Tubal sterilization is often viewed as a lasting solution for birth control and is the most widely used contraceptive method in the country. However, recent research from UC San Francisco reveals that tubal surgery has a failure rate significant enough that other contraceptive options could be more effective.
Tubal sterilization is frequently considered a permanent means of contraception and stands as the most prevalent birth control method in the U.S. Nevertheless, a recent study led by UC San Francisco indicates that tubal procedures fail often enough that various other contraceptive methods may generally be more effective.
The study found that between 3 to 5% of women in the U.S. who underwent tubal ligation eventually experienced an unplanned pregnancy. This rate of failure prompted the authors to recommend that individuals keen on preventing future pregnancies should consider using a contraceptive arm implant or an intrauterine device (IUD) instead.
This research was published on August 27 in NEJM Evidence.
Following the 2022 U.S. Supreme Court Dobbs decision, which stripped away federal protection for abortion services and made access to these services more limited in numerous states, interest in permanent contraception has surged. Consequently, the researchers assert that having knowledge about the effectiveness of various contraceptive methods is crucial.
“Since the Dobbs ruling, there has been a noticeable increase in concern about how potential pregnancies may affect someone’s health and family dynamics,” stated Eleanor Bimla Schwarz, MD, the lead author and head of the UCSF Division of General Internal Medicine at Zuckerberg San Francisco General. “This concern is particularly pronounced for individuals with pre-existing health issues such as diabetes and high blood pressure, which can complicate pregnancy.”
“Our findings indicate that tubal surgery should not be regarded as the most reliable method for preventing pregnancy,” Schwarz emphasized. “Individuals using a contraceptive arm implant or an IUD have a lower likelihood of becoming pregnant compared to those who have had their tubes tied.”
A Significant Number of U.S. Women Undergo Tubal Surgeries
According to national data, around 65% of women aged 15 to 49 in the U.S. use some form of birth control. Tubal sterilization, an abdomen-based procedure that involves clamping or severing the fallopian tubes, is employed by over 21% of women aged 30 to 39 and 39% of women over 40. This surgical method is particularly prevalent among individuals with low income and those facing chronic health issues.
Although tubal sterilization aims to permanently eliminate fertility, some women can still conceive. Past research suggested that fewer than 1% of women become pregnant post-tubal sterilization, as noted by the American College of Obstetricians and Gynecologists.
In this recent study, the researchers analyzed data from four separate rounds of the National Survey of Family Growth conducted between 2002 and 2015. The study included information from more than 31,000 women, focusing specifically on 4,184 who reported having completed tubal sterilization.
The researchers estimated that within the first year following the procedure, approximately 2.9% of women who were sterilized from 2013 to 2015 experienced a pregnancy. The likelihood of pregnancy was notably higher among younger women at the time of their surgery.
Women who had procedures funded by Medicaid did not demonstrate a higher rate of pregnancy than those with private insurance. In recent years, the share of women reporting Medicaid-funded tubal sterilizations rose from 18% in 2002 to nearly 36% between 2013 and 2015.
“When selecting the right birth control method, people often weigh various factors such as safety, convenience, and how quickly they can start using it,” Schwarz remarked. “For individuals who have opted for a ‘permanent’ solution, discovering that they became pregnant can be extremely upsetting. Unfortunately, this experience is quite common.”
