• Assess the woman's:
• Mental capacity to make the decision.
• Level of understanding of the advantages, disadvantages, and relative failure rates of tubal occlusion and alternative long-term reversible methods of contraception — see Advice for woman considering sterilization.
• Risk for later regret. Take additional care when counselling people who are:
• Less than 30 years of age.
• Without children.
• Taking decisions during pregnancy.
• Taking decisions in reaction to the loss of a relationship.
• Possibly at risk of coercion by their partner, family, or health or social welfare professionals.
• Cultural, religious, psychosocial, psychosexual, and psychological issues.
• Assess the risk for sexually transmitted infection and, when appropriate, advise testing, promote safer sex, and/or refer for counselling.
• Assess also the woman's partner's suitability for vasectomy, as the couple's clinical history, present symptoms, or abnormal examination findings may influence which partner goes forward to have sterilization.

In depth

• A woman who is requesting sterilization should be given 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 a number of 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 she thinks she might be pregnant, or if she has abnormal abdominal pain or vaginal bleeding.
• After the operation, women should be advised of the method of tubal occlusion actually used, and of any complications that occurred during the procedure.

In depth