The risk of pregnancy after tubal sterilization: Findings from the U.S. Collaborative Review of Sterilization


      OBJECTIVE: Our purpose was to determine the risk of pregnancy after tubal sterilization for common methods of tubal occlusion. STUDY DESIGN: A multicenter, prospective cohort study was conducted in U.S. medical centers. A total of 10,685 women who underwent tubal sterilization was followed up for 8 to 14 years. The risk of pregnancy was assessed by cumulative life-table probabilities and proportional hazards models. RESULTS: A total of 143 sterilization failures was identified. Cumulative 10-year probabilities of pregnancy were highest after clip sterilization (36.5/1000 procedures) and lowest after unipolar coagulation (7.5/1000) and postpartum partial salpingectomy (7.5/1000). The cumulative risk of pregnancy was highest among women sterilized at a young age with bipolar coagulation (54.3/1000) and clip application (52.1/1000). CONCLUSIONS: Although tubal sterilization is highly effective, the risk of sterilization failure is higher than generally reported. The risk persists for years after the procedure and varies by method of tubal occlusion and age. (AM J OBSTET GYNECOL 1996;174:1161-70.)


      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 access
      One-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 to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mosher WD
        • Pratt WF.
        Contraceptive use in the United States, 1973-1988.
        National Center for Health Statistics, Hyattsville, Maryland1990 (advance data from vital and health statistics no 182)
        • Peterson LS.
        Contraceptive use in the United States: 1982-90.
        National Center for Health Statistics, Hyattsville, Maryland1995 (advance data from vital and health statistics of the Centers for Disease Control and Prevention/National Center for Health Statistics no 260)
        • Institute SAS
        Inc. SAS/STAT software: changes and enhancements.
        SAS Institute, Cary, North Carolina1992 (SAS technical report p-229)
        • Chi I-C
        • Laufe LE
        • Gardner SD
        • Tolbert MA.
        An epidemiologic study of risk factors associated with pregnancy following female sterilization.
        AM J OBSTET GYNECOL. 1980; 136: 768-773
        • Bhiwandiwala PP
        • Mumford SD
        • Feldblum PJ.
        A comparison of different laparoscopic sterilization occlusion techniques in 24,439 procedures.
        AM J OBSTET GYNECOL. 1982; 144: 319-331
        • Cheng MCE
        • Wong YM
        • Rochat RW
        • Ratnam SS.
        Sterilization failures in Singapore: an examination of ligation techniques and failure rates.
        Stud Fam Plann. 1977; 8: 109-115
        • Vessey M
        • Huggins G
        • Lawless M
        • Yeates D.
        Tubal sterilization: findings in a large, prospective study.
        Br J Obstet Gynaecol. 1983; 90: 203-209
        • Hatcher RA
        • Trussell J
        • Stewart F
        • et al.
        Contraceptive technology.
        in: 16th ed. Irvington, New York1994: 684-686
        • Hulka JF
        • Reich H.
        Textbook of laparoscopy.
        in: 2nd ed. WB Saunders, Philadelphia1994: 136-143
        • Soderstrom RM
        • Levy BS
        • Engel T.
        Reducing bipolar sterilization failures.
        Obstet Gynecol. 1989; 74: 60-63
        • Jones EF
        • Forrest JD.
        Under reporting of abortion in surveys of U.S. women, 1976-1988.
        Demography. 1992; 29: 113-126
        • Harlap S
        • Kost K
        • Forrest JD.
        Preventing pregnancy, protecting health: a new look at birth control choices in the United States.
        in: The Alan Guttmacher Institute, New York1991: 33-39
        • Centers for Disease Control and Prevention
        Tubal sterilization among women of reproductive age, United States, update for 1979-1980.
        MMWR Morb Mortal Wkly Rep. 1983; 32: 9SS-14SS
        • Stovall TG
        • Ling FW
        • O'Kelley KR
        • Coleman SA.
        Gross and histologic examination of tubal ligation failures in a residency training program.
        Obstet Gynecol. 1990; 76: 461-465
        • Stovall TG
        • Ling FW
        • Henry GM
        • Ryan Jr., GM
        Method failures of laparoscopic tubal sterilization in a residency training program: a comparison of the tubal ring and spring-loaded clip.
        J Reprod Med. 1991; 36: 283-286
        • Kjer JJ
        • Knudsen LB.
        Ectopic pregnancy subsequent to laparoscopic sterilization.
        AM J OBSTET GYNECOL. 1989; 160: 1202-1204
        • McCausland A.
        High rate of ectopic pregnancy following laparoscopic tubal coagulation failures: incidence and etiology.
        AM J OBSTET GYNECOL. 1980; 136: 97-101
        • Wilcox LS
        • Chu SY
        • Eaker ED
        • Zeger SL
        • Peterson HB.
        Risk factors for regret after tubal sterilization: 5 years of follow-up in a prospective study.
        Fertil Steril. 1991; 55: 927-933
        • Peterson HB
        • DeStefano F
        • Rubin GL
        • Greenspan JR
        • Lee NC
        • Ory HW.
        Deaths attributable to tubal sterilization in the United States, 1977-1981.
        AM J OBSTET GYNECOL. 1983; 146: 131-136
        • Siegler AM
        • Hulka JF
        • Peretz A.
        Reversibility of female sterilization.
        Fertil Steril. 1985; 43: 499-510
        • Trussell J
        • Leveque JA
        • Koenig JD
        • et al.
        The economic value of contraception: a comparison of 15 methods.
        Am J Public Health. 1995; 85: 494-503
        • Jones EF
        • Forrest JD.
        Contraceptive failure rates based on the 1988 NSFG.
        Fam Plann Perspect. 1992; 24: 12-19
        • Schmidt F
        • Sivin I
        • Waldman S.
        The copper T 380 IUD.
        in: Proceedings from the fourth international conference on IUDs. Butterworth-Heinemann, Boston1994: 298-307
        • Forrest JD.
        Acceptability of IUDs in the United States.
        in: Proceedings from the fourth international conference on IUDs. Butterworth-Heinemann, Boston1994: 90-99
        • Williams EL
        • Jones HE
        • Merrill RE.
        The subsequent course of patients sterilized by tubal ligation.
        AM J OBSTET GYNECOL. 1951; 61: 423-426