Elsevier

Contraception

Volume 77, Issue 1, January 2008, Pages 6-9
Contraception

Commentary
Intrauterine contraception as an alternative to interval tubal sterilization

https://doi.org/10.1016/j.contraception.2007.09.012Get rights and content

Introduction

In countries where levonorgestrel-releasing IUD use has increased, the incidence of female surgical sterilization procedures has decreased [1], [2]. Will the same inverse relationship appear in the United States, and, if so, what would be the medical implications of such a transition in long-term contraception? A recent UK review compared long-term contraception with IUDs vs. surgical sterilization [2]; here we compare these two approaches from a US perspective. We focus on interval tubal sterilization by laparoscopy or laparotomy and will not consider postpartum sterilization.

Section snippets

Current use of female sterilization

Female sterilization has played a dominant role in family planning in the United States for decades. As of the 2002 National Survey of Family Growth, female sterilization was the second most common means of fertility regulation among women of reproductive age (17%) [3]. Only oral contraceptives (19%) were used by more women.

Several personal characteristics are strongly linked with female surgical sterilization. While the proportion of women having female sterilization procedures increases with

IUD vs. interval tubal sterilization

Long-term contraception with an IUD and tubal sterilization share common features as well as important differences (Table 1). An office-based procedure, insertion of an IUD is more convenient and rapid than tubal sterilization, which requires use of an operating room. IUD insertion is technically simple and can be performed by clinicians with a wide range of medical training; interval tubal sterilization by laparoscopy or laparotomy is moderately complex and requires sterile surgical supplies,

Conclusion

Both intrauterine contraception and tubal sterilization are “top-tier” methods of fertility regulation with comparable high effectiveness [31]. Both offer convenient “forgettable contraception” that lasts for years, and both have important noncontraceptive benefits [25], [28], [32]. A small but important minority of women who undergo tubal sterilization later regret their decision, and some of them pursue expensive and inconvenient remedies. All women, particularly young women, who are at high

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References (35)

Cited by (37)

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    Additionally, women using LARCs may be more likely than nonusers to self-select to participate in a study about these methods. Although there are mixed opinions among researchers and women about the suitability of LARCs as an alternative to sterilization for women who have achieved their desired family size (Grimes & Mishell Jr, 2008; Marasinghe & Wijeyaratne, 2008; Vancaillie, 2013; White et al., 2013), the popularity of the IUD in this sample supports its potential as an acceptable alternative to sterilization. Indeed, 25% to 35% of women using or interested in LARCs reported a reason for interest was not wanting any more children, suggesting that women are already using LARCs to end, rather than to space, childbearing.

  • Knowledge and attitudes about long-acting reversible contraception among Latina women who desire sterilization

    2013, Women's Health Issues
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    There is growing interest in increasing women's use of long-acting reversible contraception (LARC), such as the intrauterine device (IUD) and subdermal implant, to reduce rates of unintended pregnancy in the United States (Allen, Goldberg, & Grimes, 2009; Finer & Zolna, 2011; Speidel, Harper, & Shields, 2008). In addition, some have suggested that the IUD could serve as an alternative to female sterilization given the method's comparable efficacy and lower cost (Grimes & Mishell, 2008; Trussell et al., 2009). Others also note that greater IUD use among women who wish to end childbearing may reduce the incidence of post-sterilization regret (Allen et al., 2009).

  • Rates of continuation and satisfaction of immediate intrauterine device insertion following first- or second-trimester surgical abortion: A French prospective cohort study

    2013, European Journal of Obstetrics and Gynecology and Reproductive Biology
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    Immediate placement of IUD after abortion may be beneficial for several reasons: only a single visit is required for both the termination and contraception, the patient has a highly effective contraceptive immediately after her procedure and lower risk of unplanned pregnancy, with avoidance of additional discomfort from insertion at a later date [16–18]. Several large trials have demonstrated the safety and efficacy of placing an IUD after abortions [16–20]. Despite this evidence, however, some clinicians hesitate because of fears regarding possible expulsion, uterine perforation, infection and cost.

  • Tubal sterilization trends in the United States

    2010, Fertility and Sterility
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    The unchanged rate of vasectomy thus cannot explain the decline in tubal sterilization rates. Intrauterine devices (IUDs) have failed to regain popularity since their temporary withdrawal from the U.S. market during 1986–88, with incidence falling from 7% in 1982 to 1.3% in 2002 (59, 60). We hypothesize that more recent increased use of IUDs may contribute to the observed changes in tubal sterilization prevalence, a trend already demonstrated in Europe.

  • Expanding access to intrauterine contraception

    2009, American Journal of Obstetrics and Gynecology
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