Permanent Contraception Research Articles

Bilateral salpingectomy as an option of permanent contraception at time of caesarean section: A survey of practice.

Opportunistic bilateral salpingectomy during benign gynaecologic surgery is advocated as a risk-reducing strategy due to the inverse association of epithelial ovarian cancers observed in epidemiological studies in a low-risk setting. Currently, no formal guidance exists for permanent surgical contraception at time of caesarean section in Australia. Our aim was to survey Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) regarding bilateral salpingectomy compared to other procedures offered for permanent contraception at the time of caesarean section. An online survey was utilised to collect clinician demographics, opinions, barriers, and justifications in regard to options of permanent surgical contraception at time of caesarean section. Bilateral salpingectomy was identified as the most effective method of permanent contraception at time of caesarean section. However, only 62% of respondents offer the procedure as a method of permanent contraception. The two most common reasons for clinicians to offer bilateral salpingectomy at time of caesarean section were evidence suggesting a link between the fallopian tube and gynaecological cancer (80%) and efficacy as a permanent form of contraception (16%). The primary barrier identified by 51% of respondents was perceived increased risk of surgical complications, followed by reasoning that it would not allow the possibility of future tubal reversal. This study identifies diverse opinions on surgical approach to permanent contraception at time of caesarean section and offered by clinicians of RANZCOG. Further research is required to establish safety profiles and short- and long-term risks of bilateral salpingectomy.

Development of My Decision/Mi Decisión, a web-based decision aid to support permanent contraception decision making

ObjectiveTo develop a patient-centered, web-based decision aid to support informed and value-concordant decision making among Medicaid enrollees considering tubal sterilization. MethodsWe used the Ottawa Decision Support Framework and the International Patient Decision Aids Standards (IPDAS) to guide systematic development of our decision aid. We interviewed 15 obstetrician-gynecologists and 40 women, who had considered or were considering tubal sterilization. A Steering Committee—comprising healthcare providers, social scientists, reproductive health and justice advocates, and people with lived experience—provided feedback and direction. We developed English and Spanish prototypes, which were beta tested with 24 women. ResultsThe resulting web-based My Decision/Mi Decisión tool (English/Spanish) includes written and video information about tubal sterilization procedures; an interactive table of contraception options; values clarification exercises; reflection and deliberation; knowledge checks; and a summary report to share with one's provider. Users found the decision aid to be informative, engaging, easy to use, and helpful in informing contraception decision making. ConclusionMy Decision/Mi Decisión is a scalable tool that could be implemented widely to support informed decision making about tubal sterilization. InnovationThis is a novel and timely web-based decision tool for tubal sterilization, when demand for permanent contraception is rapidly increasing post-Dobbs. While designed for Medicaid enrollees, further investigation will explore more generalized use.

Contraceptive use in patients with gender dysphoria who were assigned female at birth receiving care at a specialty gender-affirming clinic

BackgroundThe Centers for Disease Control and Prevention (CDC) recommend that all patients, regardless of gender identity or sexual orientation, should be offered family planning and contraceptive options without assumptions of sexual behaviors and pregnancy risk. Current research on family planning services for lesbian, gay, bisexual, transgender, and queer or questioning patients is limited, but patients who are sexual or gender minorities are at increased risk for unintended pregnancy. ObjectivesThe objective of this study was to describe contraceptive use in patients assigned female at birth with gender dysphoria at a gender-affirming primary care clinic. MethodsA retrospective descriptive study was conducted. Patients were included if they were 18 to 44 years old, received care at University of New Mexico Truman Health Services in 2019, were diagnosed with gender dysphoria, and were assigned female at birth. Patients were excluded if they had never developed female reproductive organs. Data were collected from the electronic medical records. Potential differences in contraceptive use based on demographic characteristics, having a family planning discussion, and having a contraceptive use discussion were analyzed using chi-square analyses. Potential predictors of contraceptive use were identified using exploratory forward conditional logistic regression and univariate logistic regression analyses. ResultsA total of 163 patients were included; average age was 26.6 years; 71% identified as male, 5% identified as masculine, and 25% identified as nonbinary. Most patients (92%) were prescribed masculinizing therapy (testosterone). Forty-five (28%) patients had documented contraception use; the most common form was permanent contraception (76%). Most patients (68%) did not have any documented contraindications to contraception based on CDC US Medical Eligibility Criteria for contraceptive use. Of 113 patients with a documented sexual orientation, 45 patients (40%) reported having sex with persons who have a penis; only 13 (29%) of those patients had a documented form of contraception. Family planning discussions were documented for 82% of patients. Family planning discussions that specifically addressed contraception were documented in only 49% of patients. However, the odds of a patient having a documented use of contraception was 9.26 times higher when family planning discussions specifically addressed contraception. ConclusionDocumented contraception use was low in people assigned female at birth of childbearing age receiving care at a gender-affirming clinic. Due to increased risks of unintended pregnancy in this population and the teratogenic nature of testosterone, family planning discussion should also include discussions related to contraception, as this was associated with increased contraception use. Additional research is needed to address potential barriers to contraception use in this population.

Salpingectomy and the Risk of Ovarian Cancer in Ontario

A body of pathological and clinical evidence supports the position that the fallopian tube is the site of origin for a large proportion of high-grade serous ovarian cancers. Consequently, salpingectomy is now considered for permanent contraception (in lieu of tubal ligation) or ovarian cancer prevention (performed opportunistically at the time of surgical procedures for benign gynecologic conditions). To evaluate the association between salpingectomy and the risk of invasive epithelial ovarian, fallopian tube, and peritoneal cancer. This population-based retrospective cohort study included all women aged 18 to 80 years who were eligible for health care services in Ontario, Canada. Participants were identified using administrative health databases from Ontario between January 1, 1992, and December 31, 2019. A total of 131 516 women were included in the primary (matched) analysis. Women were followed up until December 31, 2021. Salpingectomy (with and without hysterectomy) vs no pelvic procedure (control condition) among women in the general population. Women with a unilateral or bilateral salpingectomy in Ontario between April 1, 1992, and December 31, 2019, were matched 1:3 to women with no pelvic procedure from the general population. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs for ovarian, fallopian tube, and peritoneal cancer combined. Among 131 516 women (mean [SD] age, 42.2 [7.6] years), 32 879 underwent a unilateral or bilateral salpingectomy, and 98 637 did not undergo a pelvic procedure. After a mean (range) follow-up of 7.4 (0-29.2) years in the salpingectomy group and 7.5 (0-29.2) years in the nonsurgical control group, there were 31 incident cancers (0.09%) and 117 incident cancers (0.12%), respectively (HR, 0.82; 95% CI, 0.55-1.21). The HR for cancer incidence was 0.87 (95% CI, 0.53-1.44) when comparing those with salpingectomy vs those with hysterectomy alone. In this cohort study, no association was found between salpingectomy and the risk of ovarian cancer; however, this observation was based on few incident cases and a relatively short follow-up time. Studies with additional years of follow-up are necessary to define the true level of potential risk reduction with salpingectomy, although longer follow-up will also be a challenge unless collaborative efforts that pool data are undertaken.

Social Support Among Women With Potential Essure-Related Complaints: Analysis of Facebook Group Content.

Social support groups are an important resource for people to cope with problems. Previous studies have reported the different types of support in these groups, but little is known about the type of reactions that sharing of personal experiences induce among members. It is important to know how and to what extent members of support groups influence each other regarding the consumption of medical care. We researched this in a web-based Facebook group of women sterilized with Essure. Essure was a device intended for permanent contraception. From 2015 onward, women treated with Essure for tubal occlusion raised safety concerns and numerous complaints. This study aimed to evaluate the use of social support in a Facebook community named "Essure problemen Nederland" (EPN; in English, "Essure problems in the Netherlands"). All posts in the closed Facebook group EPN between March 8 and May 8, 2018, were included. In total, 3491 Facebook posts were analyzed using a modified version of the Social Support Behavior Codes framework created by Cutrona and Suhr in 1992. Posts were abstracted and aggregated into a database. Two investigators evaluated the posts, developed a modified version of the Social Support Behavior Codes framework, and applied the codes to the collected data. We found that 92% of messages contained a form of social support. In 68.8% of posts, social support was provided, and in 31.2% of posts, social support was received. Informational and emotional support was the most frequently used form of provided social support (40.6% and 55.5%, respectively). The same distribution was seen with received social support: informational support in 81.5% and emotional support in 17.4% of cases. Our analysis showed a strong correlation between providing or receiving social support and the main form of social support (P<.001). In a total of only 74 (2.2%) cases, women advised each other to seek medical care. The main purpose of women in the EPN Facebook group was to provide and receive informational or emotional support or both.

Association of State Funding for Comprehensive Reproductive Health Care With Use of Contraception Among Latina Patients and Non-Latina Patients in Oregon

There are well-documented racial and ethnic disparities in effective contraceptive use due to multiple factors. A key contributor may be differential insurance coverage and patient costs. The Oregon Reproductive Health Equity Act (RHEA), enacted in 2017, ensures full coverage of reproductive health care without cost sharing for all Oregonians with low income. To assess whether removing financial barriers to accessing contraceptive care is associated with an improvement in use of moderately and highly effective contraceptive methods among Latina women compared with non-Latina women. This cohort study included women aged 12 to 51 years who sought contraceptive care in the Oregon Health Authority Reproductive Health Program from April 2016 to March 2020. Patients using permanent contraception, those missing data on ethnicity, and non-Oregon residents were excluded. Data analysis was performed in January 2021. Contraceptive care in the Reproductive Health Program after RHEA implementation. The main outcome was prevalence of use of moderately effective methods (contraceptive pills, patch, ring, or injection) or highly effective methods (long-acting reversible contraceptives) at the time of the contraceptive visit. Difference-in-differences analysis was used to compare moderately and highly effective contraception use between Latina and non-Latina patients. Secondary outcomes were proportions of adoption or continuation of moderately and highly effective methods, prevalence of highly effective methods, and adoption or continuation of highly effective methods. The unit of analysis was at the clinic visit level. The study sample consisted of 295 604 evaluable clinic visits, in which 28.4% of individuals identified as Latina and 71.6% of individuals identified as non-Latina. The mean (SD) age was 25.5 (8.1) years. With difference-in-differences analysis, there was a significant adjusted 1.9 percentage point (95% CI, 0.2-3.6 percentage points) increase in prevalence of moderately or highly effective contraceptive methods for Latina patients compared with non-Latina patients. There were no significant differences for other outcomes of interest. This cohort study found that in Oregon, legislation removing financial barriers to accessing contraceptive care was associated with significant mitigation in disparate moderately and highly effective contraceptive method prevalence for Latina patients compared with non-Latina patients. The findings suggest that state funds successfully supplanted federal funds to enable continued robust comprehensive family planning services after withdrawal from Title X.

Postpartum long-acting reversible contraceptive use among active-duty, female US Army soldiers

Postpartum utilization of long-acting reversible contraception (LARC) has been found to be effective at increasing inter-pregnancy intervals, reducing unintended pregnancies, and optimizing health outcomes for mothers and babies. Among female active-duty military members, reproductive planning may be particularly important, yet little is known about postpartum long-acting reversible contraceptive use among active-duty soldiers. (1) To quantify postpartum uptake of long-acting reversible contraception among U.S. Army active-duty female soldiers, and (2) to identify demographic and military-specific characteristics associated with utilization. This retrospective cohort study used longitudinal data on all digitally recorded health encounters for active-duty U.S. Army soldiers from 2014-2017. The servicewomen included in our analysis were aged 18-44 years with at least one delivery and a minimum of four months of total observed time post-delivery within the study period. We defined postpartum long-acting reversible contraception utilization as initiation in the delivery month or in the three calendar months following delivery, and identified likely immediate postpartum initiation via the proxy of placement recorded during the same month as delivery. We then evaluated predictors of postpartum long-acting reversible contraception utilization using multivariable logistic regression. Inclusion criteria were met by 15,843 soldiers. Of those, 3,162 (19.96%) received a method of long-acting reversible contraception in the month of, or within the three months following, delivery. Fewer than 5% of these women utilized immediate postpartum long-acting reversible contraception. Among women receiving a postpartum long-acting reversible contraceptive method, 1,803 (57.0%) received an IUD, 1,328 (42.0%) received an etonogestrel implant and 31 received both (0.98%). Soldiers of younger age, self-reported White race, and those married or previously married were more likely to initiate long-acting reversible contraception in the postpartum period. Race-stratified analyses showed that self-reported White women had the highest utilization rates overall. Compared to these women, the adjusted odds of postpartum utilization among self-reported Black and Asian/Pacific Islander women were 18% and 30% lower, respectively (both p<0.001). There was also a trend of decreasing postpartum utilization with increasing age within each race group. Differences observed between age groups and race identities could partially be attributed to differential utilization of permanent contraception (sterilization), which was found to be significantly more prevalent among both women aged 30 years or older, as well as among Black-identifying women. Among active-duty U.S. Army servicewomen, one in five utilized postpartum long-acting reversible contraception, with fewer than 5 percent of these women utilizing an immediate postpartum method. Within this population with universal healthcare coverage, we observed relatively low rates of utilization and significant differences in uptake of effective postpartum long-acting contraceptive methods across self-reported race categories.

Factors Affecting Immediate Use of Contraception Among Women Hospitalised for Abortion in Two Public Hospitals in Kigali, Rwanda: A Cross Sectional Study.

The 2019-20 Rwanda demographic health survey revealed an overall use of modern contraceptives of 58% but participants were not likely to use family planning in the postpartum period. Three quarters of participants intended to use contraception only after they had resumed menses and not breastfeeding. This study intended to measure post-abortion contraception uptake and to evaluate factors affecting immediate post abortion contraception uptake among patients consulting two public hospitals in Kigali, Rwanda. This is an observational cross-sectional study of women admitted for abortion in 2 hospitals' obstetric units in Kigali; the University Teaching Hospital of Kigali (CHUK) and Muhima District Hospital (MH) from November 2019 to April 2020. Admission registry was accessed daily to determine abortion admissions. After informed consent, participants underwent a standardised interview prior to their discharge from respective hospital. There were 252 participants over 6 months; 88.5% were counselled for post-abortion contraception and 52% desired contraception prior to hospital discharge. Upon discharge, 70.2% of the study participants who wished immediate post abortion contraception received it before discharge and 29.8% had no contraception despite having expressed interest for immediate post abortion contraception. Being married and involving husband in choosing post-abortion contraception were significantly associated with use of post-abortion contraception. Post-abortion contraception uptake in 2 large public hospitals in Kigali remains low. Being married and involving husband in choosing post-abortion contraception are positive factors associated with post-abortion contraception uptake while choosing a permanent contraception is associated with not receiving any contraception at the time of discharge from hospital. There is a need to consider prescribing an alternative interim methods of contraception to women desiring permanent sterilisation.

Permanent, long-acting and short-acting reversible contraceptive methods use among women in Bangladesh: an analysis of Bangladesh Demographic and Health Survey 2017–2018 data

ObjectivesThis study aims to explore the factors associated with the permanent and long-acting reversible contraceptive (LARC) method use compared with short-acting reversible contraceptive (SARC) methods among Bangladeshi ever-married women aged...

The female upper reproductive tract harbors endogenous microbial profiles.

The female reproductive tract harbours unique microbial communities (known as microbiota) which have been associated with reproductive functions in health and disease. While endometrial microbiome studies have shown that the uterus possesses higher bacterial diversity and richness compared to the vagina, the knowledge regarding the composition of the Fallopian tubes (FT) is lacking, especially in fertile women without any underlying conditions. To address this gap, our study included 19 patients who underwent abdominal hysterectomy for benign uterine pathology, and 5 women who underwent tubal ligation as a permanent contraceptive method at Hospital Clínico Universitario Virgen de la Arrixaca (HCUVA). We analyzed the microbiome of samples collected from the FT and endometrium using 16S rRNA gene sequencing. Our findings revealed distinct microbiome profiles in the endometrial and FT samples, indicating that the upper reproductive tract harbors an endogenous microbiome. However, these two sites also shared some similarities, with 69% of the detected taxa Being common to both. Interestingly, we identified seventeen bacterial taxa exclusively present in the FT samples, including the genera Enhydrobacter, Granulicatella, Haemophilus, Rhizobium, Alistipes, and Paracoccus, among others. On the other hand, 10 bacterial taxa were only found in the endometrium, including the genera Klebsiella, Olsenella, Oscillibacter and Veillonella (FDR <0.05). Furthermore, our study highlighted the influence of the endometrial collection method on the findings. Samples obtained transcervically showed a dominance of the genus Lactobacillus, which may indicate potential vaginal contamination. In contrast, uterine samples obtained through hysterescopy revealed higher abundance of the genera Acinetobacter, Arthrobacter, Coprococcus, Methylobacterium, Prevotella, Roseburia, Staphylococcus, and Streptococcus. Although the upper reproductive tract appears to have a low microbial biomass, our results suggest that the endometrial and FT microbiome is unique to each individual. In fact, samples obtained from the same individual showed more microbial similarity between the endometrium and FT compared to samples from different women. Understanding the composition of the female upper reproductive microbiome provides valuable insights into the natural microenvironment where processes such as oocyte fertilization, embryo development and implantation occur. This knowledge can improve in vitro fertilization and embryo culture conditions for the treatment of infertility.

Long-Tailed Macaque (Macaca fascicularis) Contraception Methods: A Systematic Review.

The contraception-based approach to wildlife management is a humane and effective alternative to population control methods. Wildlife management only has a few conventional ways to control overpopulation, such as culling, translocation, poisoning, and allowing natural death. Nevertheless, these methods usually have short-term, lethal, and unethical effects. The present systematic review aims to review the knowledge on contraception reported in long-tailed macaques as an alternative to population control. We obtained 719 records from searching CABI, PubMed, ScienceDirect, and Scopus electronic databases. After the screening and selection process, according to PRISMA guidelines, 19 articles that met the eligibility criteria were chosen. Of the 19 articles, 15 were studies on female long-tailed macaque contraception methods (six (6) hormonal and nine (9) non-hormonal). We analyzed four (4) selected articles on male Cynomolgus monkey contraception methods (two (2) hormonal and two (2) non-hormonal). One of the nine (9) articles on female long-tailed macaque contraception reports negative results. Furthermore, only two (2) studies used free-ranging long-tailed macaques as test subjects, while seventeen (17) tested on captive ones. The challenges of long-tailed macaque contraception identified in this review were the effectiveness of the contraceptive, the administration route, the economic feasibility, the distinction between captive and free-ranging Cynomolgus macaques, the choice of permanent or reversible contraception, the capability of contraceptive use for population control, and the lack of studies on the free-ranging long-tailed macaque. Notwithstanding the literature gap on long-tailed macaque contraception for population control, long-tailed macaque contraception exhibits potential as an alternative method to culling long-tailed macaque. Future research should address these obstacles to support the long-tailed macaque contraception as an alternative population control method.

Durable contraception in the female domestic cat using viral-vectored delivery of a feline anti-Müllerian hormone transgene

Eighty percent of the estimated 600 million domestic cats in the world are free-roaming. These cats typically experience suboptimal welfare and inflict high levels of predation on wildlife. Additionally, euthanasia of healthy animals in overpopulated shelters raises ethical considerations. While surgical sterilization is the mainstay of pet population control, there is a need for efficient, safe, and cost-effective permanent contraception alternatives. Herein, we report evidence that a single intramuscular treatment with an adeno-associated viral vector delivering an anti-Müllerian hormone transgene produces long-term contraception in the domestic cat. Treated females are followed for over two years, during which transgene expression, anti-transgene antibodies, and reproductive hormones are monitored. Mating behavior and reproductive success are measured during two mating studies. Here we show that ectopic expression of anti-Müllerian hormone does not impair sex steroids nor estrous cycling, but prevents breeding-induced ovulation, resulting in safe and durable contraception in the female domestic cat.

Association of Opioid Use Disorder and Provision of Highly Effective Inpatient Postpartum Contraception.

We sought to examine the rates of the inpatient provision of postpartum long-acting and permanent methods (IPP LAPM) of contraception in patients with opioid use disorder (OUD). This is a retrospective cross-sectional regression analysis of the National Inpatient Sample between 2012 and 2016. Patients with a diagnosis of OUD that delivered and received postpartum permanent contraception or long acting reversible contraception placement during the same hospitalization were identified. Regression analyses were performed to identify the demographic and clinical factors associated with long acting and permanent contraception method utilization. Of the 22,294 patients with OUD who delivered during the study period, 2291 (10.3%) received IPP LAPM. The majority of patients (1989) (86.6%) with OUD who chose inpatient provision of long acting or permanent methods after delivery received permanent contraception. After adjusting for covariates, patients with OUD had an overall decreased probability of receiving IPP LAPM (aOR=0.89, 95% CI: 0.85-0.95), decreased probability of receiving permanent contraception (aOR: 0.82, 95% CI: 0.78-0.88), but an increased probability of receiving long-acting reversible contraception (aOR: 1.29, 95% CI: 1.04-1.60) compared to patients without OUD. This study highlights the continued need to ensure appropriate measures (such as antepartum contraceptive counseling, availability of access to inpatient LAPM, and removal of Medicaid policy barriers to permanent contraception) are in place so that the contraceptive needs of patients with OUD are fulfilled.

Menstrual practices, fertility intentions and decision-making regarding family planning by women belonging to various indigenous groups of Wayanad- A qualitative study.

Among the different social groups in India, the tribes are the most vulnerable and socioeconomically deprived. The tribal population is distinct from the general population in terms of their unique cultural, traditional, and reproductive health practices. Therefore, the aim of the study was to conduct an exploratory analysis of the menstrual practices, fertility intentions and decision-making regarding family planning among various indigenous tribal women of Kerala. A qualitative study was conducted among the tribal women of Wayanad district using the grounded theory approach. Using purposive sampling 16 in-depth interviews, 6 key informant interviews and 2 focus group discussion (FGD) s were conducted. Interview guides were developed for in-depth interviews, key-informant interviews, and focus group discussion through extensive formative research with literature reviews and taking expert opinions. The interviews were conducted among women of reproductive age and their spouses hailing from Paniya and Kurichiya tribal groups in Kalpetta and Mananthavady areas of Wayanad district. Key informant interviews were also conducted among doctors, pharmacists, and community health workers. The key findings of this study were the identification of a web of cultural practices pertaining to menstruation among persons of tribal origin. Unique traditional practices such as "Valayamapura" and "Thirandukalyanam" were reported and most of the women were keen to carry it forward. Fertility desires among couples were found to be not significantly influenced by any gender bias. Decision-making regarding family size were found to be on a mutual agreement between the spouses. The tribal women were aware of modern spacing methods, but preferred natural methods of contraception for temporary use and tubectomy as the permanent method. Non-contraceptive use of oral contraceptive pills (OCP) was prevalent, and the majority took it occasionally for postponement of menstruation to attend various social events. Menstruation-related myths and practices are prevalent and require educational interventions. More focus needs to be given to male sterilization as the permanent method of contraception. The study underscores the need to address gender inequalities and attitudes among tribal populations and to increase efforts to promote higher education among the tribes for busting cultural myths and practices.

SALPINGECTOMY AT THE TIME OF CESAREAN DELIVERY: A SYSTEMATIC REVIEW

Candidates for tubal sterilisation include women who have finished having children and who are looking for a method of birth control that is both highly effective and permanent. It is possible for it to be carried out at any point during a woman's menstrual cycle, as well as right after a child is born or an abortion is performed. Hysteroscopy, laparoscopy, or even a mini-laparotomy might be performed instead. It is important to have a conversation about the danger of regret as well as the characteristics that increase the likelihood of regret, such as a young age at the time of sterilization (less than 30 years), a lower parity, sterilization administered in the immediate postpartum period, divorce or remarriage following sterilization, and being poor or of Hispanic origin. It would appear that being a young adult at the time of the sterilization is the most significant indicator of regret. It is extremely important to keep in mind that this does not provide full protection. According to the findings of the CREST study, the failure rate across all procedures was 18.5 out of every 1000 procedures over the course of a 10-year period. Even in the event that a cesarean birth is performed unexpectedly, a mother request for postpartum permanent contraception in the form of bilateral total salpingectomy during cesarean delivery may be a procedure that is both safe and practicable.

(437) Post-Vasectomy Semen Analysis (PVSA) Compliance Rates and Associations

Abstract Introduction Vasectomy is a highly effective, permanent method of contraception. Poor compliance rates have been observed for patients in obtaining their post-vasectomy semen analyses (PVSA). Few studies have looked at associations with low compliance. Objective The objective of our study was to identify compliance rates of post-vasectomy semen analysis and to identify associations that may increase or decrease the rates of compliance. Methods We studied 111 patients between November 2018 and April 2022 who underwent vasectomy at a single institution. Only patients who underwent vasectomy for fertility-related reasons were included in our final analysis. We excluded any patients who had undergone previous vasectomy or vasectomy reversal. Variables analyzed included age, relationship status, presence of primary care provider, anxiety diagnosis, and race. Variables were obtained via chart review which included but was not limited to reviewing notes, summary diagnostic pages, problem lists, and medication lists. All analyses were performed using R version 4.1.2 (R Foundation for Statistical Computing, Vienna, Austria). Categorical data were described with the number and percentage of patients. Continuous data were described with the median, minimum, and maximum. Associations of race and anxiety diagnosis with PVSA were explored using Fisher’s exact test. All p-values were two-sided at the 5% significance level without adjustment for multiple testing. Results Our cohort included 111 men who underwent vasectomy with exclusion of 1 patient who underwent vasectomy for non-fertility reasons. The median age of vasectomy was 38 years (range 26-59 years). Of 110 patients, 83 (75%) returned for PVSA. There were 103 (94%) married patients. Additional cohort characteristics can be seen in Table 1. As shown in Table 2, African American patients were less likely to return for PVSA than either white patients (14% vs. 79%, p&amp;lt;0.001) or Hispanic patients (14% vs. 100%, p=0.015). we did not find evidence of difference between white and Hispanic patients (p=0.58). Patients with an anxiety diagnosis were more likely to undergo PVSA compared to patients without an anxiety diagnosis (p&amp;lt;0.001). Conclusions Patients in our cohort of African American race were significantly less likely to undergo PVSA compared to white and Hispanic patients. This suggests an opportunity for improved counseling in the African American population. We do recognize a disparity in the number of white patients studied (n=95) versus African American (n=7) and Hispanic (n=5) patients. Additionally, patients with an anxiety disorder were more likely to undergo PVSA compared to patients without an anxiety disorder. The prevalence of anxiety disorder in our cohort is somewhat high relative to the overall population in the United States. This could be due to questionnaires used at our institution and the timeliness of those questionnaires. Personality traits could also lead to confounding in anxiety diagnoses. Overall, a 75% rate of PVSA speaks to an opportunity for better counseling regarding PVSA, especially in particular populations such as the African American population. Disclosure No

Provision of Postpartum Contraception Before and After the Start of the COVID-19 Pandemic in Maine.

Preliminary findings from selected health systems revealed interruptions in reproductive health care services due to the COVID-19 pandemic. We estimated changes in postpartum contraceptive provision associated with the start of the COVID-19 pandemic in Maine. We used the Maine Health Data Organization's All Payer Claims Database for deliveries from October 2015 through March 2021 (n = 45 916). Using an interrupted time-series analysis design, we estimated changes in provision rates of long-acting reversible contraception (LARC), permanent contraception, and moderately effective contraception within 3 and 60 days of delivery after the start of the COVID-19 pandemic. We performed 6- and 12-month analyses (April 2020-September 2020, April 2020-March 2021) as compared with the reference period (October 2015-March 2020). We used Poisson regression models to calculate level-change rate ratios (RRs) and 95% CIs. The 6-month analysis found that provision of LARC (RR = 1.89; 95% CI, 1.76-2.02) and moderately effective contraception (RR = 1.51; 95% CI, 1.33-1.72) within 3 days of delivery increased at the start of the COVID-19 pandemic, while provision of LARC (RR = 0.95; 95% CI, 0.93-0.97) and moderately effective contraception (RR = 1.08; 95% CI, 1.05-1.11) within 60 days of delivery was stable. Rates of provision of permanent contraception within 3 days (RR = 0.70; 95% CI, 0.63-0.78) and 60 days (RR = 0.71; 95% CI, 0.63-0.80) decreased. RRs from the 12-month analysis were generally attenuated. Disruptions in postpartum provision of permanent contraception occurred at the beginning of the COVID-19 pandemic in Maine. Public health policies should include guidance for contraceptive provision during public health emergencies and consider designating permanent contraception as a nonelective procedure.

ADENOMATOID TUMOR IN THE FALLOPIAN TUBE - A RARE CASE-INCIDENTAL FINDING

Adenomatoid tumours are less common benign neoplasm of mesothelial origin, which originates from the lining of organs. This tumour generally presents in both male and female genital tracts. [1-9]. In males, the tumour is usually foundin testis and epididymis while in females, the uterus and rarely fallopian tubes are the sites involved.Mostlty,thistumour is found incidentally.Grossly, adenomatoid tumors are usually smallin size (less than 2 cm) well-circumscribed, solitary masses that are tan, yellow, and solid [10].The histopathological examination revealed features of adenomatoid tumor supported by immunohistochemical stains positive for calretinin and cytokeratin and negative for CD34. These tumourshave a good prognosis upon surgical removal with no evidence of recurrence.We present a case where this rare tumour was found incidentally in the Salpingectomy specimen of a 39-year-old woman who underwent this procedure for permanent contraception as she requested the removal of tubes instead of blockage.

Active COVID-19 infection as a barrier to postpartum tubal ligation

ObjectivesTo identify patients unable to obtain postpartum bilateral tubal ligations (ppBTLs) due to policy prohibiting “elective” procedures for COVID-positive patients at a single academic medical center in New Jersey. ResultsUpon retrospective chart review of patients requesting ppBTLS, of 110 ppBTL requests between identified via retrospective chart review between February 1, 2020, and February 28, 2022, 24 (22%) were canceled due to COVID infection. Of these patients, 10 (42%) were uninsured, 13 (54%) had Medicaid, and 22 (92%) were Hispanic/Latinx. Postpartum, five (21%) obtained interval tubal ligation, seven (37%) never received contraception, and one had a future pregnancy. ConclusionsThis policy affected uninsured patients by preventing access to permanent contraception.

Medicaid and Fulfillment of Postpartum Permanent Contraception Requests.

To evaluate the association between Medicaid insurance and fulfillment of postpartum permanent contraception requests. We conducted a retrospective cohort study of 43,915 patients across four study sites in four states, of whom 3,013 (7.1%) had a documented contraceptive plan of permanent contraception at the time of postpartum discharge and either Medicaid insurance or private insurance. Our primary outcome was permanent contraception fulfillment before hospital discharge; we compared individuals with private insurance with individuals with Medicaid insurance. Secondary outcomes were permanent contraception fulfillment within 42 and 365 days of delivery, as well as the rate of subsequent pregnancy after nonfulfillment. Bivariable and multivariable logistic regression analyses were used. Patients with Medicaid insurance (1,096/2,076, 52.8%), compared with those with private insurance (663/937, 70.8%), were less likely to receive desired permanent contraception before hospital discharge (P≤.001). After adjustment for age, parity, weeks of gestation, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index, private insurance status was associated with higher odds of fulfillment at discharge (adjusted odds ratio [aOR] 1.48, 95% CI 1.17-1.87) and 42 days (aOR 1.43, 95% CI 1.13-1.80) and 365 days (aOR 1.36, 95% CI 1.08-1.71) postpartum. Of the 980 patients with Medicaid insurance who did not receive postpartum permanent contraception, 42.2% had valid Medicaid sterilization consent forms at the time of delivery. Differences in fulfillment rates of postpartum permanent contraception are observable between patients with Medicaid insurance and patients with private insurance after adjustment for clinical and demographic factors. The disparities associated with the federally mandated Medicaid sterilization consent form and waiting period necessitate policy reassessment to promote reproductive autonomy and to ensure equity.