Reversing Female Sterilization

The chance of reversing female sterilization has recently improved due to the use of microsurgical reversal techniques and the development of new sterilization procedures which reduce tubal destruction; however, reversal odds are still low and women should be advised that sterilization is a permanent form of contraception. In 18 recent studies, covering 560 cases of sterilization reversals performed with magnification and atraumatic techniques, 56% of the patients subsequently gave birth to live infants. In 3 series, covering 88 cases of sterilization performed with atraumatic techniques, but not with magnification, 48% of the women later had live births. The risk of ectopic pregnancy among microsurgery reversal patients was 3% and among patients who had convention reversals the risk was 7%. Microsurgical techniques involve 1) the use of an operating microscope; 2) electrocoagulation to control bleeding; 3) careful alignment of the tubes; 4) the use of fine suturing materials to join the tubes; and 5) constant irrigation. Sterilization techniques differ in regard to their reversibility potential. Electrocautery destroys about 4 cm of tube and offers little chance for reversal while the Pomeroy ligation method destroys about 3 cm of tubes and offers better reversal odds. The use of clips and rings may facilitate reversal, and recent experiments using silastic pouch to encase the fimbria and silastic plugs to block the tubes may offer even better reversal odds. At the present time the demand for reversal is small; however, the demand will probably increase as the number of women accepting sterilization increases. In developed countries, most of the women who seek reversals do so because of remarriage while in the developing countries, women are more likely to seek reversals because of the death of a child. The cost of reversing sterilization is high, and governments must consider the effect on other health needs if a portion of the health budget is used to provide reversal services. Microsurgery can be performed most effectively by experienced surgeons working in specialized centers. Microsurgery training and data collection centers, supported by U.S. Agency for International Development, are currently operating in 15 developing countries. Indication and contraindications for anastomosis were listed and a description of the physiology and function of the fallopian tube was provided. Tables compared the pregnancy outcomes for reversal procedures in selected studies for 1948-1980 and provided information on women who regretted sterilization and on the demand for reversal.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program