A comprehensive review of female sterilisation--tubal occlusion methods.

Female sterilisation using tubal occlusive methods are reviewed. The various techniques, failure rates, mortality, short and long-term morbidity, psychosexual effects and reversibility are discussed. Tubal occlusion is an effective method of female sterilisation but if failure should occur ectopic pregnancies are more likely if tubal diathermy, and less likely if Fallope rings or Filshie clips have been used for the original sterilisation procedure. Mortality rates are low and occur as a once-only risk when compared to ongoing contraception. Short-term morbidity rates are low when sterilisation is performed via the laparoscope, with single portal entry being more likely to result in complications. Mini-laparotomy and laparotomy also have low morbidity levels but complication rates are much higher when a transvaginal approach is used. There is no increase in morbidity when tubal sterilisation is performed at the time of pregnancy termination, providing uterine evacuation is not performed by hysterotomy. In the majority of cases no menstrual disturbance is noted; however, a small increase in menstrual disorders as a direct result of tubal sterilisation cannot be excluded absolutely. Sterilisation does not affect sexual satisfaction. Regret is more likely if the sterilisation is performed (i) post-termination or in the puerperium, (ii) when there is marital disharmony and (iii) for medical rather than social reasons. Low parity is not associated with regret except in cultures where high parity is prized. Microsurgical methods of reversal have higher pregnancy and lower ectopic rates than macrosurgical techniques. Successful reversal is inversely related to the degree of tubal destruction at the initial operation.