Failed female sterilization: a review of pathogenesis and subsequent contraceptive options.
OBJECTIVE
To review the published literature, outline the pathogenesis of failed sterilization and discuss the currently available contraceptive options once sterilization fails.


METHODS
Publications from January 1966 to October 2008 and indexed in the MEDLINE/PubMed database were reviewed. Medical search heading words sterilization, sterilization failure, sterilization methods and contraception were used to identify relevant articles. In addition, references were obtained through cross-referencing the bibliography cited in each work.


RESULTS
Available evidence suggests that sterilization fails in 0.13-1.3% of sterilization procedures and of these, 15-33% will be ectopic pregnancies. Tubal recanalization and cornual and tuboperitoneal fistula formation are the main causes; their occurrence can be reduced by proper training and use of appropriate sterilization techniques. Following sterilization failure, hysterosalpingography can provide valuable information about the patency of the fallopian tubes.


CONCLUSIONS
Tubal sterilization is highly effective but can fail. There is a paucity of information in the literature as to what is best or most appropriate for patients when sterilization fails. Patients should be counseled at the outset about the contraceptive options that are available should sterilization fail.
Awonuga
Awoniyi O
AO
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, 3750 Woodward Avenue, Suite 200-D, Detroit, MI 48201, USA. aawonuga@med.wayne.edu
Imudia
Anthony N
AN
Shavell
Valerie I
VI
Berman
Jay
J
Diamond
Michael P
MP
Puscheck
Elizabeth E
EE
D000328:Adult; D003267:Contraception / Q000379:methods; D005187:Fallopian Tubes / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000209:etiology*; D049168:Pregnancy, Unplanned; D013245:Sterilization, Reproductive / Q000009:adverse effects*