Female tubal sterilization: the time has come to routinely consider removal.

Abstract

Female sterilization, one of the most effective forms of pregnancy prevention, can be performed remote from pregnancy (interval sterilization) or around the time of delivery. Modern methods for sterilization include tubal interruption, salpingectomy, and transcervical sterilization. Tubal interruption has been the primary method for interval sterilization for decades, developing as a means of rapid intra-abdominal laparoscopic surgery at a time when instrumentation and operating systems were less sophisticated than today. New evidence that the most common ovarian cancer, serous adenocarcinoma, frequently may start in the Fallopian tube, has increased research and clinical use of salpingectomy as a preferred method for sterilization. With studies showing that the surgical risks with tubal interruption and salpingectomy are likely equivalent, even when performed at cesarean delivery, the rationale seems to be in place to change our clinical practice. However, we should ask why this revelation has not occurred sooner, even though surgical techniques have advanced and salpingectomy, unlike tubal occlusion or hysteroscopic sterilization, does not leave patients at risk for future intrauterine or ectopic pregnancy. We should not have started thinking about salpingectomy for female sterilization only once a decrease in ovarian cancer risk became part of the equation. Providers' failure to offer this option means that women and their true desires were not part of the conversation. If we had included the patient in the discussion, perhaps the higher efficacy of salpingectomy would have been what women desired all along.