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rrest 7 major complications during female sterilization are uncommon occurring in an estimated 0 1 3 5 of laparoscopic procedures with mortality rates in the united states estimated at 1 2 patient deaths per 100 000 procedures 7 these complications are more common for patients with a history of previous abdominal or pelvic surgery obesity and or diabetes 7 failure edit while female sterilization procedures are highly effective at preventing pregnancy there is a small continuing risk of unintended pregnancy after tubal ligation 12 several factors influence the likelihood of failure increased time since sterilization younger age at the time of sterilization and certain methods of sterilization are all associated with increased risk of failure 7 pregnancy rates at 10 years after sterilization vary depending on the type of procedure used documented as low as 7 5 per 1 000 procedures to as high as 36 5 per 1 000 procedures 7 ectopic pregnancy edit overall all pregnancies including ectopic pregnancies are less common among patients who have had a female sterilization procedure than among patients who have not 7 13 however if patients do have a pregnancy after tubal ligation a greater percentage of these will be ectopic approximately one third of pregnancies that occur after a tubal ligation will be ectopic pregnancies 7 the likelihood of ectopic pregnancy is higher among patients sterilized before age 30 and differs depending on the type of sterilization procedure used citation needed emotional after effects edit the majority of patients who undergo female sterilization procedures do not regret their decisions however regret appears to be more common among patients who undergo sterilization at a young age often defined as younger than 30 years old 14 patients who are unmarried at the time of sterilization non white patients patients with public insurance such as medicaid or patients who undergo sterilization soon after the birth of a child 7 15 regret has not been found to be associated with the number of children a person has at the time of sterilization 7 side effects edit menstrual changes edit patients who have undergone female sterilization procedures have minimal or no changes in their menstrual patterns they were more likely to have perceived improvements in their menstrual cycle including decreases in the amount of bleeding in the number of days of bleeding and in menstrual pain 7 ovarian reserve edit studies of hormone levels and ovarian reserve have demonstrated no significant changes after female sterilization or inconsistent effects 16 evidence does not indicate a strong association between tubal ligation and earlier onset of menopause 17 sexual function edit sexual function appears unchanged or improved after female sterilization compared with non sterilized females 18 hysterectomy edit patients who had tubal occlusion surgeries have been found to be four to five times more likely to undergo hysterectomy later in life than those whose partners underwent vasectomy 7 there is no known biologic mechanism to support a causal relationship between tubal ligation and subsequent hysterectomy but there is an association across all methods of tubal ligation 7 postablation tubal sterilization syndrome edit main article post ablation tubal sterilization some patients who have undergone tubal ligation prior to an endometrial ablation procedure experience cyclic or intermittent pelvic pain this may happen in up to 10 of women who have undergone both surgeries 19 contraindications edit given its permanent nature tubal ligation is contraindicated in patients who desire future pregnancy or who want to have the option of future pregnancy in such cases reversible methods of contraception are recommended 7 since most forms of tubal ligation require abdominal surgery under regional or general anesthesia tubal ligation is also relatively contraindicated in patients for whom the risks of surgery and or anesthesia are unacceptably high considering their other medical issues 7 procedure technique edit tubal ligation through blocking or removing the tubes may be accomplished through an open abdominal surgery a laparoscopic approach or a hysteroscopic approach 20 depending on the approach chosen the patient will need to undergo local general or spinal regional anesthesia the procedure may be performed either immediately after the end of a pregnancy termed a postpartum or postabortion tubal ligation or more than six weeks after the end of a pregnancy termed an interval tubal ligation 7 the steps of the sterilization procedure will depend on the type of procedure being used citation needed see tubal ligation methods below if the patient chooses a postpartum tubal ligation the procedure will further depend on the delivery method if the patient delivers via cesarean section the surgeon will remove part or all of the fallopian tubes after the infant has been delivered and the uterus has been closed 20 anesthesia for the tubal ligation will be the same as that being used for the cesarean section itself usually regional or general anesthesia if the patient delivers vaginally and desires a postpartum tubal ligation the surgeon will remove part or all of the fallopian tubes usually one or two days after the birth during the same hospitalization 20 if the patient chooses an interval tubal ligation the procedure will typically be performed under general anesthesia in a hospital setting most tubal ligations are accomplished laparoscopically with an incision at the umbilicus and zero one or two smaller incisions in the lower sides of the abdomen it is also possible to perform the surgery without a laparoscope using larger abdominal incisions 20 it is also possible to perform an interval tubal ligation hysteroscopically which may be performed under local anesthesia moderate sedation or full general anesthesia 20 while no methods of hysteroscopic sterilization are currently on the market in the united states as of 2019 the essure 21 and adiana systems were previously used for hysteroscopic sterilization and research trials are investigating new hysteroscopic approaches tubal ligation methods edit there are a number of methods of removing or occluding the fallopian tubes some of which rely on medical implants and devices postpartum tubal ligation edit performed immediately after a delivery this method removes a segment or all of both fallopian tubes the most common techniques for partial bilateral salpingectomy are the pomeroy 22 or parkland 23 procedures the ten year pregnancy rate is estimated at 7 5 pregnancies per 1000 procedures performed and the ectopic pregnancy rate is estimated at 1 5 per 1000 procedures performed 7 interval tubal ligation edit bilateral salpingectomy edit this method removes both tubes entirely from the uterine cornuae out to the tubal fimbriae this method has recently become more popular for female sterilization given evidence to support the fallopian tube as the potential site of origin of some ovarian cancers 24 some large medical systems such as kaiser permanente northern california 25 have endorsed complete bilateral salpingectomy as the preferred means of female sterilization and professional medical societies such as the society of gynecologic oncology 26 and the american college of obstetricians and gynecologists acog recommend discussing the benefits of salpingectomy during counseling for sterilization 27 while complete bilateral salpingectomy theoretically should have an efficacy rate that approaches 100 percent and eliminates the risk of tubal ectopic pregnancy there is not high quality data available comparing this method to older methods citation needed bipolar coagulation edit this method uses electric current to cauterize sections of the fallopian tube with or without subsequent division of the tube 28 the ten year pregnancy rate is estimated at 6 3 to 24 8 pregnancies per 1000 procedures performed and the ectopic pregnancy rate is estimated at 17 1 per 1000 procedures performed 7 monopolar coagulation edit this method uses electric current to cauterize the tube but also allows radiating current to further damage the tubes as it spreads from the coagulation site the tubes may also be transected after cauterization 28 the ten year pregnancy rate is estimated at 7 5 pregnancies per 1000 procedures performed 7 tubal clip edit this method uses a tubal clip filshie clip or hulka clip to permanently clip the fallopian tubes shut once applied and fastened the clip blocks sperm and eggs from meeting in the fallopian tube 29 the ten year pregnancy rate is estimated at 36 5 pregnancies per 1000 procedures performed and the ectopic pregnancy rate is estimated at 8 5 per 1000 procedures performed 7 tubal ring falope ring edit this method involves a doubling over of the fallopian tubes and application of a silastic band to the tube 30 the ten year pregnancy rate is estimated at 17 7 pregnancies per 1000 procedures performed and the ectopic pregnancy rate is estimated at 8 5 per 1000 procedures performed 7 less commonly used or no longer used procedures edit irving s procedure edit this method places two ligatures sutures around the fallopian tube and removing the segment of tube between the ligatures the medial ends of the fallopian tubes on the side closer to the uterus are then connected to the back of the uterus itself 31 uchida tubal ligation edit this method involves dissecting the fallopian tube from the overlying connective tissue serosa placing two ligatures and excising a segment of the tube then buries the end of the fallopian tube closest to the uterus underneath the serosa 32 dr uchida reported no failures among 20 000 procedures 33 34 essure tubal ligation edit this method closed the fallopian tubes through a hysteroscopic approach by placing two small metal and fiber coils in the fallopian tubes through the fallopian ostia after insertion scar tissue forms around the coils blocking off the fallopian tubes and preventing sperm from reaching the egg 35 it was removed from the us market in 2019 21 adiana tubal ligation edit this method closed the fallopian tubes through a hysteroscopic approach by placing two small silicone pieces in the fallopian tubes during the procedure the health care provider heated a small portion of each fallopian tube and then inserts a tiny piece of silicone into each tube after the procedure scar tissue formed around the silicone inserts blocking off the fallopian tubes and preventing sperm from reaching the egg 36 it was removed from the us market in 2012 reversal or in vitro fertilization after tubal ligation edit main article tubal reversal all tubal ligation procedures are considered permanent and are not reliably reversible forms of birth control patients who wish to have the option of future pregnancy should ideally be directed towards effective but reversible forms of birth control rather than sterilization procedures 7 37 examples of this include intrauterine devices however patients who desire pregnancy after having undergone a female sterilization procedure have two options tubal reversal is a type of microsurgery to repair the fallopian tube after a tubal ligation procedure successful pregnancy rates after reversal surgery are 42 69 depending on the sterilization technique that was used 38 alternatively in vitro fertilization ivf may allow patients with absent or occluded fallopian tubes to successfully carry a pregnancy the choice of whether to attempt tubal reversal or move straight to ivf depends on individual patient factors including the likelihood of successful tubal reversal surgery and the age of the patient 39 recovery and rehabilitation edit most laparoscopic methods of interval tubal ligation are outpatient surgeries and do not require hospitalization overnight patients are counseled to expect some soreness but to expect to be ready to perform daily activities 1 2 days after surgery 40 patients undergoing postpartum tubal ligations will not be delayed in their discharge from the hospital after birth and recovery is not significantly different from normal postpartum recovery 41 history edit the first modern female sterilization procedure was performed in 1880 by dr samuel lungren of toledo ohio in the united states 42 hysteroscopic tubal ligation was developed later by mikulicz radecki and freund 42 since its development female sterilization has been periodically performed on patients without their informed consent often specifically targeting marginalized populations 43 given this history of human rights abuses current sterilization policy in the united states requires a mandatory waiting period for tubal sterilization on medicaid beneficiaries this waiting period is not required for private insurance beneficiaries which has the effect of selectively restricting low income women s access to tubal sterilization 44 society and culture edit prevalence edit of the 64 of married or in union women worldwide using some form of contraception approximately one fifth 19 of all women used female sterilization as their contraception making it the most common contraceptive method globally 45 the percentage of women using female sterilization varies significantly between different regions of the world rates are highest in asia latin america and the caribbean north america oceania and selected countries in western europe where rates of sterilization are often greater than 40 rates in africa the middle east and parts of eastern europe however are significantly lower sometimes less than 2 46 an estimated 180 million women worldwide have undergone surgical sterilization compared to approximately 42 5 million men who have undergone vasectomy 46 in the united states female sterilization is used by 30 of married couples 7 and 22 of women who use any form of contraception making it the second most popular contraceptive after the birth control pill 47 slightly more than 8 2 million women in the us use tubal ligation as their main form of contraception 47 and approximately 643 000 female sterilization procedures are performed each year in the united states 7 a september 2024 study found that states which enacted abortion bans following the ruling in dobbs v jackson women s health organization saw a 39 increase in tubal ligation rates by december 2022 48 see also edit compulsory sterilization references edit 1 2 trussell james 2011 contraceptive efficacy in hatcher robert a trussell james nelson anita l cates willard jr kowal deborah policar michael s eds contraceptive technology 20th revised ed new york ardent media pp 779 863 isbn 978 1 59708 004 0 issn 0091 9721 oclc 781956734 table 26 1 table 3 2 percentage of women experiencing an unintended pregnancy during the first year of typical use and the first year of perfect use of contraception and the percentage continuing use at the end of the first year united states archived 2017 02 15 at the wayback machine vasectomy 111 wales nh...
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