Male and Female Sterilisation FSRH Sep 2014

Question 1

failure rate of tubal occlusion by intra-fallopian micro-insert

Answer 1

1 in 500 at 5 years of follow-up

this includes cases
- where luteal-phase pregnancy (- ve pregnancy test at time of sterilization doesn’t exclude)
- non-adherence with post-procedural instructions was
documented.

Question 2

contraindication of Hysteroscopic sterilisation with micro-inserts

Answer 2

-documented proven patch test for nickel allergy

Question 3

• If tubal occlusion performed at same time as a caesarean section, counselling and agreement should be given how much in advance of procedure.

Answer 3

at least 2 weeks in advance of the procedure.

Question 4

Clinicians should modify their technique if their overall failure attributable to

• technical failure,
• recanalisation and
• non-compliance with additional contraception is how much?

Answer 4

more than 1%.

Question 5

Optimal timing to schedule the first PVSA.

Answer 5

12 weeks post-vasectomy (Postal sample acceptable if Royal Mail standards are met)

Question 6

In which cases special clearance given to cease using additional contraception

Answer 6

• when less than 100 000 non-motile sperm/ml are observed in a fresh semen sample post-vasectomy.
  (In a small proportion of men non-motile sperm will persist following vasectomy.)

Question 7

When the vasectomy should be considered a failure.

Answer 7

If motile sperm are observed in a fresh sample 7 months post-procedure,

Question 8

If more than 100 000 non-motile sperm/ml are observed in a fresh sample 7 months after vasectomy,

Answer 8

clinical judgement and/or local protocols may be used to determine whether or not the procedure should be deemed a failure.

Question 9

failure rate of vasectomy has an associated

Answer 9

approximately 1 in 2000 (0.05%) after clearance has been given. several years

Question 10

lifetime risk of laparoscopic tubal occlusion failure, using a mix of occlusion methods,

Answer 10

1 in 200.

Question 11

failure rate of Filshie clip, at 10 years.

Answer 11

2–3 per 1000 procedures at 10 years.

Question 12

Incidence of unsuccessful placement of intra-fallopian implants is reported as ranging, following up to two attempts in an outpatient setting.

Answer 12

between 0% and 19%

Question 13

When & how confirmatory imaging test should be undertaken after the insertion of intra-fallopian micro-inserts.

Answer 13

• 3 months
• X-ray or TVUSS in first instance, followed by HSG in selected patients where X-ray or TVUSS cannot confirm satisfactory placement.