Tubal sterilization linked to higher risk of pregnancy

A growing interest in permanent birth control

Interest in permanent sterilization has surged since the 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization, which eliminated federal protections for abortion access. In response to increasing restrictions on reproductive healthcare, many women are opting for long-term contraceptive solutions, heightening the importance of understanding the real-world effectiveness of tubal ligation.

"Since the Dobbs decision, many more people are worried about how pregnancy may impact their health and family life," Schwarz said in the UCSF article. "This is especially true for patients with medical conditions like diabetes and high blood pressure that can complicate pregnancy."

The study is timely, given that about 65% of U.S. women between the ages of 15 and 49 use some form of birth control. Tubal sterilization, which involves cutting, clamping or removing the fallopian tubes, is the most common method of permanent contraception, particularly for women over 30. The procedure is especially prevalent among low-income women and those with chronic health conditions.

According to national data, 21% of women aged 30-39, and 39% of women over 40, have undergone tubal ligation. Historically, the American College of Obstetricians and Gynecologists advised that the risk of pregnancy following tubal sterilization was less than 1%, but the new findings indicate that the failure rate is significantly higher.

Study insights and implications

The researchers analyzed data from four rounds of the National Survey of Family Growth, focusing on more than 4,000 women who had tubal sterilizations between 2002 and 2015. Their analysis found that nearly 3% of women who underwent the procedure between 2013 and 2015 reported becoming pregnant within the first year following surgery. Younger women were at a higher risk of pregnancy after the procedure than their older counterparts.

Interestingly, the study found no significant difference in pregnancy rates based on socioeconomic or demographic factors. Patients who underwent Medicaid-funded sterilization procedures were no more likely to experience failure than those with private insurance. However, Medicaid-funded procedures have become more common, with 36% of sterilizations between 2013 and 2015 funded by Medicaid, compared to just 18% in 2002.

"For people who have chosen a 'permanent' method, learning they got pregnant can be very distressing," Schwarz said. "It turns out this is, unfortunately, a fairly common experience."

Rethinking permanent contraception

The findings highlight the need for better education and counseling on the effectiveness of tubal sterilization, especially considering the shifting legal landscape surrounding reproductive rights. Healthcare providers should inform patients that alternative long-acting reversible contraceptives like arm implants or intrauterine devices offer a more reliable method of preventing pregnancy.

As the study reveals, tubal sterilization might not offer the level of certainty once believed. The researchers call for further investigation into real-world contraceptive failure rates to help women make informed decisions about their reproductive health.

Alivia Kaylor is a scientist and the senior site editor of Pharma Life Sciences.