Abstract
Objective
To compare the expected probability of pregnancy after hysteroscopic versus laparoscopic
sterilization based on available data using decision analysis.
Study design
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%.
Conclusion
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.
Implications
Pregnancy probability at 1 year and over 10 years is expected to be higher in women
having hysteroscopic as compared to laparoscopic sterilization.
Keywords
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Article info
Publication history
Published online: April 28, 2014
Accepted:
March 16,
2014
Received in revised form:
March 11,
2014
Received:
October 9,
2013
Footnotes
☆Funding: A grant from the Society of Family Planning.
☆☆Disclosure: The authors report no conflict of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
