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Contraception - Management
What should I advise a woman who is considering sterilization (tubal occlusion)?

  • Before the operation, provide advice and written information about:
    • The advantages, disadvantages, and risks of both tubal occlusion and vasectomy.
      • Tubal occlusion has a lifetime failure rate of about 10 in 2000 women. Vasectomy has a 10-year failure rate of about 1 pregnancy per 2000 men.
      • Tubal occlusion has more risk related to the procedure.
    • Alternative long-term reversible methods of contraception, including information on the advantages, disadvantages, and relative failure rates of each method.
    • The success rates associated with reversal, should this procedure be necessary:
      • The success of reversal procedures depends on several factors, including the age of the woman, the method used for tubal occlusion and the method used for tubal re-anastomosis; as many as 90% of women may be able to become pregnant after reversal of clip sterilization.
    • The need to use effective contraception until the tubal occlusion procedure and to continue until her next menstrual period or otherwise advised.
    • The risk of ectopic pregnancy should tubal occlusion fail, and the need to seek medical advice if the woman thinks she might be pregnant or if she has abnormal abdominal pain or vaginal bleeding.
  • After the operation, advise women of the method of tubal occlusion that was used and of any complications that occurred during the procedure.
Clarification / Additional information
  • The information given to the woman should be recorded in the notes, and the provision of a supporting leaflet or tape to the woman should be documented.
  • The reported rates of ectopic pregnancy after tubal occlusion vary widely. This variation has not been explained.
  • Tubal occlusion can be performed at any time during the menstrual cycle, provided that the clinician is confident that the woman has used effective contraception up to the day of the operation. If this is not the case, the operation should be deferred until the follicular phase of a subsequent cycle. The woman should be advised to use effective contraception until the next menstrual period after the sterilization procedure.
  • A pregnancy test must be performed before the operation to exclude the possibility of a pre-existing pregnancy. However, a negative test does not exclude the possibility of a luteal-phase pregnancy.
Basis for recommendation
  • These recommendations are based on guidelines published by the Royal College of Obstetricians and Gynaecologists [RCOG, 2004].

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