Métodos quirúrgicos en anticoncepciónMétodos quirúrgicos en anticoncepción

Dr Alfredo C ElenaDr Alfredo C Elena

QUIRURGICOS

Vasectomia

Ligadura tubaria

QUIRURGICOS

Vasectomia

Ligadura tubariaLigadura tubariaLigadura tubaria

Porcentaje de ICER que optaron por la esterilización voluntaria1

Porcentaje de ICER que optaron por la esterilización voluntaria1

16

1,8

1,20

0,1Oriente Medio/Norte de África

África del Sur

MujeresHombres

3

4,4

0,6

8

4,8

15,7

21

28,5

16

0 5 10 15 20 25 30

Mundialmente

América Latina

Este de Asia

Sur de Asia

Porcentaje

1 ICER: Individuos casados en edad reproductivaFuente: Ross 1992.

La vasectomía en EE.UU.La vasectomía en EE.UU.

• El tercer método anticonceptivo más usado

• Es utilizado por el 13% de las parejas

• El tercer método anticonceptivo más usado

• Es utilizado por el 13% de las parejas

4

• Es utilizado por el 13% de las parejas casadas en edad reproductiva

• Su uso aumenta tres veces más rápido que el uso de las píldoras anticonceptivas orales

• Es utilizado por el 13% de las parejas casadas en edad reproductiva

• Su uso aumenta tres veces más rápido que el uso de las píldoras anticonceptivas orales

Fuente: Liskin, Benoit y Blackburn 1992.

Beneficios anticonceptivos de la vasectomía

Beneficios anticonceptivos de la vasectomía

• Tasa de falla (0,1-0,15 embarazos por cada 100 mujeres durante el primer año)

• Permanente• No interfiere con el coito

• Tasa de falla (0,1-0,15 embarazos por cada 100 mujeres durante el primer año)

• Permanente• No interfiere con el coito

5

• No interfiere con el coito• Se recomienda para las parejas en que el embarazo o

la oclusión tubárica impone graves riesgos a la salud de la mujer

• El procedimiento quirúrgico es sencillo y se realiza con anestesia local

• No posee efectos secundarios a largo plazo• No modifica la función sexual (no afecta la

producción hormonal de los testículos)

• No interfiere con el coito• Se recomienda para las parejas en que el embarazo o

la oclusión tubárica impone graves riesgos a la salud de la mujer

• El procedimiento quirúrgico es sencillo y se realiza con anestesia local

• No posee efectos secundarios a largo plazo• No modifica la función sexual (no afecta la

producción hormonal de los testículos)

Vasectomía sin bisturí

• Tasa de falla:– 0,2% B 0,4%

• Complicaciones

• General < 2%

• Mortalidad < 0,001%

6

• Complicaciones– Hematoma

– Infección

– Epidídimo

0,001%

Fuente: Carignan 1995.

Vasectomía incisiva: complicaciones posteriores al

procedimiento en EE.UU.

Vasectomía incisiva: complicaciones posteriores al

procedimiento en EE.UU.

Complicación Tasa 1

8

Hematoma 1,95

Infección 3,48

1 Por cada 100 vasectomías; 65.155 casosFuente: Kendrick y varios/as autores/as 1987.

Limitaciones de la vasectomíaLimitaciones de la vasectomía

• Debe considerarse permanente (no es reversible)

• El usuario puede arrepentirse posteriormente

• Demora en la efectividad (requiere hasta 3

• Debe considerarse permanente (no es reversible)

• El usuario puede arrepentirse posteriormente

• Demora en la efectividad (requiere hasta 3

9

• Demora en la efectividad (requiere hasta 3 meses o 20 eyaculaciones)

• Riesgos y efectos secundarios propios de toda cirugía menor, especialmente cuando se utiliza anestesia general

• Demora en la efectividad (requiere hasta 3 meses o 20 eyaculaciones)

• Riesgos y efectos secundarios propios de toda cirugía menor, especialmente cuando se utiliza anestesia general

Efectos de la vasectomía en la salud reproductiva a largo plazo

Efectos de la vasectomía en la salud reproductiva a largo plazo

• Cáncer de la próstata: se informó un leve aumento en el riesgo pero los estudios más recientes no respaldan esta información

• Cáncer testicular: no se halló ninguna asociación

• Cáncer de la próstata: se informó un leve aumento en el riesgo pero los estudios más recientes no respaldan esta información

• Cáncer testicular: no se halló ninguna asociación

10

• Cáncer testicular: no se halló ninguna asociación (afirmación basada en varios estudios)

• Enfermedades cardiovasculares: no se halló ninguna asociación (afirmación basada en varios estudios)

• Transmisión del VIH: no hay información que respalde una menor tasa de transmisión

• Cáncer testicular: no se halló ninguna asociación (afirmación basada en varios estudios)

• Enfermedades cardiovasculares: no se halló ninguna asociación (afirmación basada en varios estudios)

• Transmisión del VIH: no hay información que respalde una menor tasa de transmisión

Fuente: Pollack 1993.Fuente: Pollack 1993.

Vasectomía: datos demográficos de EE.UU.

Vasectomía: datos demográficos de EE.UU.

Lugar:– El 75% se realizó en la sala de

examen de consulta externa– El 21% en centros de salud

Lugar:– El 75% se realizó en la sala de

examen de consulta externa– El 21% en centros de salud

11

– El 21% en centros de salud– El 3% en centros quirúrgicos

ambulatorios

Proveedor: – El 72% fue realizado por

urólogos/as– El 28% por médicos/as generales

– El 21% en centros de salud– El 3% en centros quirúrgicos

ambulatorios

Proveedor: – El 72% fue realizado por

urólogos/as– El 28% por médicos/as generales

Cuáles son las ténicas a utilizar?

Cuáles son las complicaciones?

Que porcentaje de las pacientes Que porcentaje de las pacientes

se arrepienten?

Es una técnica irreversible?

En 1990 En 1990 170 millones de parejas170 millones de parejas, ,

en el mundo , fueron esterilizadasen el mundo , fueron esterilizadas

138 millones138 millones ( 81%)( 81%)

correspondieron a Ligaduras Tubariascorrespondieron a Ligaduras Tubarias

J.A. Ross, "Sterilization: Past, Present, Future," Studies in Family Planning, 23:187J.A. Ross, "Sterilization: Past, Present, Future," Studies in Family Planning, 23:187--198, 1992.198, 1992.

Vías de abordajeVías de abordaje

»»LaparotomíaLaparotomía

»»VaginalVaginal»»VaginalVaginal

»»LaparoscopíaLaparoscopía

»»HisteroscopíaHisteroscopía

Características de la esterilización voluntaria

Masculina Femenina

Tasas de falla 2 ,6/1000; (menos con la vasectomía sin bisturí)

18/1000 a los 2 años 1

15

1 Tasa de falla acumulativa y general.Fuente: CREST 1996.

Causa de la falla Recanalización Recanalización

Éxito de la tasa de reversibilidad

70% o más, pero la tasa de fertidad es del 50% (20B30% si está bloqueado el epidídimo)

70B80% (en EE.UU.), menor en muchos otros países

ComplicacionesComplicacionesMuerte ( 4 c/ 100.000) CDC , 1982.Muerte ( 4 c/ 100.000) CDC , 1982.

Inmediatas :Inmediatas : Hemorragias.Hemorragias.

Infecciones.Infecciones.

Tardías : Tardías : Embarazo( 2 Embarazo( 2 -- 18 / 1000)18 / 1000)Tardías : Tardías : Embarazo( 2 Embarazo( 2 -- 18 / 1000)18 / 1000)

Embarazo Ectópico ( 7.3/ 1000)Embarazo Ectópico ( 7.3/ 1000)

Sindrome post ligadura tubaria Sindrome post ligadura tubaria

( 10 %)( 10 %)

Sangrado intermenstrualSangrado intermenstrual

Dolor pélvico crónicoDolor pélvico crónico

Transtornos sexualesTranstornos sexuales

Authors: Charles S. Carignan, MD, Sangeeta Pati, MD, Authors: Charles S. Carignan, MD, Sangeeta Pati, MD, AVSC InternationalAVSC International, , New York City. New York City.

Tubal Occlusion Failures: Implications of the Tubal Occlusion Failures: Implications of the CREST ( Collaborative Review of Sterilization) CREST ( Collaborative Review of Sterilization) Study on Reducing the Risk Study on Reducing the Risk

Encuesta a 10685 mujeres esterilizadasEncuesta a 10685 mujeres esterilizadas

Tasa acumulativa de fallos en 10 años :

18 por 1000 procedimientos18 por 1000 procedimientos

6% 6% se arrepintieron en los primeros 5 añosse arrepintieron en los primeros 5 años

Tasa acumulativa de fallos en 10 años :

18 por 1000 procedimientos18 por 1000 procedimientos

6% 6% se arrepintieron en los primeros 5 añosse arrepintieron en los primeros 5 años

http://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.htmlhttp://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.htmlhttp://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.htmlhttp://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.html

1010--year Cumulative Probability of Pregnancy Among Women Undergoing Tubal year Cumulative Probability of Pregnancy Among Women Undergoing Tubal Sterilization by Method and Age (Cumulative Probability of Pregnancy per 1000 Sterilization by Method and Age (Cumulative Probability of Pregnancy per 1000 Procedures and 95%CI*)Procedures and 95%CI*)

1010--year Cumulative Probability of Pregnancy Among Women Undergoing Tubal year Cumulative Probability of Pregnancy Among Women Undergoing Tubal Sterilization by Method and Age (Cumulative Probability of Pregnancy per 1000 Sterilization by Method and Age (Cumulative Probability of Pregnancy per 1000 Procedures and 95%CI*)Procedures and 95%CI*)

MethodMethod n n 1818--44 Yrs. 44 Yrs. 1818--27 Yrs. 27 Yrs. 2828--33 Yrs. 33 Yrs. 3434--44 Yrs. 44 Yrs.

Bipolar coagulationBipolar coagulation 22672267 24.8 (16.224.8 (16.2--33.3) 33.3) 54.3 (28.354.3 (28.3--80.4) 80.4) 21.3 (9.621.3 (9.6--33.0)33.0) 6.3 (0.16.3 (0.1--12.5) 12.5)

Unipolar coagulationUnipolar coagulation 1432 1432 7.5 (1.17.5 (1.1--13.9) 13.9) 3.7 (0.03.7 (0.0--11.1) 11.1) 15.6 (0.015.6 (0.0--31.4) 31.4) 1.8 (0.01.8 (0.0--5.3) 5.3)

Silicone rubberSilicone rubber--bandband 3329 3329 17.7 (10.117.7 (10.1--25.3) 25.3) 33.2 (10.633.2 (10.6--55.9) 55.9) 21.1 (6.421.1 (6.4--35.9) 35.9) 4.5 (0.64.5 (0.6--8.4) 8.4)

Charles S. Carignan, MD, Sangeeta Pati, MD, AVSC International, New York City.

SpringSpring--clip applicationclip application 1595 1595 36.5 (25.336.5 (25.3--47.7) 47.7) 52.1 (31.052.1 (31.0--73.3)73.3) 31.3 (15.131.3 (15.1--47.5) 47.5) 18.2 (0.018.2 (0.0--36.4) 36.4)

Interval partial salpingectomyInterval partial salpingectomy 425 425 20.1 (4.720.1 (4.7--35.6) 35.6) 9.7 (0.09.7 (0.0--28.6) 28.6) 33.5 (0.033.5 (0.0--74.3) 74.3) 18.7 (0.018.7 (0.0--39.6)39.6)

Postpartum partial salpingectomyPostpartum partial salpingectomy637 637 7.5 (2.77.5 (2.7--12.3) 12.3) 11.4 (1.611.4 (1.6--21.1)21.1) 5.6 (0.05.6 (0.0--11.9)11.9) 3.8 (0.03.8 (0.0--11.4)11.4)

All methods (N) All methods (N) 10,685 18.5 (15.110,685 18.5 (15.1--21.8)21.8)

* CI = confidence interval.* CI = confidence interval.

Adapted from The Population Council.Adapted from The Population Council.[1][1]

http://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.htmlhttp://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.htmlhttp://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.htmlhttp://www.medscape.com/Medscape/womens.health/1997/v02.n11/wh3150.carigan/wh3150.carigan.html

Tubal Occlusion Failures: Implications of the Tubal Occlusion Failures: Implications of the CREST ( Collaborative Review of Sterilization) CREST ( Collaborative Review of Sterilization) Study on Reducing the Risk Study on Reducing the Risk

»» ClipsClips 3.65 %3.65 %

»» Coagulación bipolarCoagulación bipolar 2.48 %2.48 %

»» ClipsClips 3.65 %3.65 %

»» Coagulación bipolarCoagulación bipolar 2.48 %2.48 %»» Coagulación bipolarCoagulación bipolar 2.48 %2.48 %

»» Bandas de SiliconaBandas de Silicona 1.77 %1.77 %

»» Monopolar Monopolar 0.75 %0.75 %

y Salpingectomía parcialy Salpingectomía parcial

»» Coagulación bipolarCoagulación bipolar 2.48 %2.48 %

»» Bandas de SiliconaBandas de Silicona 1.77 %1.77 %

»» Monopolar Monopolar 0.75 %0.75 %

y Salpingectomía parcialy Salpingectomía parcial

Authors: Charles S. Carignan, MD, Sangeeta Pati, MD, Authors: Charles S. Carignan, MD, Sangeeta Pati, MD, AVSC InternationalAVSC International, , New York City. New York City.

Tubal Occlusion Failures: Implications of the CRESTTubal Occlusion Failures: Implications of the CREST

( Collaborative Review of Sterilization) Study on Reducing ( Collaborative Review of Sterilization) Study on Reducing the Risk the Risk

Aumenta el riesgo en mujeres < de 30 añosAumenta el riesgo en mujeres < de 30 añosAumenta el riesgo en mujeres < de 30 añosAumenta el riesgo en mujeres < de 30 años

Embarazo ectópico : 32.9 % de las embarazadas (143 mujeres)Embarazo ectópico : 32.9 % de las embarazadas (143 mujeres)

7.3 por 10007.3 por 1000

Embarazo ectópico : 32.9 % de las embarazadas (143 mujeres)Embarazo ectópico : 32.9 % de las embarazadas (143 mujeres)

7.3 por 10007.3 por 1000

< 30 años < 30 años 31.9 x 100031.9 x 1000

> 30 años > 30 años 7.6 x 10007.6 x 1000

< 30 años < 30 años 31.9 x 100031.9 x 1000

> 30 años > 30 años 7.6 x 10007.6 x 1000

Bipolar ( 17.1 x 1000 )Bipolar ( 17.1 x 1000 )

Salpingectomía parcial ( 1.5 x 1000)Salpingectomía parcial ( 1.5 x 1000)

G.S. Grubb, "Regret After Decision to Have a Tubal Sterilization," Fertility G.S. Grubb, "Regret After Decision to Have a Tubal Sterilization," Fertility

2 al 23 % de las mujeres2 al 23 % de las mujeres

se han arrepentido en algún momento se han arrepentido en algún momento

de su esterilización de su esterilización

2 al 23 % de las mujeres2 al 23 % de las mujeres

se han arrepentido en algún momento se han arrepentido en algún momento

de su esterilización de su esterilización

G.S. Grubb, "Regret After Decision to Have a Tubal Sterilization," Fertility and Sterility, 44:248-253, 1985

W.B. Miller et al., "The Nature and Dynamics of Post-Sterilization Regret inMarried Women," Journal of Applied Social Psychology, 20:506-530, 1990

L.S.Wilcox et al., "Risk Factors for Regret After Tubal Sterilization: 5 Years of Follow-up in a Prospective Study," Fertility and Sterility, 55:927-933, 1991

L.S. Zabin et al., "A Study of Women Requesting Interval Contraceptive Sterilization Who Do and Do Not Return for Surgery," Fertility and Sterility,46:876-884, 1986.

G.S. Grubb, "Regret After Decision to Have a Tubal Sterilization," Fertility and Sterility, 44:248-253, 1985

W.B. Miller et al., "The Nature and Dynamics of Post-Sterilization Regret inMarried Women," Journal of Applied Social Psychology, 20:506-530, 1990

L.S.Wilcox et al., "Risk Factors for Regret After Tubal Sterilization: 5 Years of Follow-up in a Prospective Study," Fertility and Sterility, 55:927-933, 1991

L.S. Zabin et al., "A Study of Women Requesting Interval Contraceptive Sterilization Who Do and Do Not Return for Surgery," Fertility and Sterility,46:876-884, 1986.

Países desarrolladosPaíses desarrollados Cambio de parejaCambio de pareja

A. Henry et al., "Reversing Female Sterilization," Population Reports, A. Henry et al., "Reversing Female Sterilization," Population Reports, Series C, No. 8, 1980.Series C, No. 8, 1980.

Países en desarrolloPaíses en desarrollo Muerte de un hijoMuerte de un hijo

Poststerilization Regret: Findings From the United States Collaborative Review of SterilizationSUSAN D. HILLIS, PhD, POLLY A. MARCHBANKS, PhD, LISA RATLIFF TY LOR and HERBERT B. PETERSON, MD FOR THE U.S. COLLABORATIVE REVIEW OF STERILIZATION WORKING GRO UP From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Address reprint requests to: Susan D. Hillis, PhD DRH/NCCDPHP (K-34) Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 E-mail: seho@cdc.gov

Poststerilization Regret: Findings From the United States Collaborative Review of SterilizationSUSAN D. HILLIS, PhD, POLLY A. MARCHBANKS, PhD, LISA RATLIFF TY LOR and HERBERT B. PETERSON, MD FOR THE U.S. COLLABORATIVE REVIEW OF STERILIZATION WORKING GRO UP From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Address reprint requests to: Susan D. Hillis, PhD DRH/NCCDPHP (K-34) Centers for Disease Control and Prevention 1600 Clifton Road Atlanta, GA 30333 E-mail: seho@cdc.gov

Objective: To evaluate the cumulative probability of regret after tubal sterilization, and to identify risk factors for regret that are identifiable before sterilization.

Methods: We used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization.

Objective: To evaluate the cumulative probability of regret after tubal sterilization, and to identify risk factors for regret that are identifiable before sterilization.

Methods: We used a prospective, multicenter cohort study to evaluate the cumulative probability of regret within 14 years after tubal sterilization. cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18–44 years who had tubal sterilizations between 1978 and 1987. Actuarial life tables and Cox proportional hazards models were used to identify those groups at greatest risk of experiencing regret.

Conclusion: Although most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret during follow-up interviews within 14 years after the procedure.

cumulative probability of regret within 14 years after tubal sterilization. Participants included 11,232 women aged 18–44 years who had tubal sterilizations between 1978 and 1987. Actuarial life tables and Cox proportional hazards models were used to identify those groups at greatest risk of experiencing regret.

Conclusion: Although most women expressed no regret after tubal sterilization, women 30 years of age and younger at the time of sterilization had an increased probability of expressing regret during follow-up interviews within 14 years after the procedure.

Obstetrics & Gynecology 1999;93:889-895 © 1999 by The American College of Obstetricians and GynecologistsObstetrics & Gynecology 1999;93:889-895 © 1999 by The American College of Obstetricians and Gynecologists

Poststerilization Regret: Findings From the United States Collaborative Review of Sterilization Poststerilization Regret: Findings From the United States Collaborative Review of Sterilization

Obstetrics & Gynecology 1999;93:889-895 1999 by The American College of Obstetricians and Gynecologists

Regret After Female Sterilization Among Regret After Female Sterilization Among LowLow--Income Women in Sao Paulo, BrazilIncome Women in Sao Paulo, Brazil

no85%

Elisabeth Meloni Vieira and Nicholas John Ford Elisabeth Meloni Vieira and Nicholas John Ford International Family Planning Perspectives 22 (1), Mar. 1996International Family Planning Perspectives 22 (1), Mar. 1996

Esterilizadas15%

N=3149N=3149

407407

Regret After Female Sterilization Among Regret After Female Sterilization Among LowLow--Income Women in Sao Paulo, BrazilIncome Women in Sao Paulo, BrazilRegret After Female Sterilization Among Regret After Female Sterilization Among LowLow--Income Women in Sao Paulo, BrazilIncome Women in Sao Paulo, Brazil

88 %88 % la ligadura se realizó post partola ligadura se realizó post parto

77 %77 % durante la cesáreadurante la cesárea

20 %20 % fue medicamente necesáreafue medicamente necesárea

Elisabeth Meloni Vieira and Nicholas John Ford Elisabeth Meloni Vieira and Nicholas John Ford International Family Planning Perspectives 22 (1), Mar. 1996International Family Planning Perspectives 22 (1), Mar. 1996

20 %20 % fue medicamente necesáreafue medicamente necesárea

73 %73 % lo solicitó la paciente.lo solicitó la paciente.

19 %19 % fue específicamente aconsejado por el médico.fue específicamente aconsejado por el médico.

6 %6 % el médico lo ofreció como una opción más.el médico lo ofreció como una opción más.

1 %1 % fueron esterilizadas sin su consentimiento.fueron esterilizadas sin su consentimiento.

Regret After Female Sterilization Among Regret After Female Sterilization Among LowLow--Income Women in Sao Paulo, BrazilIncome Women in Sao Paulo, BrazilRegret After Female Sterilization Among Regret After Female Sterilization Among LowLow--Income Women in Sao Paulo, BrazilIncome Women in Sao Paulo, Brazil

17 %17 % lamenta haberse ligadolamenta haberse ligado.

12 %12 % actualmente arrepentida.actualmente arrepentida.

8 %8 % lo lamentó en el pasado.lo lamentó en el pasado.

Elisabeth Meloni Vieira and Nicholas John Ford Elisabeth Meloni Vieira and Nicholas John Ford International Family Planning Perspectives 22 (1), Mar. 1996International Family Planning Perspectives 22 (1), Mar. 1996

21 %21 % hubiera deseado esterilizarse más tardíamente .hubiera deseado esterilizarse más tardíamente .

15 %15 % no tomarían la misma decisión.no tomarían la misma decisión.33 %33 % desean otro hijodesean otro hijo

18 %18 % Sindrome post ligadura tubaria.Sindrome post ligadura tubaria.

EntrevistaEntrevista

Consulta en pareja.Consulta en pareja.

Evaluación del status psicológicoEvaluación del status psicológico

Evaluar motivos de la LigaduraEvaluar motivos de la Ligadura

Asesorar sobre métodos anticonceptivos alternativosAsesorar sobre métodos anticonceptivos alternativosAsesorar sobre métodos anticonceptivos alternativosAsesorar sobre métodos anticonceptivos alternativos

Informar sobre : Informar sobre : 11--Técnica quirúrgica a realizarTécnica quirúrgica a realizar

22--MomentoMomento

33--ComplicacionesComplicaciones

44--Posiblidad de reversibilidad Posiblidad de reversibilidad

Fertility outcomes following laparoscopic tubal Fertility outcomes following laparoscopic tubal

rere--anastomosis post tubal sterilisationanastomosis post tubal sterilisation . .

Aust N Z J Obstet Gynaecol 2002 Aug;42(3):256-8 (ISSN: 0004-8666)Kaloo P; Cooper M. Department of Obstetrics and Gynaecology, University of New South Wales, Sydney, Australia.

OBJECTIVE: To determine fertility outcomes followin g laparoscopic tubal re-anastomosis. DESIGN: Retrospective mail fo llow-up. SETTING: Specialised private gynaecological endosco py practice.

POPULATION OR SAMPLE: 19 women who underwent laparoscopic 19 women who underwent laparoscopic

Fertility outcomes following laparoscopic tubal Fertility outcomes following laparoscopic tubal

rere--anastomosis post tubal sterilisationanastomosis post tubal sterilisation . .

Aust N Z J Obstet Gynaecol 2002 Aug;42(3):256-8 (ISSN: 0004-8666)Kaloo P; Cooper M. Department of Obstetrics and Gynaecology, University of New South Wales, Sydney, Australia.

OBJECTIVE: To determine fertility outcomes followin g laparoscopic tubal re-anastomosis. DESIGN: Retrospective mail fo llow-up. SETTING: Specialised private gynaecological endosco py practice.

POPULATION OR SAMPLE: 19 women who underwent laparoscopic 19 women who underwent laparoscopic POPULATION OR SAMPLE: 19 women who underwent laparoscopic 19 women who underwent laparoscopic tubal reanastomosis following tubal sterilisation.tubal reanastomosis following tubal sterilisation.

MAIN OUTCOME MEASURES: Pregnancy rate and 'take hom e baby' rate. RESULTS: 15 (78.9%) of women became pregnant , and 13 (68.4%) carried pregnancies to viability. The mean operatin g time was 115 minutes (range 90-200 minutes). The mean reversal t o pregnancy interval was 8.3 months (1-24 months). CONCLUSIONS: This study suggests that the pregnancy and 'take home baby' ra tes after laparoscopic reversal of tubal sterilisation compar e favourably with open microsurgical reversal and in vitro fertilisat ion.

POPULATION OR SAMPLE: 19 women who underwent laparoscopic 19 women who underwent laparoscopic tubal reanastomosis following tubal sterilisation.tubal reanastomosis following tubal sterilisation.

MAIN OUTCOME MEASURES: Pregnancy rate and 'take hom e baby' rate. RESULTS: 15 (78.9%) of women became pregnant , and 13 (68.4%) carried pregnancies to viability. The mean operatin g time was 115 minutes (range 90-200 minutes). The mean reversal t o pregnancy interval was 8.3 months (1-24 months). CONCLUSIONS: This study suggests that the pregnancy and 'take home baby' ra tes after laparoscopic reversal of tubal sterilisation compar e favourably with open microsurgical reversal and in vitro fertilisat ion.

Experience of reversal of sterilisation at Glasgow Royal Infirmary.Experience of reversal of sterilisation at Glasgow Royal Infirmary. J Fam Plann Reprod Health Care 2003 Jan;29(1):32-3 (IS SN: 1471-1893)Prabha S; Burnett Lunan C; Hill R. Department of Obstetric s and Gynaecology, Glasgow Royal Infirmary, Glasgow, UK.

OBJECTIVE: To review experience at the Glasgow Roya l Infirmary with regard to women who underwent reversal of sterilisa tion, to obtain a profile of these women and to evaluate the procedur e itself in terms of safety and restoration of fertility.

Experience of reversal of sterilisation at Glasgow Royal Infirmary.Experience of reversal of sterilisation at Glasgow Royal Infirmary. J Fam Plann Reprod Health Care 2003 Jan;29(1):32-3 (IS SN: 1471-1893)Prabha S; Burnett Lunan C; Hill R. Department of Obstetric s and Gynaecology, Glasgow Royal Infirmary, Glasgow, UK.

OBJECTIVE: To review experience at the Glasgow Roya l Infirmary with regard to women who underwent reversal of sterilisa tion, to obtain a profile of these women and to evaluate the procedur e itself in terms of safety and restoration of fertility. safety and restoration of fertility. DESIGN: A retrospective study based on case records from the Glasgow Royal Infirmary and from the Glasgow Royal Maternity Hospit. PARTICIPANTS: Eighty-five women underwent reversal of sterilisation between 1/1/1994 and 31/12/1998 at the Glasgow Roya l. Follow-up at the Glasgow Royal Maternity identified 43/85 women.

safety and restoration of fertility. DESIGN: A retrospective study based on case records from the Glasgow Royal Infirmary and from the Glasgow Royal Maternity Hospit. PARTICIPANTS: Eighty-five women underwent reversal of sterilisation between 1/1/1994 and 31/12/1998 at the Glasgow Roya l. Follow-up at the Glasgow Royal Maternity identified 43/85 women.

Experience of reversal of sterilisation at Glasgow Royal Infirmary.Experience of reversal of sterilisation at Glasgow Royal Infirmary. J Fam Plann Reprod Health Care 2003 Jan;29(1):32-3 (IS SN: 1471-1893)Prabha S; Burnett Lunan C; Hill R. Department of Obstetric s and Gynaecology, Glasgow Royal Infirmary, Glasgow, UK.

RESULTS: Having a new partner was responsible for 90% of requests . Median age for reversal was 34 years and most had been sterilised before the age of 30 years. There were f ew postoperative

Experience of reversal of sterilisation at Glasgow Royal Infirmary.Experience of reversal of sterilisation at Glasgow Royal Infirmary. J Fam Plann Reprod Health Care 2003 Jan;29(1):32-3 (IS SN: 1471-1893)Prabha S; Burnett Lunan C; Hill R. Department of Obstetric s and Gynaecology, Glasgow Royal Infirmary, Glasgow, UK.

RESULTS: Having a new partner was responsible for 90% of requests . Median age for reversal was 34 years and most had been sterilised before the age of 30 years. There were f ew postoperative sterilised before the age of 30 years. There were f ew postoperative complications. Pregnancy occurred in at least 43% o f women. CONCLUSION: Reversal of sterilisation is a safe and effective method of restoring fertility. The actual incidence of pregnancy after reversal is likely to be higher than the 43.5% recorded due to difficulties in achieving 100% follow-up.

sterilised before the age of 30 years. There were f ew postoperative complications. Pregnancy occurred in at least 43% o f women. CONCLUSION: Reversal of sterilisation is a safe and effective method of restoring fertility. The actual incidence of pregnancy after reversal is likely to be higher than the 43.5% recorded due to difficulties in achieving 100% follow-up.

Vasectomy reversal performed 15 years or more after vasectomy: Vasectomy reversal performed 15 years or more after vasectomy: correlation of pregnancy outcome with partner age a nd with pregnancy correlation of pregnancy outcome with partner age a nd with pregnancy results of in vitro fertilization with intracytoplas mic sperm injection.results of in vitro fertilization with intracytoplas mic sperm injection.Fertil Steril 2002 Mar;77(3):516-9 (ISSN: 0015-0282) Fuchs EF; Burt RA Division of Urology, Department of Surgery, The Ore gon Health and Science University, Portland, Oregon 97201, USA.

RESULT(S): Pregnancy rates for the intervals of 15-19 years, 2 0-25 years, and >25 years after vasectomy were 49%, 39%, and 25 %, respectively. For spousal age <30 years, 30 --35 years, 36 -40 years, and >40 years,

Vasectomy reversal performed 15 years or more after vasectomy: Vasectomy reversal performed 15 years or more after vasectomy: correlation of pregnancy outcome with partner age a nd with pregnancy correlation of pregnancy outcome with partner age a nd with pregnancy results of in vitro fertilization with intracytoplas mic sperm injection.results of in vitro fertilization with intracytoplas mic sperm injection.Fertil Steril 2002 Mar;77(3):516-9 (ISSN: 0015-0282) Fuchs EF; Burt RA Division of Urology, Department of Surgery, The Ore gon Health and Science University, Portland, Oregon 97201, USA.

RESULT(S): Pregnancy rates for the intervals of 15-19 years, 2 0-25 years, and >25 years after vasectomy were 49%, 39%, and 25 %, respectively. For spousal age <30 years, 30 --35 years, 36 -40 years, and >40 years, spousal age <30 years, 30 --35 years, 36 -40 years, and >40 years, pregnancy rates were 64%, 49%, 32%, and 28%, respec tively. The overall The overall pregnancy rate was 43%, which is similar to the pre gnancy rate of 40% for pregnancy rate was 43%, which is similar to the pre gnancy rate of 40% for ICSI in obstructive azoospermiaICSI in obstructive azoospermia . Sixty-two percent of the men required a unilateral or bilateral epididymovasostomy. CONCLUS ION(S): Spousal age is an important predictive factor after vasectomy r eversal among men who have reversal 15 years or more after vasectomy. Pre gnancy rates after vasectomy reversal compare favorably with those obt ained with ICSI.

spousal age <30 years, 30 --35 years, 36 -40 years, and >40 years, pregnancy rates were 64%, 49%, 32%, and 28%, respec tively. The overall The overall pregnancy rate was 43%, which is similar to the pre gnancy rate of 40% for pregnancy rate was 43%, which is similar to the pre gnancy rate of 40% for ICSI in obstructive azoospermiaICSI in obstructive azoospermia . Sixty-two percent of the men required a unilateral or bilateral epididymovasostomy. CONCLUS ION(S): Spousal age is an important predictive factor after vasectomy r eversal among men who have reversal 15 years or more after vasectomy. Pre gnancy rates after vasectomy reversal compare favorably with those obt ained with ICSI.

Esterilizaciones tubarias por oficio JudicialEsterilizaciones tubarias por oficio Judicial

Desde Agosto de 1991 a Agosto de 2006Desde Agosto de 1991 a Agosto de 2006Desde Agosto de 1991 a Agosto de 2006

838 procedimientos

Desde Agosto de 1991 a Agosto de 2006

838 procedimientos

Autorizaciones judiciales (1/09/05 – 30/8/06)

LT 124 (2.6 %)

Autorizaciones judiciales (1/09/05 – 30/8/06)

LT 124 (2.6 %)

Ley (1/09/06 – 1/09/07)

Partos 4602

LT 441 (9.6%)

Ley (1/09/06 – 1/09/07)

Partos 4602

LT 441 (9.6%)

EDADEDAD

• 10 – 14 0• 15 – 19 1 (0.2%)• 20 -24 49 (11%)

• 10 – 14 0• 15 – 19 1 (0.2%)• 20 -24 49 (11%)

•• 25 25 –– 2929 110 (34%)110 (34%)•• 30 30 –– 3434 149 (34%)149 (34%)• 35 – 39 100 (22.7%)• 40 – 44 29(6.6)• 45 – 49 3 (0.7%)

•• 25 25 –– 2929 110 (34%)110 (34%)•• 30 30 –– 3434 149 (34%)149 (34%)• 35 – 39 100 (22.7%)• 40 – 44 29(6.6)• 45 – 49 3 (0.7%)

Gracias !!Gracias !!