Tubal anastomosis after previous sterilization: a systematic review
Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized a...
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| Veröffentlicht in: | Human reproduction update 2017-05, Vol.23 (3), p.358-370 |
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| creator | van Seeters, Jacoba A H Chua, Su Jen Mol, Ben W J Koks, Carolien A M |
| description | Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location.
We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.
Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including |
| doi_str_mv | 10.1093/humupd/dmx003 |
| format | Article |
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We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.
Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness.
We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated.
In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.</description><identifier>ISSN: 1355-4786</identifier><identifier>EISSN: 1460-2369</identifier><identifier>DOI: 10.1093/humupd/dmx003</identifier><identifier>PMID: 28333337</identifier><language>eng</language><publisher>England</publisher><subject>Age Factors ; Fallopian Tubes - surgery ; Female ; Humans ; Pregnancy ; Pregnancy Rate ; Prospective Studies ; Retrospective Studies ; Sterilization Reversal - methods ; Sterilization Reversal - statistics & numerical data ; Sterilization, Tubal - psychology ; Treatment Outcome</subject><ispartof>Human reproduction update, 2017-05, Vol.23 (3), p.358-370</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c332t-e9b2e4f291e818f597b65edd8e227dd8659cdd8a1d57444eb8852d37210a8b533</citedby><cites>FETCH-LOGICAL-c332t-e9b2e4f291e818f597b65edd8e227dd8659cdd8a1d57444eb8852d37210a8b533</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28333337$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Seeters, Jacoba A H</creatorcontrib><creatorcontrib>Chua, Su Jen</creatorcontrib><creatorcontrib>Mol, Ben W J</creatorcontrib><creatorcontrib>Koks, Carolien A M</creatorcontrib><title>Tubal anastomosis after previous sterilization: a systematic review</title><title>Human reproduction update</title><addtitle>Hum Reprod Update</addtitle><description>Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location.
We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.
Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness.
We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated.
In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.</description><subject>Age Factors</subject><subject>Fallopian Tubes - surgery</subject><subject>Female</subject><subject>Humans</subject><subject>Pregnancy</subject><subject>Pregnancy Rate</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Sterilization Reversal - methods</subject><subject>Sterilization Reversal - statistics & numerical data</subject><subject>Sterilization, Tubal - psychology</subject><subject>Treatment Outcome</subject><issn>1355-4786</issn><issn>1460-2369</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kM1LxDAQxYMo7rp69Co9eqmb76bepPgFC17Wc0ibKVaabU1adf3rTenqXN684cdjeAhdEnxDcM7Wb6Mbe7u27htjdoSWhEucUibz47gzIVKeKblAZyG8Y0wkUdkpWlDFpsmWqNiOpWkTszNh6FwXmpCYegCf9B4-m24MSYiuaZsfMzTd7jYxSdjHk4u2SiYGvs7RSW3aABcHXaHXh_tt8ZRuXh6fi7tNWjFGhxTykgKvaU5AEVWLPCulAGsVUJpFkSKvohhiRcY5h1IpQS3LKMFGlYKxFbqec3vffYwQBu2aUEHbmh3ETzVRCnOZCzqh6YxWvgvBQ6173zjj95pgPfWm59703Fvkrw7RY-nA_tN_RbFfvKFr7A</recordid><startdate>20170501</startdate><enddate>20170501</enddate><creator>van Seeters, Jacoba A H</creator><creator>Chua, Su Jen</creator><creator>Mol, Ben W J</creator><creator>Koks, Carolien A M</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170501</creationdate><title>Tubal anastomosis after previous sterilization: a systematic review</title><author>van Seeters, Jacoba A H ; Chua, Su Jen ; Mol, Ben W J ; Koks, Carolien A M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c332t-e9b2e4f291e818f597b65edd8e227dd8659cdd8a1d57444eb8852d37210a8b533</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Age Factors</topic><topic>Fallopian Tubes - surgery</topic><topic>Female</topic><topic>Humans</topic><topic>Pregnancy</topic><topic>Pregnancy Rate</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Sterilization Reversal - methods</topic><topic>Sterilization Reversal - statistics & numerical data</topic><topic>Sterilization, Tubal - psychology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Seeters, Jacoba A H</creatorcontrib><creatorcontrib>Chua, Su Jen</creatorcontrib><creatorcontrib>Mol, Ben W J</creatorcontrib><creatorcontrib>Koks, Carolien A M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Human reproduction update</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Seeters, Jacoba A H</au><au>Chua, Su Jen</au><au>Mol, Ben W J</au><au>Koks, Carolien A M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tubal anastomosis after previous sterilization: a systematic review</atitle><jtitle>Human reproduction update</jtitle><addtitle>Hum Reprod Update</addtitle><date>2017-05-01</date><risdate>2017</risdate><volume>23</volume><issue>3</issue><spage>358</spage><epage>370</epage><pages>358-370</pages><issn>1355-4786</issn><eissn>1460-2369</eissn><abstract>Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location.
We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.
Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness.
We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated.
In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.</abstract><cop>England</cop><pmid>28333337</pmid><doi>10.1093/humupd/dmx003</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Age Factors Fallopian Tubes - surgery Female Humans Pregnancy Pregnancy Rate Prospective Studies Retrospective Studies Sterilization Reversal - methods Sterilization Reversal - statistics & numerical data Sterilization, Tubal - psychology Treatment Outcome |
| title | Tubal anastomosis after previous sterilization: a systematic review |
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