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Objective: To estimate the risk of sterilization regret based on age at the time of sterilization in a contemporary group of women., Methods: We conducted a retrospective analysis of cross-sectional data from the 2015-2017 and 2017-2019 National Survey of Family Growth, Female Respondent Files, to estimate the proportion of women who experience sterilization regret. Descriptive statistics were used to describe the population and the proportion with regret. Sterilization regret was defined as someone who either underwent sterilization reversal or who definitely wanted sterilization reversal. Multivariable logistic regression models were used to assess associations with sterilization regret., Results: A total of 1,549 women who underwent sterilization were included in the analysis; 8% were aged 21-30 years, and 92% were aged older than 30 years. Of the participants, 16.9% identified as Black, 22.0% as Hispanic, and 57.2% as White. Most (58.4%) underwent a tubal sterilization procedure between age 21 and 30 years. The cumulative proportion of regret was 10.2% (12.6% for women who underwent sterilization at age 21-30 years and 6.7% for those who underwent sterilization at older than age 30 years). After controlling for covariates including age, race, parity, educational attainment, and medical reason for sterilization, the only variable that had a statistically significant association with regret was age at the time of the interview (P<.001). As women got older, they were less likely to report sterilization regret., Conclusion: Younger women experience more sterilization regret. As women get older, sterilization regret decreases. Counseling about sterilization should reveal the unpredictability of future desire, but age alone must not be a barrier to performing sterilization., Competing Interests: Financial Disclosure The authors did not report any potential conflicts of interest., (Copyright © 2022 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: We aim to compare live birth rates, cost analysis and a survey of patient attitudes between laparosopic tubal re-anastomosis and in vitro fertilisation (IVF)., Materials and Methods: A retrospective study was done in a single reproductive medicine and IVF unit in Singapore from January 2011 to December 2016. Previously ligated patients underwent either laparoscopic tubal re-anastomosis or IVF. The primary outcome was first live birth after treatment. Interval to first pregnancy, miscarriage and ectopic pregnancies were also reported. Patients attending the subfertility clinic completed a questionnaire on IVF and tubal re-anastomosis on preferred choice of treatment, before and after reading an information sheet., Results: Twelve patients underwent tubal re-anastomosis while 31 patients underwent IVF treatment. Pregnancy (75.0% vs 35.5%) and live birth (58.3% vs 25.8%) were significantly higher in the tubal surgery group ( P <0.05%) after transferring all available embryos in one stimulated IVF cycle. Cost per live birth was lower in the tubal surgery group (SGD27,109 vs SGD52,438). One hundred patients participated in the survey. A majority of patients preferred tubal surgery to IVF (68.2% vs 31.8%) before given information on the procedures, but indicated a preference for IVF (54.6%) to surgery (45.4%) after receiving information on the procedures., Conclusions: For women less than 40 years of age, desiring fertility after tubal ligation, laparoscopic tubal re-anastomosis offers better live birth rates and cost-effectiveness. Patients in Singapore are equivocal as to their preference after education regarding the choices. Thus, laparoscopic tubal re-anastomosis remains a viable alternative to IVF treatment.

Purpose: Racial and ethnic disparities in rates of female sterilization, a prominent method of contraception, have been consistently observed for decades. Such disparities are also evident in subsequent desire for reversal of the procedure. Additional work is needed to better understand these patterns, particularly given the historical context of coercive sterilization patterns in minority and low-income women. Materials and Methods: Two cycles of the National Survey of Family Growth data are pooled (2011-2013 and 2006-2010) and used to estimate odds ratios (ORs) for race and ethnicity, controlling for payment method, age at sterilization, number of long-term partners, and other known covariates. Results: After adjusting for other factors, the odds of desire for reversal were 70% higher (OR 1.70, confidence interval [95% CI] 1.26-2.29) in non-Hispanic (NH) Black and 54% (OR 1.54, 95% CI 1.14-2.08) in Hispanic women compared to their NH White counterparts. In addition, the likelihood of desire for reversal was substantially increased with lower age at sterilization, a higher number of partners, and lower education. Conclusions: Robust findings of desire for reversal among racial and ethnic minorities, taken together with increased desire for reversal on the basis of specific personal characteristics, merit attention to the possibility that disproportionate outcomes reflect a lack of access to desired contraception and an inability to achieve desired fertility goals in marginalized populations.

Background: Female sterilisation is usually performed on an elective basis at perceived family completion, however, around 1-3% of women who have undergone sterilisation elect to undergo sterilisation reversal (SR) at a later stage. The trends in SR rates in Western Australia (WA), proportions of SR procedures between hospital types (public and private), and the effects of Federal Government policies on these trends are unknown., Methods: Using records from statutory state-wide data collections of hospital separations and births, we conducted a retrospective descriptive study of all women aged 15-49 years who underwent a SR procedure during the period 1st January 1990 to 31st December 2008 (n = 1868 procedures)., Results: From 1991 to 2007 the annual incidence rate of SR procedures per 10,000 women declined from 47.0 to 3.6. Logistic regression modelling showed that from 1997 to 2001 the odds of women undergoing SR in a private hospital as opposed to all other hospitals were 1.39 times higher (95% CI 1.07-1.81) and 7.51 times higher (95% CI 5.46-10.31) from 2002 to 2008. There were significant decreases in SR rates overall and among different age groups after the Federal Government interventions., Conclusion: Rates of SR procedures in WA have declined from 1990 to 2008, particularly following policy changes such as the introduction of private health insurance (PHI) policies. This suggests decisions to undergo SR may be influenced by Federal Government interventions.

Background: Unintended pregnancy has been significantly associated with subsequent female sterilization. Whether women who are sterilized after experiencing an unintended pregnancy are less likely to express desire for sterilization reversal is unknown., Methods: This study used national, cross-sectional data collected by the 2006-2010 National Survey of Family Growth. The study sample included women ages 15-44 who were surgically sterile from a tubal sterilization at the time of interview. Multivariable logistic regression was used to examine the relationship between a history of unintended pregnancy and desire for sterilization reversal while controlling for potential confounders., Results: In this nationally representative sample of 1,418 women who were sterile from a tubal sterilization, 78% had a history of at least one unintended pregnancy and 28% expressed a desire to have their sterilization reversed. In unadjusted analysis, having a prior unintended pregnancy was associated with higher odds of expressing desire for sterilization reversal (odds ratio [OR]: 1.80; 95% confidence interval [CI]: 1.15-2.79). In adjusted analysis controlling for sociodemographic factors, unintended pregnancy was no longer significantly associated with desire for reversal (OR: 1.46; 95% CI: 0.91-2.34)., Conclusion: Among women who had undergone tubal sterilization, a prior history of unintended pregnancy did not decrease desire for sterilization reversal.

A case-control study was carried out at a public teaching hospital in Recife, Pernambuco State, Brazil in 1997 to investigate risk factors among women who feel regret after undergoing sterilization through tubal ligation. The study compared sterilized women who had requested or undergone a tubal reversal with women who were also sterilized but had not undergone this surgery, nor had requested to do so. Women showing a significantly greater probability of regret were those sterilized at a young age, those who had not themselves made the decision to undergo surgery , those for whom the sterilization was carried out up to the 45th day after childbirth and those who had acquired knowledge about contraceptive methods after the tubal ligation procedure. Having had a deceased child, a partner with no children prior to the current union or a change of partner after the tubal sterilization procedure were also associated to the request for or submission to tubal sterilization reversal. It is necessary to assess women's psycho-socio-demographic profiles, their reasons for requesting tubal ligation and to advise the patient about family planning in order to reduce rates of post-sterilization regret.

Objective: To examine the independent effects of race/ethnicity and insurance status on desire for tubal sterilization reversal., Design: Secondary analysis of cross-sectional data collected by the 2002 National Survey of Family Growth (NSFG)., Setting: Interviews were conducted in person by a trained female interviewer in the participant's home., Patient(s): The NSFG is designed to represent women and men 15-44 years of age in the U.S. household population. The sample consisted of 934 women who had undergone tubal sterilization at any time before being interviewed., Intervention(s): None., Main Outcome Measure(s): Desire for sterilization reversal., Result(s): Among women older than 30 years at time of surgery, black women were significantly more likely to desire sterilization reversal compared with white women (adjusted odds ratio, 2.6; 95% confidence interval, 1.2, 5.8). In the total cohort and in the subset of women 30 years or younger, there were no significant racial/ethnic variations in desire for sterilization reversal., Conclusion(s): Among women over age 30 at the time of tubal sterilization, black women were much more likely to express desire for reversal than white women.

Background: Brazil is a country with a high prevalence of tubal ligation, which is frequently performed at the time of delivery. In recent years, an increase in tubal reversal has been noticed, primarily among young women., Objectives: To study characteristics correlated with the procedure, determine frequency of intrapartum tubal ligation, measure patient satisfaction rates and tubal sterilization regret, in a sample of post-tubal patients., Methods: Three hundred and thirty-five women underwent tubal ligation. The variables studied were related to the procedure: age at tubal ligation, whether ligation was performed intrapartum (vaginal or cesarean section) or after an interval (other than the intrapartum and puerperal period), health service performing the sterilization, medical expenses paid for the procedure, reason stated for choosing the method and causes related to satisfaction/regret: desire to become pregnant after sterilization, search for treatment and performance of tubal ligation reversal. The women were divided into two groups, a group undergoing ligation in the intrapartum period and a second group ligated after an interval, to evaluate the association between variables by using Fisher's exact test and chi-squared calculation with Yates' correction. The study was approved by the Ethics Committee of the institution., Results: There was a predominance of Caucasian women over 35 years of age, married, and with a low level of education of which 43.5% had undergone sterilization before 30 years of age. Two hundred and forty-five women underwent intrapartum tubal ligation, 91.2% of them had cesarean delivery and 44.6% vaginal delivery. In both groups undergoing intrapartum tubal ligation and ligation after an interval, 82.0% and 80.8% reported satisfaction with the method. Although 14.6% expressed a desire to become pregnant at some time after sterilization, consultation regarding sterility occurred in 3.4% and 2.3%, respectively, and one woman underwent tubal reversal. The most frequent reasons for choosing the method were satisfaction with the number of offspring (35.5% and 46.7%) and medical indication (41.6% and 32.2%), respectively., Conclusion: The incidence of intrapartum tubal ligation was higher when the last delivery had been a cesarean section. No difference was detected among the groups regarding rates of satisfaction and regret after performance of the sterilization procedure.

Objective: The aim of this study is to emphasize the role of counseling methods that are meant to decrease the request for tubal ligation reversal, such as tubal ligation scoring., Method: This study covers 389 patients who were admitted for tubal sterilization to Cukurova University, Faculty of Medicine, Obstetrics and Gynecology Department, between 1 January 1990 and 31 December 1999. We have used the 'Tubal ligation score' on these 389 patients. Four hundred and seventeen patients who underwent bilateral Pomeroy type tubal ligation during cesarean section without having undergone tubal ligation scoring in the same time interval, were accepted as the control group., Results: Laparoscopic tubal ligation (with a Yoon ring) was performed on 368 patients who had a score of 6 or higher. Twenty-one patients who got a score of 6 or lower were recounseled and another family planning method was prescribed to them. None of the 368 patients to whom tubal ligation scoring was done previous to laparoscopic tubal ligation returned to our clinic for tubal reanastomosis. Fifteen of the 417 patients (3.6%) in the control group returned to our clinic for tubal reanastomosis., Conclusion: Tubal ligation scoring may decrease the ratio of patients who request a tubal ligation reversal.

Our objective was to assess the influence of preliminary counseling that provided information about age-related fertility rates on the decision of women to undergo reversal of sterilization. There was no apparent influence; this raises the question as to whether couples seeking fertility therapy base their decision making on factual information provided by the clinician.

Objective: We sought to identify the characteristics of women in a military population who are likely to seek a tubal anastomosis after a previous bilateral tubal ligation (BTL)., Method: A written investigational review board-approved questionnaire was administered to 56 women, ages 18-40 years, requesting evaluation for a reversal of a prior BTL and 52 women of the same age range not seeking reversal. The questionnaire identified demographics and relationship characteristics of volunteers at the time of their decision to have a BTL and at the present time., Results: Age 25 years or younger, sterilization due to pressure from a partner, poor marital relationship at the time of the BTL and a new marriage are highly predictive of tubal sterilization regret and a request for sterilization reversal in a military population. In addition, women requesting a tubal anastomosis reported less preoperative counseling on the permanence of a BTL and of the male alternative for permanent female sterilization, vasectomy., Conclusion: Women with these characteristics should have extensive counseling before undergoing tubal sterilization.

Women who undergo sterilization may later regret this decision. This systematic review examines whether age at sterilization is associated with poststerilization regret. Using MEDLINE and EMBASE, we identified 19 articles that examined associations between women's age at sterilization and later regret, requests for sterilization reversal and undergoing sterilization reversal or requesting in vitro fertilization (IVF) procedures. Study results showed that the younger women were at the time of sterilization, the more likely they were to report regretting that decision. Women undergoing sterilization at the age 30 years or younger were about twice as likely as those over 30 to express regret. They were also from 3.5 to 18 times as likely to request information about reversing the procedure and about 8 times as likely to actually undergo reversal or an evaluation for IVF. Results of studies that examined risk by continuous age showed a consistent inverse relationship between women's age at sterilization and their likelihood of regretting having had the procedure.

Tubal sterilization is one of the contraceptive methods whose use has increased the most in Brazil, but a growing number of women have expressed regret after the procedure. A case-control study was conducted at the Centro Integrado de Saúde Amaury de Medeiros (CISAM), Recife, Pernambuco, Brazil, in 1997 to investigate the association between changes in family structure and request for or submittal to surgical reversal of tubal sterilization, comparing 304 sterilized women who had requested or submitted to reversal of tubal sterilization and 304 women who were also sterilized but had not requested, had not submitted to, and who did not wish to submit to reversal. The simple and adjusted odds ratios were estimated using logistic regression. The results of the current study showed that death of children, partners without children prior to the current union, and partner change after tubal sterilization were associated with the request for or submittal to reversal of tubal sterilization. More strict criteria are suggested in the indication of tubal sterilization, including an in-depth profile of the woman requesting tubal sterilization and identification of risk factors for future regret.

Objective: To audit the effectiveness of a female sterilisation counselling clinic., Design: A prospective, observational study of a female sterilisation counselling clinic over a 6-month period to determine the proportions of attenders keeping their appointment, proceeding to sterilisation, and attending for surgery., Setting: A hospital-based, city centre family planning clinic run by permanent, family planning-trained staff., Results: A total of 226 women had appointments for female sterilisation counselling and most confirmed attendance. Only 153 (68%) women attended; of those 101 (66%) chose to be sterilised, the remainder choosing reversible contraception. Ninety-three (92%) women went ahead with the sterilisation procedure. Thus only 61% of the original attenders were sterilised; this was only 41% of those referred., Conclusions: The study suggests that many women referred for sterilisation counselling fail to attend. This finding needs to be further explored. For those women who do attend, accurate information and informed counselling is important. Many women are still unaware of highly effective long-term reversible contraception, and following discussion decide against female sterilisation. Services offering counselling for female sterilisation should also be able to provide easy access to a full range of contraceptive methods.

Objective: Besides manifestations of hormonal deficits, psychological problems are also known as possible negative effects of tubal sterilization (here termed "operative contraception"--OC). It is generally assumed that the age at time of operation and the number of children play a crucial role in enabling the patient to come to terms with surgical contraception. We investigated whether these patients were satisfied and the frequency of a desire for refertilization as well as further factors possibly affecting our patients., Patients and Methods: A standardized questionnaire was sent to 274 women in whom surgical contraception was performed from 1984 to 1990 in our hospital. Besides physical symptoms, the questions mainly inquired as to satisfaction, degree of regret and desire for refertilization., Results: 5.4% of women were not satisfied with the operation. 13.7% of the patients regretted the operative contraception and 6.5% wished to have refertilization. The negative appraisal did not correlate with the number of children and age at the time of operative contraception. Altogether, satisfaction was very much greater in patients who had completed family planning than in patients who had received operative contraception for medical reasons. Appraisal of operative contraception was especially negative in women in whom the operation had been performed on the occasion of a cesarean section., Conclusion: Our follow-up investigation confirmed that operative contraception was experienced as being very liberating by most women and was accordingly appraised positively on the whole. The number of children and age only played a subordinate role in how patients came to terms with their situation. For a positive experience of operative contraception, the time of the operation appears to be of major importance. In particular, "favorable opportunities" on the occasion of cesarean section and the if anything doubtful need for this measure in the condition after prior cesarean sections must be avoided, since in these cases a free decision in favor of operative contraception, which the woman concerned feels to be autonomous, is not possible.

Two hundred twenty women who were subjected to reversal of female sterilisation over 7 years were analysed. It was found that death of the male child was the strongest reason for seeking a reversal. This was coupled with the parity of these subjects being two or less in 70% instances at the time of primary sterilisation surgery. Nearly 85.9% reversal were sought in the higher age groups clubbed together. This has an adverse bearing on success of reversal surgery as the fertility potential of a woman declines physiologically as age advances.

Brazil has one of the highest prevalence rates of female surgical sterilization in the world. At the same time there is an increased demand for sterilization reversal. In order to understand which women tend to later request reversal of the procedure, a case-control study was carried out comparing 216 women who requested reversal with sterilized women who did not, paired by year of surgery. The relative risk of requesting reversal for women sterilized before age 25 was 18 times that of women sterilized after age 29. The elevated risk remained even after controlling for a number of variables present at the time of surgery. Multiple regression analysis showed that request for reversal was associated with younger age, less information about the procedure, and fewer contraceptive methods known before sterilization. These results support the recommendation that women should be fully informed about the tubal ligation procedure and have access to other contraceptive options before being sterilized.

Contraceptive sterilization of men and women was made legal in Sweden in 1976. Males presently account for approximately 20% of the 8-10,000 people sterilized yearly in the country. Only few long-term follow-ups have been performed on Swedish men. Since 1983 preoperative counselling of men has been available in the county of Blekinge at family planning clinics. Prior to this counselling was available only at urologic or surgical departments. To evaluate long term satisfaction and the new counselling possibilities, all men vasectomized in Blekinge during 1985-1986 (n = 108) were investigated by a mailed questionnaire 2 years and 7 years after the operation. Response rates were 98% after 2 years and 96% after 7 years. 93% of the responding men were satisfied with their vasectomy when asked after 2 years. 95% reported satisfaction 5 years later. Problems mentioned concerned sexual performance, long lasting pain, and wanting children in new relationships. Regret was not encountered among the 25% who had been counselled at family planning centers.

Objective: To analyze the follow-up of a cohort of women who requested reversal of surgical sterilization., Methods: This retrospective study was carried out at the State University of Campinas, Brazil. A cohort of 394 women who requested sterilization reversal was followed up for one year after reversal surgery. The analysis includes the percentage of women who completed the steps between the initial consultation up to one year after reversal surgery., Results: After an initial consultation, 55.1% of the patients decided not to continue with the procedures. Of the patients who did undergo laparoscopy (n = 177), 48.6% had no possibility of a successful surgical reversal because the Fallopian tubes were in very poor condition. Only 17.5% of the initial patients requesting reversal ultimately underwent surgery and 3.3% became pregnant., Conclusions: The analysis of regret about surgical sterilization should include not only women who undergo surgery but also women requesting surgery. Better patient selection and counseling prior to sterilization are necessary in order to prevent increasing rates of sterilization regret in Brazil.

In this exploratory study, 37 sterilized women applying for sterilization reversal were questioned thoroughly to establish why they had decided to undergo sterilization and why they now wished for it to be reversed. Taking an interactive behavioral model as our starting point, we concentrated on the psychosocial circumstances leading to the definitive decision to be sterilized. A relationship crisis at the time of sterilization was found to be a prognostically unfavorable factor. Furthermore, 20 of the 37 patients cited new partnerships as their main reason for seeking reversal. Those who felt pressurized by their gynecologist or partner into undergoing sterilization had significantly more problems in overcoming the psychological stress accompanying such an operation than those who, through a series of consultations on contraception, had had sufficient time and opportunity to make their own decisions. Sterilization performed for medical reasons was found to have particularly problematical consequences, especially where the doctor had made the decision largely on his own, failing to give an adequate explanation for the medical necessity of the operation. Regarding the time chosen for sterilization, the study revealed that the patient's postoperative psychological condition was significantly worse when sterilization was carried out immediately after a delivery, after abortion or after Caesarean section, rather than in the interval between pregnancies. The resulting increase in the incidence of psychosomatic complaints and depressive states is also confirmed in the literature. The findings of this study offer practical suggestions for improved preoperative consultation and should help to determine the course of action to be taken when a patient wishes to be sterilized.

In a psychosomatic study we interviewed 33 women who had undergone tubal anastomosis or IvF after tubal ligation. As a control group we chose a randomised sample of 45 women after elective tubal ligation. We used a semi-structured interview and the Giessen-test as psychometric instruments. According to the leading indication for reanastomosis, we allocated women to one of 2 groups: 21 patients had found a new partner (R-partner), 12 mentioned experiences of loss (R-loss). The groups were well comparable in respect of sociodemographic items, but showed relevant differences in psychological variables, like motivation for and time for deliberation to sterilisation or age difference between partners. Women of the R-partner group were highly satisfied with tubal reanastomosis as compared to R-loss subjects. Satisfaction with the procedure was basically independent of an actual pregnancy. Women experienced the two methods in different, rather specific ways. Cluster analysis of the Giessen-test result confirmed group allocation. We conclude that experiences of loss as a leading reason for tubal reanastomosis are unfavourable prognostic factors. IvF has an unfavourable prognosis in women with the intention to restore the mutilated body image. Preoperative counselling by a psychotherapeutically trained counsellor seems mandatory.

Tubal sterilization is the world's most commonly used contraceptive method. Even a small proportion of women incurring poststerilization regret would translate into a large number of sufferers. In this review, we examine recent reports on the incidence of, and the risk factors for, posttubal sterilization regret in women and requests for sterilization reversal in both developed countries and less-developed countries. We also consider the implications of our findings in the practical prevention of poststerilization regret and requests for sterilization reversal, and discuss methodological issues.

This retrospective study presents data from 26 women who underwent a reversal of female sterilization. The intrauterine pregnancy rate and ectopic pregnancy rate were 38.5% and 7.7% respectively. The most successful site of tubal anastomosis was isthmic-isthmic anastomosis. The importance of proper patient selection and factors that affect the success rate in attempted reversals are emphasised. The importance of microsurgical approach is highlighted.

Aims: To determine the outcome of request for reversal of sterilisation and to compare demographic and social factors of women who subsequently withdrew their request with those who proceeded with the reversal assessment and operation., Methods: Information relating to the sterilisation and regret intervals were sought from 210 women. Demographic and social factors were recorded and the outcome of the reversal request determined. Patients who withdrew or were deferred/declined were compared on relevant factors with the group who proceeded to, or are still planning, the reversal operation., Results: Ninety-two (44%) withdrew before or during the assessment phase. Another 13 withdrew after laparoscopy identified a poor prognosis. Three declared their intention not to conceive after they underwent the reversal operation. To date, 83 have had surgery with the cumulative intrauterine pregnancy rate at 1, 2 and 3 years being 0.46, 0.62 and 0.78 respectively. In comparing those women who proceeded and withdrew, there were no differences in mean age at referral, age at sterilisation, the number of living children nor marital status. The regret interval prior to referral was significantly longer in the women who proceeded (27.9 and 19.5 months respectively, p = 0.03). Those who were highly motivated in their reversal request were also more likely to proceed (p = 0.003)., Conclusions: There is a large dropout rate of women who seek a reversal of sterilisation. Women who regret sterilisation may have sought sterilisation as a solution to problems that were psychosocial rather than contraceptive in nature. We stress the importance of counselling for both sterilisation and its reversal, since in the latter many developmental personality and relationship problems remain unresolved.

This study investigates the psychological concomitants and sequelae of surgical reversal (tubal reanastomosis) or of IVF after tubal ligation. We held semi-structured interviews and used the Giessen test and the Strauss-Appelt body image questionnaire. The sample comprised 25 women; a new partner was the leading reason for reversal in 16 cases ('New Partner'), while in 9 cases experiences of loss (of a child or of ideal values) prevailed ('Loss'). The two groups differed in a number of relevant demographic and psychological data. 'New Partner' patients showed a pattern of factors known to be associated with regret of sterilization. 'Loss' women were less satisfied with reversal than 'New Partner' subjects (P < .01). Satisfaction with reversal was independent of an achieved pregnancy. Patients considered surgical reversal to be preferable to IVF because of the "restoration of the mutilation." In the Giessen test, 'New Partner' women were more depressive (P < .05) and more submissive (P < .05) than 'Loss' subjects. Cluster analysis of the whole sample revealed four well distinguishable profiles. 'Loss' patients experienced less insecurity of their body image than both 'New Partner' women and the general female population. We conclude that reversal of sterilization helps to restore body-image and self-esteem, but it may counteract mourning. Consequences for pre-reversal counseling are discussed.

Many different criteria and profiles have been suggested for the possible cause of regret and requests for reversal after tubal sterilization. Evaluation of data obtained from 2253 women who had undergone tubal sterilization showed a strong correlation between regrets and youthful age and to changes in marital situation. Previously demonstrated risk factors, such as sterilization in connection with abortion or labor were not related to regret in this study material.

The characteristics and circumstances of 55 women who underwent reversal of sterilisation were compared with those of 55 women who had a sterilisation performed at the same time, but who did not subsequently undergo reversal. Patients who underwent reversal were sterilised at a significantly younger age, and were more likely to have been sterilised at the time of therapeutic abortion or miscarriage. The parity at the time of sterilisation was the same for both groups. The reason for requesting reversal was a change of partner in the vast majority of cases. From this and other studies we conclude that alternative contraception should be sought in patients who are young or whose relationships appear unsteady at the time of sterilisation request, and that sterilisation at the time of therapeutic abortion should be abandoned in favour of an interval procedure. By so doing we may stem the rising tide of patients who subsequently seek a reversal of their sterilisation.

Within the framework of this exploratory study, 37 sterilised women wishing to be refertilised, were questioned thoroughly on what had indicated their sterilisation and why they wish to be refertilised. Assuming the existence of an interactive behaviour pattern, we concentrated on the psycho-social circumstances accompanying the definitive decision to be sterilised. Here, a critical situation in the relationship between the partners at the time of sterilisation could be established as a prognostically unfavourable factor. Accordingly, 20 of the 37 patients developed the wish to be refertilized because of a new partnership. Those who felt induced by their gynaecologist or partner to undergo sterilisation had significantly more problems in overcoming the psychological stress accompanying such an operation than those who, after repeated consultations, had enough time and possibilities to make their own decision concerning contraception. Furthermore, sterilisation due to medical indication could be suggested as another highly critical factor, especially where the gynaecologist failed to give sufficient explanation of its medical necessity. With regard to the time set for the sterilisation, the study revealed that the patient's psychological condition after the operation was significantly worse, when sterilisation was carried out immediately after a delivery or an abortion. The fact that in such cases sterilisation is often followed by an increase in psychosomatic trouble and depressive states, of mind is also confirmed by literature. The results of the study are a practical contribution towards improving preoperative consultation and coordinating the course of action to be taken where a patient has the wish to be sterilised.

Forty men who had their vasectomy reversed were psychoanalitically examined. The changes of mind were above all concerned with the results of new relationships, initially no (more) children, then (more) children. The stability of the relationship at the time of vasectomy had been wrongly evaluated which must subsequently influence any advice given. Between 22 and 26 months after the reversal there was a telephone follow-up. Fertilization occurred with 32.1% of the cases, sperm was present in 77.4% (according to the men). The time between vasectomy and reversal was 4.8 years on average, the longest period being 8 years. A fertilization followed even when the anastomosis was only possible in one side in vas deferens area or on both sides in the caput area of the epididymis.

The Collaborative Review of Sterilization is a prospective study of women undergoing tubal sterilization at selected medical centers in the United States. This analysis examined 5817 study participants who were asked whether they had sought information on tubal reanastomosis after their sterilizations and whether they had actually obtained reanastomosis surgery. Characteristics that predicted the likelihood of seeking reanastomosis information were examined in multivariate, logistic regression models that included age, race, number of living children, history of abortion, education, timing of sterilization in relation to pregnancy, initial marital status, and change in marital status. Among the women studied, 6.2% reported that they had sought information on reanastomosis. Women who were younger than 30 years old at the time of sterilization were twice as likely to seek such information as women aged 30-34, and women who had experienced changes in martial status after sterilization were 2.8 times as likely to seek information as women with unchanged marital status. Thirteen women had actually obtained reanastomosis. Compared with the overall study population, these women were more likely to be white, to have lower gravidity, to be younger, and to have experienced changes in marital status.

In order to study subsequent regret as a complication of female sterilisation, hospital records of women requesting reversal of their sterilisation were compared with women who had not requested a reversal. Regret was more likely in women sterilised at a younger age, but was not associated with lower parity. Women requesting reversal were interviewed to determine the psychosocial factors likely to produce later regret. The clinical implications are discussed.

Demographic socio-economic and decision-making aspects of sterilization and reversal of sterilization were compared in a group of 103 women requesting reversal (RR) and 117 women about to undergo sterilization (S), to determine the practicality of identifying in advance the woman likely to request reversal. The willingness of patients to pay for these procedures and the ethical implications of these decisions were also examined. RR were younger at the first relationship, birth of first child and birth of last child. There were no differences (RR vs S) between the number of full-term pregnancies, living children and therapeutic abortions. The timing of sterilization (puerperal versus interval) did not influence the decision to be reversed. The level of education, partner's level of education and mean family income were lower in the group requesting reversal. Multiple regression analysis revealed three characteristics which were most discriminatory: youth at first birth; lack of spousal support; and failure to choose 'family complete' as a reason for sterilization. The predictability was not strong enough to provide an accurate assessment of the individual woman. RR were of significantly lower socio-economic standing but were more likely to be prepared to pay a large sum of money for the reversal. The ethical implications of this finding are discussed.

The application of microsurgery in gynaecology is discussed. The necessity for a proper training programme and correct selection of patients is stressed. A classification pertaining to surgical procedures is necessary to compare the results of such surgery. The limitations of microsurgery in dealing with adhesions is considered, as well as the markedly improved results in tubal anastomosis, and the possibility of substitution of oviducts is considered.

A study was designed to assess satisfaction with presterilization counseling, contentment with being sterilized and the effect of variables, such as age, number of children at the time of surgery and ethnic background, on the level of contentment with being sterilized. A total of 1,716 questionnaires were distributed at various hospitals and clinics. Questionnaires were collected from 492 women, who had ranged from 17 to 46 years of age at the time of sterilization. The majority of the women were married, and their average number of children was two. Of 487 women who replied, 30% did not receive any presterilization counseling from a physician; 15% of 480 women received their counseling from a nurse. Of 487 women, 2% fully regretted their sterilization, and the majority of them wanted more children. A positive correlation was found between the degree of satisfaction with presterilization counseling and the level of contentment with being sterilized. It was also found that 6 of the 53 women who were under 25 years of age at the time of surgery fully regretted their sterilization. The ethnic backgrounds of the women and their number of children at the time of surgery had no significant effect on their contentment with sterilization.

To help identify potential regretters of female sterilization, the women sterilized at Frederiksborg County Hospital, Hørsholm, Denmark, from 1978 through 1982 were contacted by questionnaires, and their medical records were reviewed. Ninety-two per cent (547/594) responded. The median observation time was 50 months. Five per cent of the women (n = 28) regretted the sterilization. The risk of regretting the sterilization was significantly increased among women who at sterilization experienced marital disharmony (12.5% regretted), had a child less than one year old (14.7% regretted), had the sterilization performed in connection with another surgical procedure (16.1% regretted), were outside the social groupings (17.0% regretted), or had no paid work (10.0% regretted). No association between number of children at the time of sterilization, prior number of contraceptives used, abortion at sterilization, and later regret was found. Twenty-five per cent of the regretters had had psychiatric problems prior to the sterilization. The regretters were sterilized shortly after their request (median 1 month) compared to 3 months among non-regretters. The main reason for regret of sterilization was the desire for more children, independent of a change in marital status. Sequelae to the sterilization was a common complaint. Refertilization was requested by 1% of the sterilized women. The study suggests that the psychosocial situation should be carefully evaluated in women requesting sterilization. A time lag from request to the sterilization should be mandatory and a thorough pre-sterilization counseling including information about possible sequelae and alternative contraceptives should be given.

Research to date has not been able to dispel controversy over the question of "psychogenicity" of infertility. Increasing numbers of studies suggest that neuroendocrinological factors play a role in what is most likely a multidetermined condition. Whatever the etiology, and whether infertility occurs spontaneously (e.g., anovulation) or by choice (e.g., surgical sterilization), the physician must be alert to the special needs of the patient, to the environmental setting, and to the intricate interplay between infertility and emotional reaction. The physician-patient relationship as a triadic rather than dyadic relationship introduces unique transference and counter-transference considerations which must be an acknowledged part of evaluation and treatment.

Ninety-two men were explored by depth psychological interviews before vasectomy and 12-15 months later. Eighty-six of them were completely satisfied with the operation. Six men were dissatisfied and would not undergo the operation again. Forty men requesting refertilization were also explored by depth psychological interviews one day before operation. The comparison of these two groups shows that vasectomy is problematic for men who are younger than 30 years, being in training, and whose partners are not willing to undergo sterilization as well. Men without partners and without children should reconsider their decision for vasectomy and particularly those who show the above-mentioned characteristics and/or those who make the decision without being able to use condoms and/or are unable to handle the situation in case of an abortion. The length of partnership is not important for the sequelae of vasectomy.

51 women asking for refertilization were evaluated by means of a half-standardized questionnaire before laparoscopy. Special attention was directed towards the psychological situation at the time of sterilisation as well as the reasons for refertilization desired. In addition the Giessen-test was performed as standardized psychological personality inventory. In general, the sterilization was initiated by the women because of social, financial or marital difficulties. In 2/3 of the females sterilization was performed in association with other gynecological or obstetrical procedures. Most of the women did not have any kind of adequate psychological or social counseling. The desire for refertilization was mainly caused by changes in the personal situation. 29 of 51 women reported to have a new partner, 27 of them after divorce or separation, two after the previous partner's death. Ten women reported the loss of a child, however, 12 women desired refertilization without any obvious change in their private situation. In conclusion, it appeared that refertilization was desired and experienced as a real need as well as a result of a conflict in the women's self-understanding expressed by a tendency towards depression.

A the Women's Hospital, Crown Street in the past 4 years 64 women who requested reversal of tubal sterilization have been studied. Some of their characteristics at the time of sterilization and the reasons for their request for reversal are examined. It would appear that relatively young women of low parity whose reasons for sterilization are primarily socioeconomic in association with an unstable martial state are those most likely to request reversal. Furthermore, postpartum sterilization in such women is more likely to lead to requests for reversal than interval sterilization. The overwhelming reason for requesting reversal is the establishment of a new marital relationship. However, there is a small group whose reason is the death of the antecedent child, usually a cot death, under the age of 6 months.

The authors compare their experience with pregnancies after laparoscopic sterilization with thos reported in the literature. When misidentification and luteal phase pregnancies are excluded, the true failure rate for laparoscopic sterilization varies between 0.9 and 6 per 1000 sterilizations, depending in part on the technique used. This rate is similar to that of nonlaparoscopic techniques. The mechanical methods have a slightly higher rate than do the electrical methods. Pregnancies that occur after a method failure have a high risk of being ectopic. Reversal of laparoscopic sterilizations has now been reported with most methods. Reimplantation of the tube into the uterus and microsurgical techniques appear to produce similar results in patients sterilized by electrosurgical methods. Patients sterilized by mechanical methods are best managed by microsurgical reanastomosis.

With large numbers of women seeking sterilization each year, including over half a million in 1983 alone, the problem of regretted sterilization and efforts to prevent regret have become matters of concern to health care providers. This paper describes a sterilization counseling program designed to reduce the likelihood of regretted sterilization. Discussed are factors which help predict satisfaction or regret following sterilization. A psychodynamic approach to sterilization counseling informed by these factors is described. Case vignettes are included, as is a retrospective analysis of candidates counseled during one year of the program.

Reanastomosis of the fallopian tube represents a potential means of restoring fertility to women who have previously had sterilization procedures. During a 40-month period from January 1977 to June 1980, 46 such women had ent-to-end reanastomosis at Vanderbilt University Hospital, 59% after a change in their martial status. The surgical procedure included microsurgical technic, with the use of antibiotics, corticosteroids, intraperitoneal dextran, and postoperative hydrotubation. No stents or splints were used. Tubal patency was demonstrated in 43 patients (93%). Pregnancy was achieved in 25 of the 37 patients (68%) properly followed up for one year. There were no ectopic pregnancies. In three patients who did not conceive, a "second-look' laparoscopy revealed the presence of pelvic adhesions. Such a procedure allows a more accurate assessment of both the cause of the continued infertility and the future prognosis.