[Male and female sterilization techniques: Summary of ANAES assessments (May 2005)].

OBJECTIVE: To summarize assessments carried out by ANAES on male and female sterilization techniques. The summary was requested by the French Health Directorate after the law authorizing sterilization as a means of contraception was passed.

RESULTS (FEMALE STERILIZATION): (i) EFFICACY of tubal ligation, electrocoagulation, clips or rings: the annual pregnancy rate is 0-2% depending on the study, with no significant difference between techniques. No data were found on fimbriectomy. (ii) EFFICACY of a hysteroscopically placed micro-insert device: no pregnancies were observed in patients with bilateral tube obstruction diagnosed by hysterosalpingography at 3 or at 6 months after placement (placement rate: 87-89%). (iii) SAFETY of tubal ligation, electrocoagulation, clips or rings: (a) By approach: There was no difference in the incidence of major complications between laparoscopy and minilaparotomy but there were significantly fewer minor complications with laparoscopy than with minilaparotomy. There were significantly more major complications with culdoscopy than with minilaparotomy and significantly more minor complications than with laparoscopy. (b) By operative technique: major and minor complications were significantly more common with the Pomeroy technique than with electrocoagulation; the difference could be due to the approach used. No data were available on fimbriectomy. (iv) SAFETY of a hysteroscopically placed micro-insert device: there were 11 cases of myometrial or tubal perforation among 734 patients (with device displacement into the peritoneal cavity in 3 cases).

RESULTS (MALE STERILIZATION): (i)

EFFICACY: efficacy varied from 84% to 100% depending on the approach and the mode of vas deferens obstruction. There was no significant difference in efficacy according to approach (transcutaneous or scrotal). However, no conclusion could be drawn on the comparative efficacy of the occlusion techniques used from published data. (ii)

SAFETY: the rate of postoperative complications was low, below 10% in most series. Complications were benign and only rarely necessitated surgical revision.

CONCLUSION: The advantage of sterilization methods is that they lack any permanent contraindication. They should be presented as being generally irreversible. Fimbriectomy is not recommended for female sterilization. Laparoscopy is the preferred approach. Sterilization by hysteroscopic placement of a micro-insert device should be restricted to cases presenting a risk on laparoscopy; the technique should be re-assessed in 2006. The two approaches used for male sterilization are technically similar and do not seem to differ in efficacy. The Public Health Code states that "Fallopian tube or deferens duct ligation for contraceptive purposes is not allowed in minors" and that ligation "cannot be performed unless the adult involved has given his/her informed and motivated consent, expressed after taking into consideration clear, complete information on the consequences of the procedure". A waiting period of four months must follow the moment the decision to sterilize is taken and consent is given. An informed consent form must be signed. Sterilization in young or nulliparous women should be proposed with the greatest prudence and with many reservations.