Probability of pregnancy after sterilization: a comparison of hysteroscopic versus laparoscopic sterilization.
OBJECTIVE
To compare the expected probability of pregnancy after hysteroscopic versus laparoscopic sterilization based on available data using decision analysis.


METHODS
We developed an evidence-based Markov model to estimate the probability of pregnancy over 10 years after three different female sterilization procedures: hysteroscopic, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation. Parameter estimates for procedure success, probability of completing follow-up testing and risk of pregnancy after different sterilization procedures were obtained from published sources.


RESULTS
In the base case analysis at all points in time after the sterilization procedure, the initial and cumulative risk of pregnancy after sterilization is higher in women opting for hysteroscopic than either laparoscopic band or bipolar sterilization. The expected pregnancy rates per 1000 women at 1 year are 57, 7 and 3 for hysteroscopic sterilization, laparoscopic silicone rubber band application and laparoscopic bipolar coagulation, respectively. At 10 years, the cumulative pregnancy rates per 1000 women are 96, 24 and 30, respectively. Sensitivity analyses suggest that the three procedures would have an equivalent pregnancy risk of approximately 80 per 1000 women at 10 years if the probability of successful laparoscopic (band or bipolar) sterilization drops below 90% and successful coil placement on first hysteroscopic attempt increases to 98% or if the probability of undergoing a hysterosalpingogram increases to 100%.


CONCLUSIONS
Based on available data, the expected population risk of pregnancy is higher after hysteroscopic than laparoscopic sterilization. Consistent with existing contraceptive classification, future characterization of hysteroscopic sterilization should distinguish "perfect" and "typical" use failure rates.


CONCLUSIONS
Pregnancy probability at 1 year and over 10 years is expected to be higher in women having hysteroscopic as compared to laparoscopic sterilization.
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA. Electronic address: aileen.gariepy@yale.edu.
Aileen M
AM
Gariepy
Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA 95817, USA.
Mitchell D
MD
Creinin
Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA.
Kenneth J
KJ
Smith
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA.
Xiao
X
Xu
D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006306:Health Surveys; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D008137:Longitudinal Studies; D008390:Markov Chains; D008954:Models, Biological; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D013246:Sterilization, Tubal / Q000379:methods*; D014481:United States / Q000453:epidemiology
Female sterilization; Hysteroscopic sterilization; Laparoscopic sterilization; Pregnancy after sterilization; Sterilization failure; Tubal ligation