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Other transcervical methods are in the development stages but are not expected to be available any time soon. One method, transcervical insertion of quinacrine pellets, is somewhat controversial because it was used to sterilize approximately 30,000 women in Vietnam without adequate clinical testing and evaluation. This method also has wide variations in pregnancy rates, and needs further evaluation before phase III clinical trials can begin.
Currently, Family Health International is sponsoring research on the use of the antibiotic Erythromycin as a method of transcervical sterilization. Two other potential methods include a disposable Intratubal Ligation Device (ILD) and the Adiana Procedure, which uses bipolar radiofrequency to create a superficial lesion into which a porous nonbiogradeable implant is then inserted.
"Transcervical sterilization is a revolutionary and highly effective method of permanent birth control which, because of its non-invasiveness and its ability to be performed under local anesthesia, dramatically changes the risk/reward ratio for the patient,” Dr. Cooper says. “We expect this technology to be embraced by both physicians and patients because of the advantages it offers, as compared to more traditional types of female sterilization."
How often do women regret sterilization? When making the decision to choose sterilization rather than reversible methods of contraception, women must be certain that they are comfortable with the probability of never having any more children. "Making a decision of this magnitude needs to be done carefully and thoughtfully," says Dr. Vanessa Cullins of Planned Parenthood, who points out that although some of these methods can potentially be reversed, or pregnancy might be able to achieved through In Vitro Fertilization (IVF), it is important to consider them as methods which are intended to be permanent.
"To avoid the possibility of post-sterilization regret, adequate counseling is very important for any women making this life-changing decision," says Phyllis Greenberger, M.S.W., president and CEO of the Society for Women's Health Research. Women considering the idea of sterilization need to discuss the present and future ramifications with their partner (if they are involved in a committed relationship) and to explore all the possibilities — would they regret their inability to bear any more children if one of their children died, or if through divorce or death their circumstances changed and they became involved with someone new who wanted to have children? These are painful questions which need to be asked and answered before a decision can be made, Greenberger urges.
The U.S. Collaborative Review of Sterilization (CREST) Study, conducted by the Centers for Disease Control and Prevention, collected data on sterilization procedures performed between 1978 and 1987 at 16 of the nation’s hospitals. To determine the incidence of post-sterilization regret, women were interviewed yearly for the first five years after the procedure was conducted, with one final follow-up interview conducted 8-14 years after sterilization. Patients were asked, "Do you still think tubal sterilization as a permanent method of birth control was a good choice for you?"
Of the more than 7,000 women interviewed annually for up to five years post-procedure, about 6 percent of them expressed regret or sought reversal. Overall CREST findings indicate that the probability of expressing regret within 14 years was 20.3 percent for women age 30 or younger at the time of sterilization, and 5.9 percent for women who were older than 30 when the procedure was done. On the basis of the study results, the majority of women (80 percent) are satisfied with their decision to undergo sterilization. Regret was highest at 14 years for African American women, women whose procedures were performed either postpartum or within one year of the birth of their youngest child, for those who were age 30 or younger, and for those who were unmarried at the time of sterilization.
