Changes in ovarian function after tubal sterilization

Changes in ovarian function were evaluated in 43 women, before and after tubal ligation. Midluteal endocrine profiles and endometrial biopsies were investigated before and at 3, 6 and 12 months after the operations. During postoperative follow-up there was significant increase in luteal phase deficiency and midluteal FSH, LH and E₂ levels (p<0.001). Progesterone levels significantly decreased (p<0.001) and anovulation was observed in 13 (30.2%) of 43 cases. Our data suggest that tubal sterilization carried increased risk in ovarian function, particularly luteal phase deficiency and anovulation.

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Resumen Las modificaciones de la función ovárica se evaluaron en 43 mujeres, antes y después de ligarse las trompas. Se investigaron los perfiles en la mitad de la fase lútea y las biopsias del endometrio antes de la intervención y a los 3, 6 y 12 meses posteriores. Durante el período de seguimiento postoperatorio, se verificó un aumento significativo de carencia en el curso de la fase lútea y de los niveles de la hormona foliculoestimulante, la hormona luteinizante y E₂ en la mitad de la fase lútea (p<0,001). Los niveles de progesterona disminuyeron significativamente (p<0,001) y se observó falta de ovulación en 13 (30,2%) de los 43 casos. Nuestros resultados hacen pensar que la esterilización de las trompas presenta un riesgo mayor para la función ovárica, en particular, carencia en la fase lútea y anovulación.

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Resumé Les modifications de al fonction ovarienne ont été évaluées chez 43 femmes, avant et après la ligature des trompes. Des profils endocriniens midluténiques et des biopsies de l'endomètre ont été étudiés avant l'intervention et 3, 6 et 12 mois après. Durant la période de suivi postopératoire, on a constaté une augmentation significative de carence au cours de la phase lutéle et des niveaux de l'hormone folliculostimulante, de l'hormone lunéinisante et de E₂ au milieu de la phase lutéale (p<0,001). Les niveaux de progestérone ont significativement baissé (p<0.001) et l'absence d'ovulation a été observée chez 13 (30,2%) des 43 cas. Nos résultats laissent penser que la stérilisation tubaire présente un risque accru pour la fonction ovarienne, notamment une carence dans la phase lutéale et l'anovulation.

     

Assessment of luteal function after surgical tubal sterilization

To evaluate ovarian luteal function after tubal occlusion, a group of women who underwent Pomeroy sterilization were studied. A prospective group I (n=16) were followed for one year and scheduled for blood sampling every other day during their luteal phase before surgical procedure and at 3 and 12 months thereafter. Group II (n=15) included women who were studied during their luteal phase at 1 or 5 years post-surgery. Mid-luteal progesterone and estradiol serum levels were calculated by estimating the average of at least 3 values of serum samples obtained in days 20–25 of a menstrual cycle. The data suggest that no major changes occur in ovarian function after surgical tubal occlusion, as assessed by the mid-luteal hormone serum levels, and underscore the safety of this procedure.     

Long-term luteal changes after tubal sterilization

In this study the luteal function was evaluated in 109 subjects 2 to 108 months following tubal sterilization by Pomeroy's technique or laparoscopic tubal rings. Midluteal endometrial biopsies determined by basal body temperature charts were performed and dated in all subjects. Midluteal serum progesterone was estimated by RIA in 40 women. Our results indicated that the mean time which had elapsed since sterilization was significantly shorter in the subjects who revealed luteal defects than in those with normal luteal function. There were no statistically significant differences between the 2 occlusive techniques in terms of poststerilization incidence of luteal defects.     

Menstrual disorders and pelvic pain after sterilization

Changes in menstrual cycle length, menstrual duration, number of pads, dysmenorrhea and non-cyclic pelvic pain were studied in 43 women following tubal sterilization with three different techniques. One group consisted of 17 women undergoing laparotomy by Pomeroy technique; the second group consisted of 11 women undergoing laparoscopy by Fallope rings; and the third group consisted of 15 women undergoing colpotomy by fimbriectomy. The differences before and after sterilization in cycle length were non-significant in all groups (p<0.05). After sterilization, menstrual duration and number of pads were significantly increased in the laparotomy (p<0.001) and laparoscopy (p<0.01) groups but non-significantly in the colpotomy group (p>0.05). Comparison of these parameters between the groups did not show any significant differences (p>0.05). After sterilization, increases in the severity of dysmenorrhea and non-cyclic pelvic pain were non-significant in all groups (p>0.05). We concluded that there were no significant differences in menstrual disorders after sterilization among these three different techniques.

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Resumen Los cambios en la duración del ciclo menstrual, el número de compresas, la dismenorrea y el dolor pelviano aciclico se estudiaron en 43 mujeres tras la esterilización tubaria con tres técnicas diferentes. El Grupo I consistió en 17 mujeres sometidas a laparotomia con la técnica de Pomeroy. El Grupo II consistió en 11 mujeres sometidas a laparoscopia con anillos de Falopia. El Grupo III consistió en 15 mujeres sometidas a colpotomia por fimbriectomia. Las diferencias en la duración del ciclo antes y después de la esterilización no fueron significativas en ninguno de los grupos (p>0,05). Después de la esterilización, la duración menstrual y el número de compresas aumentaron significativamente en los grupos de laparotomia (p<0,001) y laparoscopia (p<0,01) pero no fueron significativas en el grupo de colpotomia (p<0,05). Las comparaciones de estos parámetros entre los grupos no señalaron ninguna diferencia significativa (p>0,05). Después de la esterilización, el aumento en la severidad de la dismenorrea y el dolor pelviano aciclico no fue significativo en ninguno de los grupos (p>0,05). Se llegó a la conclusión de que los trastornos menstruales después de la esterilización no señalaban ninguna diferencia significativa entre estas tres técnicas diferentes.

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Resumé Les modifications de la durée du cycle menstruel et des menstruations, le nombre de protections périodiques utilisées, la dysménorrhée et les douleurs pelviennes non cycliques, sont autant d'éléments qui ont été étudiés chez 43 femmes à la suite d'une stérilisation tubaire opérée par trois techniques différentes. Le Groupe I comprenait 17 femmes soumises à une laparotomie par la méthode de Pomeroy. Le Groupe II comprenait 11 femmes soumises à laparoscopie avec bagues de Fallope. Le Groupe III comprenait 15 femmes soumises à une colpotomie et une résection des franges. Aucun des groupes n'a fait apparaïtre de différence significative dans la durée du cycle avant et après la stérilisation (p>0,05). Après la stérilisation, la durée des menstruations et le nombre de protections périodiques ont augmenté de façon significative dans les groupes de laparotomie (p<0,001) et laparoscopie (p>0,01) et non significative dans le groupe de colpotomie (p>0,05). La comparaison de ces paramètres entre les groupes n'a pas révélé de différences significatives (p>0,05). Après la stérilisation, la dysménorrhée et les douleurs pelviennes non cycliques n'ont augmenté significativement en sévérité dans aucun des groupes (p>0,05). Nous en avons conclu que les troubles menstruels à la suite d'une stérilisation ne faisaient apparaïtre aucune différence significative entre les trois différentes techniques.

     

Long-term risk of hysterectomy after tubal sterilization

Previous studies with only short-term follow-up have produced conflicting results on whether a tubal ligation increases a woman's risk for having a hysterectomy. By use of population-based data from the province of Manitoba's universal health insurance plan, all women aged 25-44 years who had a tubal ligation in 1974 (n = 4,374) were identified. As a comparison group, a random sample of 10,000 Manitoba women who were registered with the insurance plan on July 1, 1974 was chosen. Women undergoing hysterectomy prior to July 1, 1974 or a tubal ligation from 1970-1982 were excluded, leaving 6,835 in the comparison group. All health care utilization for two years before tubal ligation or July 1, 1974 (comparison group) was recorded to identify health characteristics of the women. Information was recorded on rate of hysterectomy, dilatation and curettage, all hospitalization, and hospitalization for menstrual disorders for two years after tubal ligation or July 1, 1974. For the longer term analysis, information on hysterectomy up to December 31, 1982 was recorded. At two years there was no increase in adverse gynecologic outcomes between the two groups. Survival curves (life table method) comparing the two groups for up to nine years found higher hysterectomy rates for women aged 25-29 beginning at two years after tubal ligation and increasing with time. Multivariate analysis (Cox's regression model) confirmed that for women aged 25-29, tubal ligation increased the probability of a hysterectomy 1.6 times (1.2-2.3, 95% confidence interval) after controlling for previous gynecologic history, marital status, number of physician visits, and hospitalizations. For women aged 30 and over, tubal ligation was not a risk factor for subsequent hysterectomy in either the short or long term.     

Hormone levels before and after tubal sterilization

OBJECTIVE: The aim of this study was to determine whether women experience significant luteal phase hormonal changes following interval tubal sterilization. DESIGN: This is a partly randomized, prospective clinical study. SETTING: This study involved healthy volunteers in an academic research environment. PATIENTS: This study involved 118 fertile women seeking tubal sterilization and 57 fertile controls with at least three normal cyclic menstrual periods before entry into the study. INTERVENTIONS: The patients were randomized to bipolar cautery or Hulka clip as sterilization methods. Barrier contraception or abstinence was used by controls. MAIN OUTCOME MEASURES: The main outcome measures are serum estradiol and progesterone levels and urinary estradiol and pregnanediol levels obtained during the luteal phase before, 1 year and 2 years after sterilization. RESULTS: The women randomized to the bipolar cautery group had higher midluteal progesterone levels measured between Days 5 and 11 postovulation (15.5 ng/mL before sterilization, 14.5 ng/mL at 1 year and 14.5 ng/mL at 2 years) than did the other two groups. The clip group had progesterone levels of 14.1, 12.0 and 12.5 ng/mL at baseline, 1 year and 2 years, respectively, and the control group had levels of 12.0, 11.9 and 11.3 ng/mL for the same periods. Serum estradiol and progesterone and urinary pregnanediol and estradiol were not significantly changed over the 2-year period, nor were there significant differences between the two groups. CONCLUSIONS: There were no significant hormonal changes in sterilized women over a period of 2 years when compared with their baseline levels or when compared with unsterilized age-matched controls.     

Proctoscopic tubal sterilization

A report on a series of 215 cases of interval tubal sterilization via a proctoscope, introduced transabdominally under local anaesthesia and neuroleptanalgesia, is presented. The safety of the procedure was enhanced by obviating pneumoperitoneum. Pomeroy's method of tubal occlusion was used. Surgical time averaged less than 30 minutes. The patient was allowed home within two hours after the operation.An effective method of permanent fertility control which is cheap and simple would appear to be desirable in any developing country where over-population is hampering its progress.     

Laparoscopic tubal sterilization: long-term postoperative follow-up.

93 women who underwent laparoscopic tubal coagulation during 1972-1973 were followed up for periods of 18 months to 3 years. Ages ranged from 17 to 47 years (mean 30.7) and 71% had 2-4 children. 8 requested sterilization prior to conception and 5 had pregnancy previously terminated by abortion. Most common postoperative complaints were tenderness at the incision site and shoulder or neck pain. In the 64 cases in which sterilization alone was performed average blood loss was less than 50 cc. In 8 cases it was associated with diagnositc dilatation and curettage, in 20 with therapeutic abortion, and in 1 with laparotomy. Complications included 1 case each of bleeding mesosalpinx controlled by cautery, wound hematoma, hematoma epiploic appendix, and peritoneal burn. A detailed menstrual history 18-36 months after operation found 73 of the 93 had regular periods with amount of bleeding and length of cycle generally unchanged. Of the 20 with menstrual changes, 2 developed amenorrhea within 1 year and 8 with preoperative menstrual irregularities were unchagned. 10 developed longer periods and/or shorter intervals. 5 related these changes to discontination of oral contraceptives. Of the remaining 1 had an abnormal Pap smear, 2 were 40-45 years of age (1 of whom refused vaginal hysterectomy for stress incontinence), and 2 were 35-40 with no previous history of cesarean sections or pelvic complaints. The majority (77%) of the women were satisfied with the procedure, 16% uncertain, and 5 patients expressed regret. 4 of the 5 who regretted the operation reported gynecological complaints. 5 required subsequent surgery. In 3 of the 5 the indication preexisted the sterilization and a more thorough screening might have prevented 2 surgical procedures. In this series the incidence of postoperative gynecological disease 18-36 months after laparoscopic tubal ligation is significantly lower than that reported in the literature for conventional tubal ligation.     

Counseling women for tubal sterilization

In view of the current concern about sterilization abuse, the federal government has issued guidelines to prevent women from being sterilized without their knowledge or consent. The authors describe a counseling program in a large inner-city hospital that followed these specifications.     

Immediate sequelae following tubal sterilization

A total of 32,177 female sterilizations performed by different surgical procedures under different time scales were studied with reference to the effectiveness of the procedure and immediate, short-term and longterm complications arising out of the procedure. The results of immediate sequelae only are being reported in this article.Laparoscopic technique was employed in 7.1% of cases, culdotomy in 6.9% and minilaparotomy/laparotomy in the remaining 86% of cases.The findings indicate that minilaparotomy performed in the postpartum period is most suitable and safe for Indian women under existing conditions. Complications including mortality were least when the operation was performed as a minilaparotomy in the early postpartum period. Visceral injuries were maximum with the laparoscopic technique (10.45/1000). Mortality of interval sterilization was higher than that of postpartum sterilization (6.19/10,000 Vs 0.7/10,000) but this rate is lower than the current maternal mortality of the country (41.76/10,000).In view of the results obtained, it appears that minilaparotomy will continue to be “the method” of choice on a mass scale.     

Reversibility of tubal ring sterilization

The reversibility of the tubal ring sterilization technique was studied in 22 rabbits. Using microsurgery for end-to-end reanastomosis, a patency rate of 96% and a pregnancy rate of 86% was obtained. It is suggested that human tubal ring sterilization has a high probability of being reversible, although several factors of reversibility remain to be further determined.     

Child disability and mothers' tubal sterilization

CONTEXT: The needs of children with disability can be substantial, leading some parents to consider contraceptive sterilization to prevent additional births.
METHODS: Matched records from the 1993 National Health Interview Survey and the 1995 National Survey of Family Growth were used to investigate the relationship between child disability and mothers' sterilization. Data included the birth records of 8,711 children, information on older children in the household, and the mothers' background and reproductive characteristics. Logistic and Cox regression models were used to estimate the effect of the birth of a child with a disability on the risk of mothers' sterilization.
RESULTS: The birth of a child with disability has no effect on the likelihood that a mother will undergo sterilization within the next month; however, women who have an older child with severe disability are more likely than those whose older children are nondisabled to undergo sterilization within a month after the birth of another child (odds ratio, 2.6). Severe disability in a newborn significantly increases the risk of sterilization 1-36 months after birth (risk ratio, 1.7); severe disability among older children also appears to increase the risk of sterilization 1-36 months after birth (1.5), although this result was only marginally significant.
CONCLUSIONS: Women often respond to the birth of children with disabilities by changing their fertility plans, although usually not immediately unless they have older children with severe disability. These findings are consistent with parents' desire to have a nondisabled child and with their need to care for an exceptional child by forgoing additional births.     

Changes in menstrual blood loss after four methods of female tubal sterilization

One-hundred females requesting tubal sterilization were included in this study. They were enrolled into 4 groups, each n = 25. They were allocated to a particular method of sterilization on a randomized basis. The four modalities used were: laparoscopic Falope ring application, bipolar electrocoagulation, Hulka clip application and Pomeroy tubal ligation via minilaparotomy. The menstrual blood loss (MBL) was quantitatively estimated, using the alkaline hematin method, prior to sterilization and after 3, 6 and 12 months. No significant changes in MBL were observed after the four sterilization techniques. Moreover, they did not differ significantly in this context.     

Hormonal profile of the menstrual cycle in chinese women after tubal sterilization

Ten women after tubal sterilization were studied for the hormonal profile of the menstrual cycle. They had undergone sterilization procedures, on the average 5.3 years (range 1.5–10 years) earlier. The serum concentrations of LH, FSH, prolactin, estradiol and progesterone were measured by RIA in daily blood samples of a complete menstrual cycle. Another ten normal women were studied at the same time and were used as the control group. There were no significant differences in the hormonal patterns of the menstrual cycle between the two groups. There was a significantly lower LH level in the early luteal phase of the tubal ligation group compared to the control group. Also, a significantly lower E2 luteal peak compared to the preovulatory peak was observed in the tubal ligation group. The physiological significance of these minor changes is not clear.

Only one out of ten women in the tubal ligation group, who had undergone sterilization 1.5 years prior, showed a deficiency in luteal function, but her ovulatory function and menstrual cycle appeared normal. This study indicates that normal hormonal profiles are retained after tubal sterilization.     

The risk of menstrual abnormalities after tubal sterilization: a case control study

Background  

Tubal sterilization is the method of family planning most commonly used. The existence of the post-tubal-ligation syndrome of menstrual abnormalities has been the subject of debate for decades.     

聚氨酯铋输卵管栓堵术18～24个序月的临床研究

为进一步了解聚氨酯铋输卵管栓堵的效果,采用一次性医用带囊双腔管,经宫腔注入聚氯酯铋行输卵管栓堵术585例,观察18～24个序月的栓堵效果及术后X光片显影,对10例术后检查输卵管通畅者实行补做。结果,随访至18个月者409例(70％);24个月者176例(30％),11例妊娠均发生在18个月内。术后2～3个月行输卵管通畅试验,其中造影者132例,123例堵塞成功;通水试验442例,成功383例。总成功率为86.7％,累积妊娠率为1.8％,无术中术后反应。经宫腔注入高分子材料的输卵管栓堵术为一种简便价廉、无副反应、不经腹部的输卵管绝育术。术后X光片检查双显者可做为成功指标,术后不能肯定者,需做输卵管通畅试验。不成功者立即补做,可提高成功率。     

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.