Effective techniques for tubal sterilisation (blocking the fallopian tubes) include cutting, tying, clips, rings and electric current, but their comparative effectiveness is not clear.

Lawrie TA, Nardin JM, Kulier R, Boulvain M

Published Online:

February 16, 2011

Tubal sterilisation prevents pregnancy by stopping the woman's unfertilised egg (ovum) passing through the fallopian tubes where it can be fertilised by sperm. Techniques to close the tubes include cutting and tying, blocking mechanically by using clips or rings, blocking by applying electric current, and blocking by using chemicals or tubal micro inserts that cause tubal scarring. The review of trials found that all techniques are effective in preventing pregnancy, with few adverse effects. There is too little evidence to which technique is most effective. Pregnancy after tubal sterilisation is less likely if an experienced practitioner has performed the procedure.

Abstract (click to read)

Background:

Female sterilisation is the most popular contraceptive method worldwide. Several techniques are described in the literature, however only few of them are commonly used and properly evaluated.

Objectives:

To compare the different tubal occlusion techniques in terms of major and minor morbidity, failure rates (pregnancies), technical failures and difficulties, and women's and surgeons' views.

Search strategy:

Originally MEDLINE and The Cochrane Controlled Trials Register were searched. For the 2010 update, searches of Popline, Lilacs, Pubmed and The Cochrane Controlled Trials Register were performed. Reference lists of identified trials were searched.

Selection criteria:

All randomised controlled trials comparing different techniques for tubal sterilisation, regardless of the route of Fallopian tube access or the method of anaesthesia.

Data collection and analysis:

Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Nine relevant studies were included and the results were stratified in five groups: tubal ring versus clip, modified Pomeroy versus electrocoagulation, tubal ring versus electrocoagulation, modified Pomeroy versus Filshie clip and Hulka versus Filshie clip. Results are reported as odds ratio for dichotomous outcomes and weighted mean differences for continuous outcomes.

Main results:

Tubal ring versus clip: Minor morbidity was higher in the ring group (Peto OR 2.15; 95% CI 1.22, 3.78). Technical difficulties were found less frequent in the clip group ( Peto OR 3.87; 95% CI 1.90, 7.89). There was no difference in failure rates between the two groups (Peto OR 0.70; 95% CI 0.28, 1.76).
Pomeroy versus electrocoagulation: Women undergoing modified Pomeroy technique had higher major morbidity than those with the electrocoagulation technique (Peto OR 2.87; 95% CI 1.13, 7.25). Postoperative pain was more frequent in the Pomeroy group (Peto OR 3.85; 95% CI 2.91, 5.10).
Tubal ring versus electrocoagulation: Post operative pain was more frequently reported in the tubal ring group. No pregnancies were reported.
Pomeroy versus Filshie clip: In the only trial comparing the two interventions only one pregnancy was reported in the Pomeroy group after follow-up for 24 months.
No differences were found when comparing Hulka versus Filshie clip in the only study that compared these two devices.

Authors' conclusions:

Electrocoagulation was associated with less morbidity including post-operative pain when compared with the modified Pomeroy and tubal ring methods, despite the risk of burns to the small bowel. The small sample size and the relative short period of follow-up in these studies limited the power to show clinical or statistical differences for rare outcomes such as failure rates. Aspects such as training, costs and maintenance of the equipment may be important factors in deciding which method to choose.

This record should be cited as:

Lawrie TA, Nardin JM, Kulier R, Boulvain M. Techniques for the interruption of tubal patency for female sterilisation. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD003034. DOI: 10.1002/14651858.CD003034.pub2

Assessed as up to date:

July 20, 2010

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Primary Review Group:

Fertility Regulation Group

Health topics:

Gynaecology > Contraception > Female sterilization

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Effective techniques for tubal sterilisation (blocking the fallopian tubes) include cutting, tying, clips, rings and electric current, but their comparative effectiveness is not clear.

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