Tubo-Tubal Anastomosis Versus In Vitro Fertilization in the Management of Iatrogenic Infertility

Abstract

In the last two decades, tubal sterilization has been used increasingly as a mode of contraception. This increase has resulted from changing social attitudes and the development of simpler tubal sterilization techniques, especially via laparoscopy. In North America, more than 800,000 tubal sterilizations are carried out each year.¹ This has led to a parallel increase in the demand for restoration of fertility. The most common cause for this request is change in marital union (61%).² This is not surprising in a mobile society with a high divorce rate such as ours; and considering further than sterilization procedures are frequently performed at a young reproductive age, in the midst of marital discord, during separation, or soon after divorce. The next two largest groups comprise women who desire more children and those who have experienced the loss of a child, usually during the first few months of life (Table l).³ In our study, women in these two groups were all in the same marital union, and were all sterilized during the puerperal period or soon after. These observations define a “risk population” with regard to tubal sterilization that include women in early reproductive years, those in an unstable marital union or in transitional or stress situtions such as separation, divorce and the puerperal or postabortal periods.^3–5