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BENEFITS AND RISKS
OF STERILIZATION
Dr. Javardo McIntoshIntern
Department of Obstetrics and Gynecology
Princess Margaret Hospital
18th Janary !"1#
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Otline
Introdction
$tatistics
%iming
$terili&ation 'pproaches and %echni(es Hysteroscopic
)aparoscopic
Minilaparotomy Male $terili&ation
*linical *onsiderations and
+ecommendations
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Introdction
$terili&ation ' permanent method of birth control.
$terili&ation for ,omen is called tbalsterili&ation. i.e. fallopian tubes are occlded
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$tatistics
Prevalence !""#!"1" /ational $rvey of 0amily Gro,th
28.3 million ,omen aged 1433 years sed
contraception $terili&ation ,as the most common method sed
by 35.26 of married coples 7tbal occlsion2".!6 vasectomy 15.169
18.#6 of married coples sed oralcontraceptives
14.26 sed male condoms
5.16 sed intraterine devices 7I:Ds9
2.;6 sed in
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Female Sterilization
=hen> %iming
Ho,> $terili&ation 'pproaches and %echni(es
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=hen>
%iming Postpartm
' time of *?section or after vaginal delivery
Post?abortion immediately after an ncomplicated
spontaneos or indced abortion
Interval Procedre performed separate from pregnancy
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Ho,>
$terili&ation 'pproaches and %echni(es Hysteroscopy
)aparoscopy
@lectrocoaglation Mechanical Devices
%bal @Acision
Minilaparotomy
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Hysteroscopy
is commonly performed as an oBceprocedre ,hich involves the se of aparacervical blocC ,ith or ,ithot oral or
intravenos sedation %,o approved 0D' approved methods
@ssre
'diana
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Hysteroscopy
@ssre
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Hysteroscopy
'diana
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Hysteroscopy
eneEts 7@ssre9 High eBcacy
)o, procedre related risC
'void entry into peritoneal cavity Decrease risC of in
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Hysteroscopy
+isC It may not be possible to place the devices
in one or both fallopian tbes.
%here is a risC of in
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)aparoscopy
Interval and postabortal tbal occlsionprocedres @lectrocoaglation
Mechanical Devices %bal @Acision
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)aparoscopy
@lectrocoaglation ipolar electrocoaglation for tbal
occlsion
eAclsively ,ith laparoscopic approaches 't least 2 cm of the isthmic portion of the
fallopian tbe mst be completelycoaglated
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)aparoscopy
Mechanical Devices silicone rbber band
the spring?loaded clip
titanim clip lined ,ith silicone rbber More eFective ,ith normal fallopian tbes
Decreased eBcacy ,ith tbal adhesions
thicCened tbes
dilated fallopian tbes
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)aparoscopy
%bal @Acision *omplete or partial salpingectomy
may be preferable in the setting of
abnormal fallopian tbes %bal division accomplished sing
Monopolar or bipolar energy
*tting device
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)aparoscopy
eneEts
*ompared to Hysteroscopic provides an opportnity to inspect the
abdominal and pelvic organs immediately eFective
*ompare to Minilaparotomy re(ires small incisions
icCer recovery
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)aparoscopy
+isC Most common complications are those
related to general anesthesia
+isC of bo,el bladder or ma
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Minilaparotomy
Generally is reserved for postpartmprocedres
Performed sing a !2?cm incision
placed in relation to the terine fnds re(ires only basic srgical instrments
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Minilaparotomy
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Minilaparotomy
eneEts *an be done immediately post partm and
at time of *?section
appropriate for lo,?resorce settings,here speciali&ed srgical e(ipment is notavailable
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Minilaparotomy
+isCs It has a lo, risC of death and complications.
Most common complications are to general
anesthesia. Other risCs inclde bleeding and infection.
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Male $terili&ation
asectomy otpatient procedre ,ith local anesthesia
*ompared ,ith abdominal approaches to female
sterili&ation is safer more eFective and less eApensive
not immediately eFective an alternative form of contraception mst be sed ntil
semen analysis conErms a&oospermia.
Most men are a&oospermic at 2 months aftervasectomy and ;8;;6 are a&oospermic at #months after vasectomy
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Male $terili&ation
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*linical *onsiderations and+ecommendations
=ho are good candidates for femalesterili&ation>
=omen ,ho have completed their
childbearing Preoperative conseling shold be
comprehensive
Inclde a discssion of $rgical techni(e
@Bcacy
$afety
Potential com lications
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*omponents of Presterili&ation *onseling
Permanent natre of the procedre notintended to be reversible
'lternative methods available particlarly
long?acting reversible contraception andvasectomy
Details of the procedre inclding risC andbeneEts of anesthesia
%he possibility of failre inclding ectopicpregnancy ,ith sterili&ation and othermethods
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*omponents of Presterili&ation *onseling
%he need to se condoms for protectionagainst $%Is inclding HI
%he need to se an alternative form ofcontraception after hysteroscopicsterili&ation ntil hysterosalphongogram
conErms tbal occlsion
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+eferences
Obstetrics and Gynecology at a glance
'*OG Practice blletin no. 122 beneEtsand risCs of sterili&ation.
httpKK,,,.ncbi.nlm.nih.govKpbmedK!22332"4 httpKK,,,.acog.orgKPatientsK0'sK$terili
&ation?for?=omen?and?Men