O&G · Gynaecological surgery — permanent contraception and fertility restoration
Tubal sterilisation and reversal: methods, regret, IVF and re-anastomosis
Also known as Female sterilisation · Tubal ligation · Filshie clip · Pomeroy sterilisation · Partial salpingectomy · Essure · Tubal reversal · Tubal re-anastomosis · Sterilisation regret
Exam-exhaustive FRANZCOG fellowship topic on tubal sterilisation and reversal: Filshie clips, Pomeroy and partial salpingectomy, coagulation, the Essure hysteroscopic device and its withdrawal, consent and age-related regret, cumulative failure rates, tubal re-anastomosis, IVF comparison and method- and age-dependent success. ANZ primary with RANZCOG, RCOG and ACOG consent principles, globally tagged.
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Target exams
Red flags
- Sterilisation is intended to be permanent — if the patient is uncertain, offer LARC and defer
- Consent during labour, immediately after birth, or soon after pregnancy loss — check voluntariness and capacity; do not rely on a signature alone
- Pregnancy after sterilisation — diagnose location early because ectopic pregnancy remains a concern
- Essure without the three-month confirmatory test — occlusion is not established
- Reversal without a semen analysis, ovarian-reserve assessment, or original operative report — success cannot be counselled honestly
- Tubal re-anastomosis in a woman over 40 with poor reserve — IVF usually gives the more efficient path
At the counselling visit, the patient asks, "Can I change my mind?" The answer is not "no"; it is "this operation is designed to be permanent, and I want to make sure your decision is voluntary, informed and not driven by the pregnancy or relationship you are living through today." She needs the failure rate, the regret risk, the alternatives, and the practical limits of reversal. The surgeon needs the same conversation in the consent form. [4][6]
Definition and classification
Tubal sterilisation interrupts fallopian-tube patency to prevent sperm and ovum meeting. Classify the method by tissue damage and setting because this predicts both failure and future reversibility. [1]
[1]Interval laparoscopic
- Filshie (titanium-silicone) clip — small segment compressed, relatively tissue-sparing
- Bipolar coagulation — destroys a segment; failure depends on number and spacing of burns
- Laparoscopic route requires anaesthesia and carries trocar and visceral-injury risk
Postpartum or caesarean
- Pomeroy or modified Pomeroy — loop of tube ligated and a segment excised
- Partial salpingectomy — the excised segment is sent to pathology where locally required
- Mini-laparotomy or operation through the caesarean incision
Hysteroscopic
- Essure micro-inserts placed at the tubal ostia, relying on fibrosis
- Required a three-month HSG or equivalent confirmation before relying on contraception
- Withdrawn from Australia and the global market; not an option for new patients
References16ShowHide
- [1]Lawrie TA, Kulier R, Nardin JM Techniques for the interruption of tubal patency for female sterilisation Cochrane Database Syst Rev, 2016.PMID 27494193
- [2]Jokinen E, Heino A, Karipohja T, Gissler M, Hurskainen R Safety and effectiveness of female tubal sterilisation by hysteroscopy, laparoscopy, or laparotomy: a register based study BJOG, 2017.PMID 28464415
- [3]Walhof KA, Gawron LM, Turok DK, Sanders JN Long-Term Failure Rates of Interval Filshie Clips As a Method of Permanent Contraception Womens Health Rep (New Rochelle), 2021.PMID 34327509
- [4]Hillis SD, Marchbanks PA, Tylor LR, Peterson HB Poststerilization regret: findings from the United States Collaborative Review of Sterilization Obstet Gynecol, 1999.PMID 10362150
- [5]Schmidt JE, Hillis SD, Marchbanks PA, Jeng G, Peterson HB Requesting information about and obtaining reversal after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization Fertil Steril, 2000.PMID 11056229
- [6]Grubb GS, Peterson HB, Layde PM, Rubin GL Regret after decision to have a tubal sterilization Fertil Steril, 1985.PMID 4018280
- [7]Mao J, Pfeifer S, Schlegel P, Sedrakyan A Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study BMJ, 2015.PMID 26462857
- [8]Zou C, Davis B, Wigle PR, Hincapie AL, Guo JJ Safety reporting of Essure medical device: a qualitative and quantitative assessment on the FDA manufacturer and user facility device experience database in 2018 Front Reprod Health, 2023.PMID 37519343
- [9]Chene G, Cerruto E, Moret S, Lebail-Carval K, Chabert P, Mellier G, Nohuz E, Lamblin G, Clark TJ Quality of life after laparoscopic removal of Essure(®) sterilization devices Eur J Obstet Gynecol Reprod Biol X, 2019.PMID 31404292
- [10]Sastre J, Mínguez JÁ, Alcázar JL, Chiva L Microsurgical anastomosis of the fallopian tubes after tubal ligation: a systematic review and meta-analysis Eur J Obstet Gynecol Reprod Biol, 2023.PMID 38353086
- [11]Messinger LB, Alford CE, Csokmay JM, Henne MB, Mumford SL, Segars JH, Armstrong AY Cost and efficacy comparison of in vitro fertilization and tubal anastomosis for women after tubal ligation Fertil Steril, 2015.PMID 26006734
- [12]Garg N, Milad MP Female sterilization reversal in the era of in-vitro fertilization Curr Opin Obstet Gynecol, 2022.PMID 35895967
- [13]Chua KH, Chan JKY, Liu S, Tan TY, Phoon JWL, Viardot-Foucault VC, Nadarajah S, Tan HH Laparoscopic Tubal Re-anastomosis or In Vitro Fertilisation in Previously Ligated Patients: A Comparison of Fertility Outcomes and Survey of Patient Attitudes Ann Acad Med Singap, 2020.PMID 32296806
- [14]Nolan W, Ohaeri H, Georger L, Ghomi A Robotic-assisted laparoscopic Essure removal: a novel surgical approach J Robot Surg, 2021.PMID 33237557
- [15]Tan HH, Loh SF Microsurgical reversal of sterilisation - is this still clinically relevant today? Ann Acad Med Singap, 2010.PMID 20126810
- [16]American College of Obstetricians and Gynecologists' Committee on Practice Bulletins—Gynecology ACOG Practice Bulletin No. 208: Benefits and Risks of Sterilization Obstet Gynecol, 2019.PMID 30640233