Reproductive Health (Jul 2021)
Comparing options for females seeking permanent contraception in high resource countries: a systematic review
Abstract
Plain Language Summary There are multiple options available to help people end their fertility: each option with accompanying benefits and risks. A comprehensive comparison of the benefits and risks of available options is important to support informed decision-making. We aimed to understand the comparability of laparoscopic tubal ligation, hysteroscopic tubal occlusion, bilateral salpingectomy, and a long-acting reversible contraceptive, the levonorgestrel-releasing intrauterine contraception (LNG-IUC), among females seeking permanent contraception in high resource countries. We followed PRISMA guidelines for conducting systematic reviews. We assessed for risk of bias using the Newcastle–Ottawa scale, to ensure that we were including high-quality studies. We found high variability between the included articles, so we performed a narrative synthesis. We identified 6612 articles and reviewed the full text of 154, of which 34 met our inclusion criteria. We further excluded 10 studies due to high risk of bias and included 24 articles in our synthesis. Most compared hysteroscopic tubal occlusion and/or laparoscopic tubal ligation. No included studies compared LNG-IUC to other methods. Most comparisons reported effectiveness and adverse events, with fewer reporting tolerability, patient recovery time, non-contraceptive benefits, and costs to the healthcare system. We found inconclusive evidence comparing the effectiveness of hysteroscopic tubal occlusion to laparoscopic tubal ligation. All options reported adverse events, and all forms of tubal interruption reported a protective effect against cancers. There is insufficient research directly comparing surgical forms of permanent contraception, such as tubal ligation or removal, with alternative options, such as intrauterine contraception. High-quality studies are needed to support informed decision-making.
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