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The efficacy and safety of vacuum aspiration on an outpatient basis without anesthesia or cervical dilatation within 14 days of a missed menstrual period was evaluated in 1,009 women. Among those patients in whom pregnancy could be documented (54.8%), 4.2% were still pregnant after the procedure. Potentially serious complications were pelvic infection (0.4%), bleeding requiring a repeat curettage (0.3%), and prolonged bleeding (0.7%). For comfort, 26.7% received local anesthesia or analgesia. To allow selection of a higher proportion of pregnant patients, the probability of pregnancy was derived for patients with either a positive or negative pregnancy test at each length of amenorrhea. To determine the best vacuum pressure and source, and the cannula size and type at each duration of pregnancy, a more extensive (large, controlled, comparative) study is required.

The long-term safety and effectiveness of Lippes Loops, A, C, and D, Dalkon Shields, Saf-T-Coils, and Cu 7-200 intrauterine devices (IUDs) were evaluated on the basis of 670 insertions in 588 women. Ten-year life-table rates for the Lippes Loops C (291 first insertions) and D (213 first insertions) were evaluated. The Loop C was consistently associated with a significantly higher expulsion rate but lower pregnancy rate as compared with the Loop D. Over-all, the removal rates for these two IUDs were similar. The incidence of pelvic infection and abnormal Papanicolaou smears, the time from IUD removal to conception, pregnancy outcome, and the need for any surgery post-IUD insertion were evaluated for all IUDs and all segments of use.

Among 2283 patients, rates of technical failure, technical difficulty, and operative and early postoperative complications were evaluated for different methods of tubal occlusion at laparoscopy: electrocoagulation (980 cases), spring-loaded clip application (991 cases), and Silastic band application (312 cases). Rates of technical failure and technical difficulty at surgery were significantly higher (P less than 0.05) for the spring-loaded clip technique than for the electrocoagulation and Silastic band techniques. Mechanical and optical difficulties with the prototype spring clip applicator were the major sources of technical difficulties. Rates of operative (1.2%) and early postoperative (1.9%) complications were not significantly different for the three techniques of tubal occlusion. It is concluded that all three study techniques appear to be practical, and large, long-term, randomized, comparative studies to determine rates of failure and subsequent gynecologic problems are necessary to determine the best method of sterilization.