Elsevier

Contraception

Volume 86, Issue 5, November 2012, Pages 488-493
Contraception

Original research article
Tubal sterilization during cesarean section or as an elective procedure? Effect on the ovarian reserve

https://doi.org/10.1016/j.contraception.2012.03.002Get rights and content

Abstract

Background

The purpose of this study is to compare the effects of tubal sterilization on the ovarian reserve by means of hormonal and ultrasonographic evaluation during a cesarean section or when performed as a planned interval procedure.

Study Design

Fifty women who had undergone tubal sterilization during a cesarean section (n=24) and by minilaparotomy as an elective procedure (n=26) were included in the study. Tubes were ligated with the Pomeroy technique in both groups. The women who had chosen to use barrier method or intrauterine device for contraception (n=30) constituted the control group. Among the women in the control group, two separate control groups were constituted (control 1 and control 2) who were age matched with the women in each study group. Hormone levels including antimüllerian hormone (AMH) and inhibin B and ultrasonographic evaluations were performed on the third day of the menstrual cycle 1 year after the tubal sterilization procedure.

Results

Mean blood estradiol, follicle stimulating hormone and luteinizing hormone levels on the third day of the cycle postoperative 12 months after the surgical intervention did not show any significant differences in the groups with respect to their age-matched controls. There was no significant difference in terms of mean serum AMH and inhibin B levels between the groups and their age-matched controls. However, significantly higher postoperative levels of mean AMH levels were detected in the tubal sterilization during cesarean section group when compared with the minilaparotomy group, and significantly lower postoperative levels of mean inhibin B were detected in the elective tubal sterilization via minilaparotomy group when compared with the cesarean section group. Statistically significant differences were observed in terms of number of antral follicles and mean ovarian volumes being less in the elective tubal sterilization via minilaparotomy group when compared with age-matched controls.

Conclusion

Intraoperative cesarean section tubal sterilization seems to be a practical and safe method, and has less effect on the ovarian reserve when compared with planned tubal sterilization by minilaparotomy.

Introduction

Contraception by tubal sterilization is the most popular method of fertility regulation among women throughout the world [1]. Between 1950 to 1982, voluntary sterilization increased 30-fold worldwide, the increase partly being attributed to surgical innovations that made sterilization a safe and effective outpatient procedure [2]. Approximately 190 million couples use tubal sterilization worldwide as a safe and reliable method of permanent birth control [3], [4]. In 2008, the frequency of the use of tubal sterilization as a contraceptive method among Turkish women aged between 15 and 49 years was found to be 8% [5].

There are various ways of occluding or disrupting tubal patency. Fallopian tubes may be surgically cut and ligated with or without a section of tube being removed; they may be mechanically blocked using clips or rings; they may be electrically coagulated; and they may be blocked by a fibrotic reaction induced by chemicals or microinserts [6].

Sterilization has been hypothesized to be associated with menstrual dysfunction by affecting ovarian function adversely resulting in dysfunctional uterine bleeding, dysmenorrhea, dyspareunia, exacerbation of premenstrual symptoms and pelvic pain, and hormonal disturbances that characterize the so-called post-tubal ligation syndrome [7], [8]. These complications are thought to be related with the damage to the arterial blood supply to the ovaries. In addition, venous drainage may be compromised because venous plexuses are located near the arteries [9].

Tubal sterilization during a cesarean section is cost-effective and practical as the cost of the procedure is included in the cesarean section and it saves the patient from an additional intervention. In addition, tubal sterilization can also be performed as a planned interval procedure after the delivery. However, no reports have been published investigating the effects of tubal sterilization during cesarean section or as an elective procedure on the ovarian reserve. The aim of the present study is to evaluate the effect of the timing of tubal sterilization procedure on the ovarian reserve.

Section snippets

Materials and methods

The study was carried out in the family planning unit between March 2010 and June 2011. Patient recruitment was done from the outpatient clinic, and all patients gave their informed consent for the study, which was also approved by the Ethics Committee of the Hospital, and the procedures followed were in accordance with the institutional guidelines. Fifty women admitted to our hospital who had undergone tubal sterilization 1 year before the study period were enrolled in the study. Data from the

Results

The characteristics of the patients included in the groups are shown in Table 1. There was no statistically significant difference in terms of mean age and BMI between the study and the control groups. The postoperative hormonal and ultrasonographic evaluations of the groups are summarized in Table 2. Mean blood E2, FSH and LH levels on the third day of the cycle postoperative 12 months after the surgical intervention did not show any significant differences in the groups with respect to their

Discussion

To the best of our knowledge, this is the first report which investigates the effects of tubal sterilization during cesarean section or performed as a planned interval procedure on the ovarian reserve. In the present study, ovarian function after tubal sterilization has been assessed by means of hormonal assays and ovarian morphology. Currently, the main techniques used to show ovarian function are hormonal tests reflecting ovarian follicular activity and transvaginal ultrasonography. Serum FSH

Acknowledgment

No funds were received for this study.

References (32)

Cited by (14)

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  • The effect of tubal sterilization with the Pomeroy technique and bipolar electrocauterization on the ovarian reserve and serum anti-Müllerian hormone levels in a rat model

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    Advancements in minimally invasive surgical techniques have led to various approaches for occluding tubal patency, such as surgically cutting or ligating, mechanically blocking using clips or rings, electrically coagulating, and blocking chemically or with a micro-insert [3]. However, tubal sterilization has been known to cause post-tubal ligation syndrome, which is associated with menstrual irregularities, dysmenorrhea, dyspareunia, early menopausal symptoms, increased risk of osteoporosis, changes in sexual behavior [4], low luteal phase progesterone levels, low pre-ovulatory estradiol (E2) peak, and high mid-luteal E2 levels [5,6]. All of these complications are hypothesized to be associated with damage to the arteriovenous blood and neural supply of the ovaries [7].

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