State-of-the-art of non-hormonal methods of contraception: V. Female sterilisation.

Objective: Systematic review of the literature on the effectiveness and safety of permanent female contraception.

Material And Methods: A systematic Medline and Cochrane Library review of the literature on technique, effectiveness, safety and complications of female sterilisation. Keywords used for research were 'female sterilisation', 'tubal occlusion', 'history', 'counselling', 'hysteroscopy', 'laparoscopy', 'complications' and 'effectiveness'.

Results: Worldwide over 220 million couples have resorted to either male (nearly 43 million) or female sterilisation (180 million). In this review the different methods of female sterilisation are described and their advantages and disadvantages discussed. Tubal occlusion is carried out via (mini-) laparotomy, laparoscopy or hysteroscopy. The Ovabloc, Essure and Adiana permanent contraception systems make use of the latter route.

Conclusions: Female sterilisation via the transcervical route is an outpatient or office procedure; it is performed under local anaesthesia or even without anaesthesia. Its complication rate is low. It should be preferred to the abdominal procedures provided the equipment and the experience required are available. Counselling should include information on vasectomy for the partner as well as on alternative long-acting reversible contraceptives. The ten-year cumulative pregnancy rate of sterilisation techniques ranges from 0.1 to 3.6 per 1000 procedures. The life-time risk of failure is around 1/200.