Incidence, risk factors, and prevention of poststerilization regret in women: an updated international review from an epidemiological perspective

Abstract

Tubal sterilization is the world's most commonly used contraceptive method. Even a small proportion of women incurring poststerilization regret would translate into a large number of sufferers. In this review, we examine recent reports on the incidence of, and the risk factors for, posttubal sterilization regret in women and requests for sterilization reversal in both developed countries and less-developed countries. We also consider the implications of our findings in the practical prevention of poststerilization regret and requests for sterilization reversal, and discuss methodological issues.

PIP: Used by approximately 138 million women of reproductive age, tubal sterilization is the world's most popular contraceptive method. Some women, however, regret having undergone the procedure. Curious about the incidence of, and the risk factors for post-tubal sterilization regret in women, as well as requests for sterilization reversal in both developed and developing countries, the authors searched literature through the Popline and Medline databases published on the subject since 1980. Review of studies' findings indicate that poststerilization regret is limited to a small number of women, regardless of their cultural backgrounds or the development stage of the country in which they reside. Young age at sterilization is an universally strong risk factor for regret, while remarriage is a strong risk factor for request of reversal, especially in developed countries and some African countries where remarriage is common. The death of an infant or child is an important risk factor for regret and desire for reversal in less-developed countries. Careful and thorough counseling by service providers is the key to preventing poststerilization regret and request for the reversal of sterilization. It is recommended that service providers avoid making the sterilization decision for women, avoid performing sterilizations immediately after delivery and concurrently with other surgical procedures in "high risk" women, and when practical, use a tubal occlusion technique for sterilization such as clips or rings which causes the least damage to fallopian tubes. The authors close in affirming that sterilization clients should regard the sterilization procedure as irreversible, yet physicians should perform it as if the procedure may one day need to be reversed.