Live delivery outcome after tubal sterilization reversal A population based study

Capsule:
Within the first 5 years after sterilization reversal, at least 50% of women sterilized before the age of 40 years successfully deliver a child, but the delivery rate halves after the age of 40 years.

Authors:
Eva Malacova, Ph.D., Anna Kemp-Casey, Ph.D., Alexandra Bremner, Ph.D., Roger Hart, M.D., C.R.E.I., Louise Maree Stewart, Ph.D., David Brian Preen, Ph.D.

Volume 104, Issue 4, Pages 921-926

Abstract:

Objective:
To determine the cumulative incidence of live delivery in women who underwent reversal of tubal sterilization.

Design:
Population-based retrospective cohort study.

Setting:
Hospitals in Western Australia.

Patient(s):
All women aged 20–44 years, with a history of hospital admission for tubal sterilization, who subsequently underwent reversal of sterilization during the period 1985 to 2009 in Western Australia (n = 1,898).

Intervention(s):
Data regarding reversal of sterilization and prior tubal sterilization were extracted from routinely collected administrative hospital separation records, until commencement of IVF treatment.

Main Outcome Measure(s):
First live-delivery rates.

Result(s):
There were 969 first live deliveries observed during the study period. The overall cumulative live-delivery rate was 20% (95% confidence interval [CI] 18–23) within the first year after reversal, 40% (95% CI 38–42) at 2 years, 51% (95% CI 48–53) at 5 years, and 52% (95% CI 50–55) at 10 years. The 5-year cumulative live-delivery rate was significantly lower in women who were aged 40–44 years (26%) compared with younger women (aged 20–29, 30–34, and 35–39 years) (50%, 56%, and 51%, respectively).

Conclusion(s):
Women undergoing reversal of sterilization before they reach age 40 years have at least a 50% chance of delivering a live baby within the next 5 years. Up to that age, there is no significant difference in live deliveries. The live-delivery rate halves after the age of 40 years.

  • Daniel J. Kaser, MD

    Dear authors,

    Congratulations on a very well-written report. The sample size, and also some of your subanalyses (interval vs. immediate postpartum, method and duration of sterilization) are helpful for patient counseling. It would be interesting to compare the population that ultimately delivered a liveborn to the one that did not, according to age. Any basic parameters that you could share regarding this?

    Thanks for your comments!

    • Eva Malacova

      Thank you for your comment. We are pleased to hear that our findings
      are of practical use for patient counselling. Please see below the distribution
      of timing and method of sterilization according to age for women who delivered
      a liveborn and those did not.

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