Abstract
Objective
To understand women's preferences for permanent contraception by salpingectomy or
tubal occlusion following standardized counseling and evaluate the practicality of
a future randomized trial.
Study design
We invited pregnant and non-pregnant women planning permanent contraception at the
University of California, Davis (UCD) and University of Tennessee (UT) Obstetrics
and Gynecology clinics to participate. We enrolled women when they received routine
counseling and signed procedure consent. Participants received standardized information
sheets reviewing permanent contraception options based on pregnancy status then completed
an anonymous survey with questions about demographics, method preference, and willingness
to participate in a hypothetical randomized trial comparing salpingectomy and tubal
occlusion. We evaluated predictors for salpingectomy preference using multivariable
analysis.
Results
From July 2015 to October 2016, we enrolled 75 women at UCD and 63 women at UT. Overall,
respondents preferred salpingectomy (63.0%); among the 47 women not currently pregnant
at both sites, 40 (85.1%) preferred salpingectomy, most commonly because of higher
efficacy. Although population characteristics differed significantly between the sites,
only UCD site (aOR 4.2; 95% CI 1.9, 9.4) and non-pregnancy status (aOR 4.2; 95% CI
1.6, 10.8) predicted preference for salpingectomy in the multivariable model. Most
participants (n=84, 60.9%) would not be willing to be randomized to a theoretical trial comparing
salpingectomy and tubal occlusion procedures.
Conclusion
Among a diverse group of women from two different areas in the U.S. given a choice
of permanent contraception methods, salpingectomy is preferred over tubal occlusion.
Most women planning a permanent contraceptive procedure would not agree to a randomized
comparison of these methods.
Implications statement
Salpingectomy, which offers theoretically higher efficacy and potentially greater
ovarian cancer protection compared to tubal occlusion, is preferred by the majority
of patients and should be offered to all women seeking permanent contraception. Differences
in method choices less likely reflect the patient population and more likely the counseling
provided.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Contraceptive method use in the United States: trends and characteristics between 2008, 2012 and 2014.Contraception. 2018; 97: 14-21
- The risk of pregnancy after tubal sterilization: findings from the U.S. collaborative review of sterilization.Am J Obstet Gynecol. 1996; 174: 1161-1168
- The role of the fallopian tube in the origin of ovarian cancer.Am J Obstet Gynecol. 2013; 209: 409-414
- Female tubal sterilization: the time has come to routinely consider removal.Obstet Gynecol. 2014; 124: 596-599
- Tubal ligation and the risk of ovarian cancer: review and meta-analysis.Hum Reprod Update. 2011; 17: 55-67
- Tubal ligation and risk of ovarian cancer subtypes: a pooled analysis of case-control studies.Int J Epidemiol. 2013; 42: 579-589
- Effect of tubal sterilization technique on the risk of serous epithelial ovarian and primary peritoneal carcinoma.Gynecol Oncol. 2014; 135: 423-427
- Opportunistic salpingectomy: uptake, risks, and complications of a regional initiative for ovarian cancer prevention.Am J Obstet Gynecol. 2014; 210: 471.e1-11
- Safety outcomes of female sterilization by salpingectomy and tubal occlusion.Contraception. 2017; 95: 505-508
- Total bilateral salpingectomy versus partial bilateral salpingectomy for permanent sterilization during cesarean delivery.Arch Gynecol Obstet. 2017; 295: 1185-1189
- Salpingectomy for sterilization: change in practice in a large integrated health care system, 2011–2016.Am J Obstet Gyncecol. 2017; 130: 961-967
- Successful completion of total and partial salpingectomy at the time of cesarean delivery.Contraception. 2018; 38: 232-236
- Obstet Gynecol. 2015; 125: 279-281
- The use of opportunistic salpingectomy at the time of benign hysterectomy.J Minim Invasive Gynecol. 2018; : 53-61
- An updated assessment of postpartum sterilization fulfillment after vaginal delivery.Contraception. 2017; 96: 41-46
- Trends in contraceptive use in the United States: 1982-1995.Fam Plann Perspect. 1998; 30 ([46]): 4-10
Article info
Publication history
Published online: October 06, 2018
Accepted:
September 18,
2018
Received in revised form:
September 18,
2018
Received:
April 24,
2018
Footnotes
☆Funding: This work was supported at University of California, Davis by the Melissa Cooke Johnsen Family Planning and Reproductive Health Fund and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant number UL1 TR001860. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
☆☆Conflicts of interest: none.
★This information was reported in part as a poster abstract at the North American Forum on Family Planning, Atlanta, GA, October 14–16, 2017.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
