Pregnancy rates after surgical sterilization higher than expected: Study

USA: A recent study published in the journal Fertility and Sterility showed that the pregnancy rates after female sterilization are considerably higher than expected, regardless of the sterilization procedure performed (hysteroscopically or laparoscopically). The findings are reassuring that the effectiveness of hysteroscopic sterilization is not inferior to laparoscopic sterilization.

Aileen M. Gariepy, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, and the team aimed to compare the real-world effectiveness of hysteroscopic and laparoscopic sterilization.

This retrospective cohort included women of age 18 to 50 years and was based on the Medicaid claims for hysteroscopic (5,906) or laparoscopic (23,965) sterilization procedures performed all over California, from 2008 to 2014.  Postpartum procedures were excluded and regression models for clustered person-period data, weighted for propensity to receive either (Hysteroscopic or laparoscopic) procedures, sociodemographic and clinical variables to examine the post-sterilization pregnancy rates were applied. Post-sterilization pregnancy was measured by pregnancy-related claims.

Study highlights are as follows:

• A total of post-sterilization pregnancy claims were identified for 4.74% of women after hysteroscopic sterilization and 5.57% after laparoscopic sterilization. The pregnancy rates decreased overtime after both the procedures.
• The crude incidence of pregnancy claims was higher for hysteroscopic sterilization than for laparoscopic sterilization after a yea of the procedure (3.26:2.61 per 100 woman-years)
• Between 13 and 24 months after the procedure, Fewer pregnancies for women after hysteroscopic sterilizations were observed than for those after laparoscopic sterilizations by 13 to 24 months, with no statistical differences in later years.
• The cumulative pregnancy rates 5 years after sterilization were lower with hysteroscopic sterilization than with laparoscopic sterilization (6.26:7.22 per 100 woman-years; propensity-weighted, adjusted risk ratio, 0.76). 

By the end of the study, the authors concluded that the findings reassure hysteroscopic sterilization was not inferior to laparoscopic sterilization.

Reference:

Gariepy, A. M., Lewis, C., Zuckerman, D., Tancredi, D. J., Murphy, E., McDonald-Mosley, R., Sonalkar, S., Hathaway, M., Nunez-Eddy, C., & Schwarz, E. B. (2022). Comparative effectiveness of hysteroscopic and laparoscopic sterilization for women: a retrospective cohort study. In Fertility and Sterility. Elsevier BV. https://doi.org/10.1016/j.fertnstert.2022.03.001