Update on Permanent Contraception for Women

Alton, Katie; Jensen, Jeffrey T.

doi:10.1007/s13669-018-0253-3

Cited by 5 publications

(11 citation statements)

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“…The LNG-IUC is a long-acting reversible contraceptive that may be considered as an alternative to permanent contraception for females seeking to end their fertility. The insertion of the LNG-IUC has efficacy and effectiveness rates similar to tubal ligation [1][2][3]5], as after insertion, it does not require maintenance. The LNG-IUC requires re-purchase and re-insertion every 5 or more years [22], may cause irregular bleeding [23], and in extremely rare cases, the device may migrate and cause uterine perforation [24].…”

Section: Plain Language Summarymentioning

confidence: 99%

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Comparing options for females seeking permanent contraception in high resource countries: a systematic review

et al. 2021

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Background Multiple options for permanent or long-acting contraception are available, each with adverse effects and benefits. People seeking to end their fertility, and their healthcare providers, need a comprehensive comparison of methods to support their decision-making. Permanent contraceptive methods should be compared with long-acting methods that have similar effectiveness and lower anticipated adverse effects, such as the levonorgestrel-releasing intrauterine contraception (LNG-IUC). We aimed to understand the comparability of options for people seeking to end their fertility, using high-quality studies. We sought studies comparing laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and insertion of the LNG-IUC, for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs among females in high resource countries seeking to permanently avoid conception. Methods We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We used the Newcastle–Ottawa Scale to assess risk of bias and excluded studies with medium–high risk of bias (NOS < 7). Due to considerable heterogeneity, we performed a narrative synthesis. Results Our search identified 6,612 articles. RG, BV, BC independently reviewed titles and abstracts for relevance. We reviewed the full text of 154 studies, yielding 34 studies which met inclusion criteria. We excluded 10 studies with medium–high risk of bias, retaining 24 in our synthesis. Most studies compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events; fewer reported tolerability, patient recovery, non-contraceptive benefits, and/or healthcare system costs. No comparisons reported accessibility, eligibility, or follow-up required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No high-quality studies included the LNG-IUC. Conclusions Studies are needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception to support decision-making. Systematic review registration PROSPERO [CRD42016038254].

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Section: Plain Language Summarymentioning

confidence: 99%

“…Permanent contraception is the most common method of fertility control worldwide [ 1 , 2 ]. Globally, nearly one in four females in high income countries use either intrauterine contraception or female sterilization [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

et al. 2021

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“…5 Permanent contraception is traditionally achieved using laparoscopic tubal ligation, with the clipping, coagulation, or other blocking of the fallopian tubes to prevent sperm from travelling to an ovulated oocyte. 2 However, in the last two decades, other methods to achieve permanent contraception have emerged including bilateral salpingectomy and the levonorgestrelreleasing intrauterine contraceptive (LNG-IUC), while Essure,™ micro inserts used in hysteroscopic tubal occlusion, has been taken off the market in select countries. [6][7][8] Bilateral salpingectomy is increasingly being considered as an alternative option to laparoscopic tubal ligation.…”

Section: Introductionmentioning

confidence: 99%

“…Although a reversible contraceptive method, insertion of the LNG-IUC has e cacy and effectiveness rates similar to tubal ligation. [1][2][3]5 Although the LNG-IUC requires re-purchase and re-insertion every 5 or more years, 16 this option may be attractive due to the avoidance of surgery and of the faster recovery time compared to that required for other methods. 17 For this reason, we have included LNG-IUC as a permanent contraception alternative for the purpose of this analysis.…”

Section: Introductionmentioning

confidence: 99%

“…Permanent contraception is the most common method of fertility control worldwide. 1,2 Globally, nearly one in four females in high income countries use either intrauterine contraception or female sterilization. 3 Female permanent contraceptive methods are the fourth most commonly relied upon method for preventing pregnancy among people in Canada, 4 and the second most common method in the United States.…”

Section: Introductionmentioning

confidence: 99%

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Comparing Female Permanent Contraception Options in High Resource Countries: A Systematic Review

Gormley

Vickers

Cheng

et al. 2020

Preprint

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Background: Multiple options for permanent or long-acting contraception are available, each with adverse effects and non-contraceptive benefits. A comprehensive comparison of methods to support decision-making for people seeking to end their fertility and their healthcare providers is needed. We aimed to understand what is known from high quality studies about the comparability of options for permanent contraception. We sought studies comparing these methods of permanent or long-acting contraception: laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and levonorgestrel-releasing intrauterine contraception (LNG-IUC), for effectiveness, adverse events, tolerability, patient recovery, non-contraceptive benefits and healthcare system costs among females in high resource countries seeking to permanently avoid conception. Methods: We followed PRISMA guidelines, searched EMBASE, Pubmed (Medline), Web of Science, and screened retrieved articles to identify additional relevant studies. We extracted data on population, interventions, outcomes, follow-up, health system costs, and study funding source. We assessed risk of bias using the Newcastle-Ottawa Scale, excluding studies with high risk of bias. Due to considerable heterogeneity, we performed a narrative synthesis. Results: Our search identified 6,612 articles. We reviewed the full text of 154 studies, yielding 35 studies which met inclusion criteria. We excluded 10 studies with high risk of bias, retaining 25 at low or medium risk for bias in our synthesis. Most studies assessed hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. Most comparisons reported on effectiveness and adverse events, with fewer reporting tolerability, patient recovery, non-contraceptive benefits, and healthcare system costs. No comparisons reported accessibility, eligibility, or follow-ups required. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All studies reported adverse events. All forms of tubal interruption reported a protective effect against cancers. Tolerability appeared greater among tubal ligation patients compared to hysteroscopic tubal occlusion patients. No medium or high-quality studies compared LNG-IUC to other methods.Conclusions: High-quality studies comparing outcomes relevant for those seeking female permanent contraception are needed to support informed decision-making. Research is needed to directly compare surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception.Systematic review registration: PROSPERO [CRD42016038254].

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Reversible Mechanical Contraception and Endometriosis Treatment Using Stimuli‐Responsive Hydrogels

Anthis,

Kilchenmann,

Murdeu

et al. 2024

Advanced Materials

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Female sterilization via fallopian tube ligation is a common procedure. However, after the operation, over 10% of women seek re‐fertilization, which is frequently unsuccessful. In addition, there is evidence that fallopian tubes contribute to the spread of endometriotic tissue as they serve as channels for proinflammatory media entering the abdominal cavity via retrograde menstruation. Here, we present stimuli‐degradable hydrogel implants for the functional, biocompatible, and reversible occlusion of fallopian tubes. The hydrogel implants, designed with customized swelling properties, mechanically occlude fallopian tubes in a high‐performance manner with burst pressures reaching 255–558 mmHg, exceeding normal abdominal pressures (95 mmHg). Their damage‐free removal can be achieved within 30 minutes using near‐visible UV light or a glutathione solution, employing a method akin to standard fallopian tube perfusion diagnostics. We demonstrate ultrasound‐guided implant placement using a clinical hysteroscope in a human‐scale uterus model and biocompatibility in a porcine in vivo model. Importantly, the prevention of live sperm as well as endometrial cell passage through blocked fallopian tubes is demonstrated. Overall, we present a multifunctional system that constitutes a possible means of on‐demand, reversible contraception along with the first ever mechanical approach to abdominal endometriosis prevention and treatment.This article is protected by copyright. All rights reserved

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Update on Permanent Contraception for Women

Cited by 5 publications

References 50 publications

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

Comparing options for females seeking permanent contraception in high resource countries: a systematic review

Comparing Female Permanent Contraception Options in High Resource Countries: A Systematic Review

Reversible Mechanical Contraception and Endometriosis Treatment Using Stimuli‐Responsive Hydrogels

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