Recommendations for Contraceptive Use
		Female Sterilization

Recommendations	Rationale
a) The factor most strongly associated with regret is young age. b) Other factors which may increase regret are changes in marital status or partners, the death of a child, low parity, decision made by partner, sterilization for medical reasons, post-cesarean section sterilization and perhaps, postpartum sterilization. However, the incidence of regret even with these factors remains low. Counseling is important to minimize the incidence of regret.	a-b) Age at time of sterilization has been found to be a risk factor for regret in both women and men. A large prospective study of U.S. women followed-up for five years found that women less than 30 years of age at sterilization were two to three times more likely to report regret than those sterilized between 30 and 35 years of age. This effect was independent of number of living children or marital status at the time of sterilization. Young age has also been found to be a major factor in other U.S. studies and in studies of women in Canada and Puerto Rico. Wilcox LS, Chu SY, Eaker ED, Zeger SL, Peterson HB. Risk factors for regret after tubal sterilization: 5 years of follow-up in a prospective study. Fertility and Sterility 1991;55:927-33. Henshaw SK, Singh S. Sterilization regret among U.S. couples. Family Planning Perspectives 1986;18:238-40. Marcil-Gratton N. Sterilization regret among women in metropolitan Montreal. Family Planning Perspectives 1988;20:222-7. Boring CC, Rochat RW, Becerra J. Sterilization regret among Puerto Rican women. Fertility and Sterility 1988;49:973-81. Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of pregnancy after tubal sterilization: findings from the U.S. collaborative review of sterilization. American Journal of Obstetrics and Gynecology 1996; 174:1161-70.
	a-b) Parity has often been discussed as a risk factor for regret in women. Several major studies have not found parity to be a significant predictor of regret. However, some experts suspect that parity may still be an important predictor of regret in some cultures. Timing of procedure has also been reported as a possible risk factor for regret in women. Clients who underwent each type of postpartum procedure have been compared to interval clients in a range of studies. An increase in regret in women who had female sterilization concurrent with cesarean section was found in some studies when compared to a group having interval procedures. Likewise, women who had a vaginal delivery followed by postpartum sterilization had an increased incidence of regret in some data sets, but not in others. Pitaktepsombati P, Janowitz B. Sterilization acceptance and regret in Thailand. Contraception 1991;44:623-37. Leader A, Galan N, George R, Taylor P. A comparison of definable traits in women requesting reversal of sterilization and women satisfied with sterilization. American Journal of Obstetrics and Gynecology 1983;145:198-202. Wilcox LS, Chu SY, Eaker ED, Zeger SL, Peterson HB. Risk factors for regret after tubal sterilization: 5 years of follow-up in a prospective study. Fertility and Sterility 1991;55:927-33. Boring CC, Rochat RW, Becerra J. Sterilization regret among Puerto Rican women. Fertility and Sterility 1988;49:973-81. Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of pregnancy after tubal sterilization: findings from the U.S. collaborative review of sterilization. American Journal of Obstetrics and Gynecology 1996;174:1161-70.

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