into 2 groups. In the first group, rats underwent bilateral uterine horn ligation with Pomeroy method, and one ovary of each rat was excised and weighed. The other ligated ovary was left intact. In the second group, only unilateral oophorectomy was performed.Histopathological studies revealed the presence of primary, secondary, and tertiary follicles in the ovaries of all the rats at the beginning of the study. Such follicles were found in 20 of the 22 rats in the first group and 23 of the 26 rats in the second group at the end of the study. Poststerilization ovarian weight remained unchanged in both groups. There was no difference in terms of histologic examination between pre- and post-ligation. These findings suggest that tubal ligation in the rats performed using surgical method does not cause any alteration in the ovarian morphology.     

A qualitative study of barriers to postpartum sterilization and women's attitudes toward unfulfilled sterilization requests

BACKGROUND: This longitudinal, qualitative study explores barriers to postpartum sterilization from the perspective of low-income minority women. We examine women's feelings and attitudes regarding a canceled or postponed procedure over time. STUDY DESIGN: We conducted structured, in-depth baseline interviews with 34 postpartum women with unfulfilled sterilization requests in a university hospital setting. Follow-up phone interviews were conducted at 6 weeks and 6 months postpartum. RESULTS: Reasons for unfulfilled sterilization requests included last-minute misgivings, maternal medical complications, lack of a valid Medicaid consent form, fear of the procedure and provider influence. Sense of autonomy regarding sterilization decision making and ability to obtain interval sterilization or initiate and/or successfully use reversible contraception influenced subsequent attitudes regarding an unfulfilled request. CONCLUSIONS: Sterilization counseling should include comprehensive information regarding the surgical procedure and associated risks and the development of a backup contraceptive plan, with particular emphasis on increasing contraceptive self-efficacy and autonomy in sterilization decision making.     

输卵管妊娠腹腔镜保守性手术后早期通液治疗的价值

目的:探讨输卵管妊娠腹腔镜保守性手术后早期通液治疗对患侧输卵管的通畅率、术后宫内妊娠率、重复性异位妊娠率的影响。方法:前瞻性研究110例有生育要求行腹腔镜保守性手术的输卵管妊娠患者,随机分为A、B两组。A组(n=68例)术后首次月经干净即行输卵管通液治疗。B组(n=42例)术后首次月经后未行通液治疗。所有病例均于术后3～4个月行输卵管碘油造影检查(HSG),并随访术后1～2年的再次妊娠情况。结果:患侧输卵管通畅率A组85.29%,B组66.67%,差异有统计学意义(P<0.05);宫内妊娠率A组86.76%,B组71.43%,差异有统计学意义(P<0.05);其中患侧输卵管通畅者宫内妊娠率A组83.82%,B组57.43%,差异具有统计学意义(P<0.01);重复性异位妊娠率A组1.47%,B组2.38%。结论:术后早期的输卵管通液治疗有助于提高患侧输卵管的通畅率及术后的宫内妊娠率,降低重复性异位妊娠的发生。     

局麻单孔腹腔镜双极电凝与经腹近端抽芯包埋两种输卵管绝育术对生殖激素近期影响的对比观察

目的:比较观察局麻单孔腹腔镜双极电凝输卵管绝育术与经腹近端抽芯包埋输卵管绝育术对卵巢功能的影响。方法:在贵州省内14个县随机抽取2014年10月~2015年10月行上述两种输卵管绝育术妇女各100例,测定卵巢基础激素(FSH、LH和E2)。结果:共133例研究对象进入观察,其中腹腔镜输卵管绝育术组82名,年龄28.84±4.02岁;开腹输卵管绝育术组51名,年龄27.61±4.20岁。两组术后1个月的卵巢基础性激素平均水平无统计学改变;术后1个月基础FSH≥10U/L、基础FSH/LH升高2的比例开腹组明显高于腹腔镜组。结论:腹腔镜输卵管绝育术近期对卵巢功能的影响小于开腹输卵管绝育术。     

不同清洗方法对腹腔镜手术器械灭菌效果的影响

目的探讨不同清洗方法对腹腔镜手术器械清洗和灭菌效果的影响。方法选择2010年5月-2012年2月使用后的腹腔镜手术器械2 499件,将其随机分为A组833件、B组833件、C组833件,分别采用单纯手工清洗方法、手工加酶清洗方法、加酶超声清洗方法,清洗效果监测采用目测检查,3组器械均采用高压蒸汽灭菌器灭菌,灭菌后采用营养琼脂培养法对腹腔镜手术器械进行细菌学检测,数据采用SPSS13.0软件进行统计分析。结果清洗效果合格率A、B、C 3组分别为93.9%、97.4%、100.0%,C组清洗合格率明显优于B组和A组,差异有统计学意义(P<0.05);器械灭菌后A、B、C 3组细菌学检测合格率依次为95.7%、97.2%、100.0%,C组细菌学检测合格率明显优于B组和A组,差异有统计学意义(P<0.05)。结论超声联合多酶清洗显著提高器械的清洗质量,可作为一种有效、安全、简便的清洗方法在临床中广泛应用。