New mothers choose "tied tubes" over IUDs: study

NEW YORK Fri Aug 26, 2011 7:06pm EDT

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NEW YORK (Reuters Health) - Very few women choose to get an intrauterine device (IUD) inserted soon after giving birth, even though it's one of the most effective methods of long-term contraception, according to a new study. Instead, the research showed, many opt for tubal sterilization -- usually a permanent closure of the fallopian tubes -- including young women who may go on to regret the surgery.

"I think it's important to realize that the two methods work equally well, but (IUDs) have the added benefit of being entirely reversible," said Dr. Eleanor Schwarz, who studies contraception at the University of Pittsburgh but was not involved in the new study.

"Generally in all settings in my mind, it makes sense to prefer an IUD over a surgical procedure," she told Reuters Health.

There are two different types of IUDs available in the United States: one made out of copper (sold under the name ParaGard), and Mirena, which releases the contraceptive hormone levonorgestrel. IUDs are inserted into the uterus, where they can prevent pregnancy for up to five or 10 years.

But if a woman changes her mind and does want to become pregnant, she or her doctor can remove the device. In some cases, tubal ligation -- which blocks eggs from leaving the fallopian tubes -- can also be reversed, or women can use in vitro fertilization to get pregnant again.

But those options can be invasive and expensive. For the current study, researchers from the Centers for Disease Control and Prevention (CDC) in Atlanta used information from a nationwide database on inpatient stays at about 1,000 different hospitals.

The database includes information on patients, their diagnoses, and any surgeries they had. Led by Maura Whiteman, the team collected data for all women who were admitted to have a baby, then checked how many of the new moms were given an IUD or had tubal sterilization surgery as part of the same hospital stay.

Women who don't want to become pregnant again need some form of temporary or permanent contraception starting just a few weeks after giving birth.

Some choose to get an IUD or sterilization surgery while they're already in the hospital with access to the right doctors.

Between 2001 and 2008, women had an IUD inserted shortly after giving birth in one in every 37,000 deliveries, researchers reported in the American Journal of Obstetrics and Gynecology.

Tubal sterilizations, on the other hand, were done after one in every 13 deliveries.

"Sterilization is an excellent option for appropriate candidates who are confident in their choice for permanent contraception," Whiteman told Reuters Health.

But, researchers said, the new data suggest the surgeries may be done too often in comparison to IUD insertion, especially in some groups of women.

For example, about 15 percent of all women who had tubal sterilization were younger than 25. That's a group that often regrets the decision to get sterilized -- for example, if women break up with their current partner and later want to have kids with a new partner, said James Trussell, a Princeton University researcher specializing in contraception and cost-effectiveness.

"The only advantage to tubal sterilization is that it lasts forever," Trussell, who was not involved in the new research, told Reuters Health.

"For some women that turns out to be a disadvantage." There's also the difference in expense. IUDs cost $600 to $900 for insertion, but are virtually free after that.

Sterilization typically runs a few thousand dollars. Both are often covered by insurance.

With the IUD, "we have something that offers essentially no downsides," Schwarz said.

A lot of women just don't know IUDs are an option, researchers pointed out, and some doctors are still concerned about the risk of infection with IUDs -- which is not a problem with current models, they added.

Whiteman concluded that, "In general, pregnant women and their healthcare providers should be encouraged to discuss options for postpartum contraception," including the IUD.

SOURCE: bit.ly/nTzQEa American Journal of Obstetrics and Gynecology, online August 11, 2011.

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