Approximately 30 percent of pregnancies that follow a failed tubal sterilization procedure are ectopic. his rate is 20 percent for those following a postpartum procedure (Peterson, 1996, 1997). hus, any symptoms of pregnancy in a woman after tubal sterilization must be investigated, and an ectopic preg nancy excluded.
Overall, risks for ovarian cancer decline and for breast cancer are unafected following sterilization (Gaudet, 2013; Pearce, 2015). Women who have undergone tubal sterilization are highly unlikely to subsequently have salpingitis (Levgur, 2000). For menorrhagia and intermenstrual bleeding following tubal sterilization, most studies of the risk have found no association (DeStefano, 1985; Peterson, 2000; Shy, 1992).
Less objective but important psychological sequelae of sterilization have also been evaluated. In the CREST study, Costello (2002) found that tubal ligation did not change sexual interest or pleasure in 80 percent of women. In most of the 20 percent of women who did report a change, positive efects were 10 to 15 times more likely.
Invariably, a number of women express regrets regarding sterilization, and this is especially true if it is performed at a younger age (Curtis, 2006; Kelek:i, 2005). In the CREST study, Jamieson (2002) reported that 7 percent of women who had undergone tubal ligation had regrets by 5 years. his is not limited to their own sterilization, because 6.1 percent of women whose husbands had undergone vasectomy had similar regrets.
No woman should undergo tubal sterilization believing that subsequent fertility is guaranteed either by surgery or by assisted reproductive techniques. Both approaches are technically dificult, expensive, and not always successful. In general, pregnancy rates after tubal reversal favor women with age younger than 35 years, with 7 cm of remaining tube, with a short time from antecedent sterilization, and with isthmic-isthmic repairs. With reanastomosis via laparotomy, rates of live births range from 44 to 82 percent (Deieux, 2011; Malacova, 2015). The rate of ectopic pregnancy is 2 to 10 percent after reanastomosis (American Society for Reproductive Medicine, 2015). With reanastomosis to reverse Essure sterilization, only 27 percent of women had subsequent live births (Monteith, 2014).
Devices can be inserted via hysteroscopy to occlude the proximal fallopian tubes. he Essure micro insert has a ine stainless-steel inner coil enclosed in polyester fibers and an expandable outer coil of Nitinol-a nickel and titanium alloy (Fig. 39-4). he outer coil expands after placement, allowing the inner fibers to expand. These synthetic fibers incite a chronic inflammatory response to prompt local tissue ingrowth that leads to complete tubal lumen occlusion. For hysteroscopic placement, sedation, paracervical block, or both may be used, and in-oice insertion is often elected. Devices cannot be placed in all women, and some do not tolerate the procedure while awake (DuY, 2005). Bilateral placement is achieved in 81 to 98 percent of cases on a first attempt (la Chapelle, 2015).
FIGURE 39-4 Essure microinsert placement hysteroscopically and ingrowth of tissue. (Reproduced with permission from Thompson M, Kho K: Minimally invasive surgery. In Hoffman BL, Schorge JO, Bradshaw KD, et al (eds): Williams Gynecology, 3rd ed. New York, McGraw-Hill,o201o6.)