Rendering follicle tubes permeable again after post-partum sterilization. A report on 25 cases. Should post-partum sterilization be performed or not?
Body, G.; Sagot, P.; Sauvanet, E.; Cancel, J.; Lansac, J.
Contraception Fertilite Sexualite 14(7-8): 675-681
1986
ISSN/ISBN: 0301-861X PMID: 12268400 Document Number: 399203
This article discusses the success of microsurgical reversal attempts after postpartum tubal sterilization and assesses the risk of later reversal requests after postpartum sterilization. 25 of 37 requests for tubal sterilization reversals received by the authors between January 1977-December 1983 followed postpartum sterilizations. The only criteria were contraindications to another pregnancy, a history of bilateral salpingectomy, and existence of a serious hypofertility factor. No minimal tubal length was required. All reversal procedures were microsurgically performed by 3 operators. The average age of patients was 26.7 years at sterilization and 32.5 years at reversal. Ages ranged from 25 to 41 at reversal. The parity of the women ranged from 2 to 9 and averaged 4.2 children. The sterilization was performed during a cesarean section in 19 cases, of which 8 were emergency procedures. The indication for the sterilization was medical in only 7 cases. 20 of the procedures were tubal ligations and resections, 1 was application of a Yoon ring, and 4 were bilateral salpingectomies. Reasons for reversal requests were change of partner in 16 of 25 cases, death of an infant in 1 case, fear of repudiation by the husband in the cases of 4 Muslim women, and change of mind by the couple in 4 cases. 6 of the 25 women were unacceptable candidates for reversal, 4 because of bilateral salpingectomy and 2 because of poor tubal state and failure of previous surgery. 17 women underwent tubotubal anastomoses and 2 had tubouterine reimplantations. The reversal operations resulted in 12 term pregnancies, 1 spontaneous abortion, and 1 extrauterine pregnancy. The delays to pregnancy ranged from 1 to 18 months and averaged 6.6 months. The intrauterine pregnancy rate was 83% for reversals within 5 years of sterilization and 61% later. Age of the woman appeared to play no role. The postpartum period does not seem to be an ideal moment for sterilization because of its association with later requests for reversal. Several factors seem to be involved in requests for reversal, including young age at sterilization, the unpredictability of death in small children, and haste in making the initial sterilization decision. The policy of automatically recommending sterilization after a 3rd cesarean section should be reviewed since in many cases a successful delivery is still possible. Factors in successful reversal include the length of tube remaining, which is related to the sterilization technique employed, and the site of the sterilization, with ligations at the cornu and fimbriectomies giving poor results. The least mutilating forms of sterilization should be used in young women. Clips, rings, and ligations using absorbable thread with limited resection of the isthmus are reliable methods which have the advantage of not definitively compromising fertility. They can also be done by a simple laparoscopic procedure after the postpartum period.