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Reliability of laparoscopic compared with hysteroscopic sterilization at 1 year: a decision analysis
Aileen M Gariepy1, Mitchell D Creinin, Eleanor B Schwarz
1From the Department of Obstetrics, Gynecology, and Reproductive Sciences, the Department of Medicine, Division of General Internal Medicine, and the Department of Medicine, Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine; the Center for Family Planning Research, Magee-Womens Research Institute; and the Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
Objective:
To estimate the probability of successful sterilization after an hysteroscopic or laparoscopic sterilization procedure.
Methods:
An evidence-based clinical decision analysis using a Markov model was performed to estimate the probability of a successful sterilization procedure using laparoscopic sterilization, hysteroscopic sterilization in the operating room, and hysteroscopic sterilization in the office. Procedure and follow-up testing probabilities for the model were estimated from published sources.
Results:
In the base case analysis, the proportion of women having a successful sterilization procedure on the first attempt is 99% for laparoscopic sterilization, 88% for hysteroscopic sterilization in the operating room, and 87% for hysteroscopic sterilization in the office. The probability of having a successful sterilization procedure within 1 year is 99% with laparoscopic sterilization, 95% for hysteroscopic sterilization in the operating room, and 94% for hysteroscopic sterilization in the office. These estimates for hysteroscopic success include approximately 6% of women who attempt hysteroscopically but are ultimately sterilized laparoscopically. Approximately 5% of women who have a failed hysteroscopic attempt decline further sterilization attempts.
Conclusion:
Women choosing laparoscopic sterilization are more likely than those choosing hysteroscopic sterilization to have a successful sterilization procedure within 1 year. However, the risk of failed sterilization and subsequent pregnancy must be considered when choosing a method of sterilization.
