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Contraceptive failure after hysteroscopic sterilization: Analysis of clinical and demographic data from 103 unplanned pregnancies.

Sills ES, Li X, Jones CA, Wood SH - Obstet Gynecol Sci (2015)

Bottom Line: Patients age ≥30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively).Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS.Further follow-up studies are planned to capture additional data on this issue.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Research Section, Center for Advanced Genetics, Carlsbad, CA, USA. ; Department of Molecular & Applied Biosciences, University of Westminster, London, UK.

ABSTRACT

Objective: This investigation examined data on unplanned pregnancies following hysteroscopic sterilization (HS).

Methods: A confidential questionnaire was used to collect data from women with medically confirmed pregnancy (n=103) registered after undergoing HS.

Results: Mean (±SD) patient age and body mass index (BMI) were 29.5±4.6 years and 27.7±6.1 kg/m(2), respectively. Peak pregnancy incidence was reported at 10 months after HS, although <3% of unplanned pregnancies occurred within the first three months following HS. Mean (±SD) interval between HS and pregnancy was 19.6±14.9 (range, 2 to 84) months. Patients age ≥30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively). The recommended post-HS hysterosalpingogram (to confirm proper placement and bilateral tubal occlusion) was obtained by 66% (68/103) of respondents.

Conclusion: This report is the first to provide patient-derived data on contraceptive failures after HS. While adherence to backup contraception 3 months after HS can be poor, many unintended pregnancies with HS occur long after the interval when alternate contraceptive is required. Many patients who obtain HS appear to ignore the manufacturer's guidance regarding the post-procedure hysterosalpingogram to confirm proper device placement, although limited insurance coverage likely contributes to this problem. The greatest number of unplanned pregnancies occurred 10 months after HS, but some unplanned pregnancies were reported up to 7 years later. Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS. Further follow-up studies are planned to capture additional data on this issue.

No MeSH data available.


(A) Probability density of interval to pregnancy after hysteroscopic sterilization (HS) as reported in 103 unplanned pregnancies. (B) Cumulative probability of interval to pregnancy following HS in months. Conceptions recorded during the first three months following HS reflect the observation that most (97.1%) unplanned pregnancies occurred later than 3 months after HS (inset).
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Figure 1: (A) Probability density of interval to pregnancy after hysteroscopic sterilization (HS) as reported in 103 unplanned pregnancies. (B) Cumulative probability of interval to pregnancy following HS in months. Conceptions recorded during the first three months following HS reflect the observation that most (97.1%) unplanned pregnancies occurred later than 3 months after HS (inset).

Mentions: In this sample, mean (±SD) interval between the HS procedure and positive pregnancy test was 19.6±14.9 (range, 2 to 84) months, although peak incidence (mode) for pregnancy was recorded 10 months after HS. Only three of 103 unplanned pregnancies (2.9%) occurred within the initial three months following HS. Fifteen patients (14.6%) reported an ongoing pregnancy at time of survey. Cumulative probability of pregnancy is shown in Fig. 1. Younger patients (age <30 years) who underwent HS had unplanned pregnancy slightly later than patients age ≥30 years, although this difference was not significant (P=0.68). At time of survey, mean±SD BMI was reported as 27.7±6.1 kg/m2 for this group. While weight gain after HS was reported by 81.6% (84 of 103) of women, the time interval between HS and unplanned pregnancy was somewhat longer for those with BMI ≥25 compared to those with BMI <25 (21.1±13.7 vs. 17.6±16.1 months, P=0.09).


Contraceptive failure after hysteroscopic sterilization: Analysis of clinical and demographic data from 103 unplanned pregnancies.

Sills ES, Li X, Jones CA, Wood SH - Obstet Gynecol Sci (2015)

(A) Probability density of interval to pregnancy after hysteroscopic sterilization (HS) as reported in 103 unplanned pregnancies. (B) Cumulative probability of interval to pregnancy following HS in months. Conceptions recorded during the first three months following HS reflect the observation that most (97.1%) unplanned pregnancies occurred later than 3 months after HS (inset).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663227&req=5

Figure 1: (A) Probability density of interval to pregnancy after hysteroscopic sterilization (HS) as reported in 103 unplanned pregnancies. (B) Cumulative probability of interval to pregnancy following HS in months. Conceptions recorded during the first three months following HS reflect the observation that most (97.1%) unplanned pregnancies occurred later than 3 months after HS (inset).
Mentions: In this sample, mean (±SD) interval between the HS procedure and positive pregnancy test was 19.6±14.9 (range, 2 to 84) months, although peak incidence (mode) for pregnancy was recorded 10 months after HS. Only three of 103 unplanned pregnancies (2.9%) occurred within the initial three months following HS. Fifteen patients (14.6%) reported an ongoing pregnancy at time of survey. Cumulative probability of pregnancy is shown in Fig. 1. Younger patients (age <30 years) who underwent HS had unplanned pregnancy slightly later than patients age ≥30 years, although this difference was not significant (P=0.68). At time of survey, mean±SD BMI was reported as 27.7±6.1 kg/m2 for this group. While weight gain after HS was reported by 81.6% (84 of 103) of women, the time interval between HS and unplanned pregnancy was somewhat longer for those with BMI ≥25 compared to those with BMI <25 (21.1±13.7 vs. 17.6±16.1 months, P=0.09).

Bottom Line: Patients age ≥30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively).Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS.Further follow-up studies are planned to capture additional data on this issue.

View Article: PubMed Central - PubMed

Affiliation: Reproductive Research Section, Center for Advanced Genetics, Carlsbad, CA, USA. ; Department of Molecular & Applied Biosciences, University of Westminster, London, UK.

ABSTRACT

Objective: This investigation examined data on unplanned pregnancies following hysteroscopic sterilization (HS).

Methods: A confidential questionnaire was used to collect data from women with medically confirmed pregnancy (n=103) registered after undergoing HS.

Results: Mean (±SD) patient age and body mass index (BMI) were 29.5±4.6 years and 27.7±6.1 kg/m(2), respectively. Peak pregnancy incidence was reported at 10 months after HS, although <3% of unplanned pregnancies occurred within the first three months following HS. Mean (±SD) interval between HS and pregnancy was 19.6±14.9 (range, 2 to 84) months. Patients age ≥30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively). The recommended post-HS hysterosalpingogram (to confirm proper placement and bilateral tubal occlusion) was obtained by 66% (68/103) of respondents.

Conclusion: This report is the first to provide patient-derived data on contraceptive failures after HS. While adherence to backup contraception 3 months after HS can be poor, many unintended pregnancies with HS occur long after the interval when alternate contraceptive is required. Many patients who obtain HS appear to ignore the manufacturer's guidance regarding the post-procedure hysterosalpingogram to confirm proper device placement, although limited insurance coverage likely contributes to this problem. The greatest number of unplanned pregnancies occurred 10 months after HS, but some unplanned pregnancies were reported up to 7 years later. Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS. Further follow-up studies are planned to capture additional data on this issue.

No MeSH data available.