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Tubal Ligation No Better Than IUD at Preventing Pregnancy

  1. A new study has shown that IUDs are less effective than tubal ligation and have fewer side effects.The analysis was based on six years worth of Medi-Cal claims data. It is the first comprehensive look at the performance of long-term birthcontrol methods in real life.

    The study disproves the widespread belief that tubal ligation (which requires permanent surgery) is more effective than IUDs, which can be removed easily when pregnancy is desired.

    Published February 22, 2022 in the Journal of General Internal Medicine The study showed that hormonal IUDs are more effective at preventing pregnancies than tubal ligation, and copper IUDs are equally effective.

    Eleanor Bimla Black, MD, is a professor of Medicine at UC San Francisco, and chief of the Division of General Internal Medicine of Zuckerberg San Francisco General Hospital. “Tubal ligation has really not been the gold standard for pregnant prevention.”

    To find out how many women became pregnant in a year, researchers looked at claims data from over 83,000 Medi-Cal recipients who had either a tubal or IUD ligation between 2008 and 2014. The researchers found that 2.40 percent of patients who had levonorgestrel IUDs were pregnant and 2.99 percent with copper IUDs. This compares to 2.64 percent for those who underwent laparoscopic tubeal ligations.

    Schwarz stated that although women are told there is a one-in-1,000 chance of getting pregnant with contraceptives, we found significantly higher rates. “This real-world data span is very important for clinical decision making span

    A study found that IUD-treated women were less likely than others to develop complications or get infected.

    Tubal Ligation is permanent. It is difficult to regret after these procedures, especially when there is limited coverage for infertility treatment, such as Medicaid clients.


    Researchers were surprised by the high failure rate of tubal ligations as well as the presence of persistent pelvic pain. They conducted the study after being urged by their patient advisory group. Patient-Centered Outcomes Research Institute, which is a nonprofit organization that seeks input from patients, funded the study.

    Schwarz stated that “Our stakeholders wanted the following: When women use permanent contraceptive methods, how safe and efficient are they?” “That question evolved into a more general one: How do these surgical procedures compare with long-acting contraceptives like IUDs span>

    These were good questions and Schwarz advised that both patients and providers should pay attention to the answers.

    “Tubal-ligation is permanent,” Schwarz stated. “Regrets following these procedures can be hard, especially when coverage for infertility treatment, such as Medicaid, is limited.”

    IUDs offer at least the same level protection against unintended pregnancy than these surgical procedures. Schwarz stated that patients should be encouraged to test an IUD before undergoing a permanent procedure.

    Authors. The first author, Schwarz, was joined by Melanie S. DOVE and Carrie A. Lewis, MPH. Eryn MURPHY and Daniel J. Tancredi, PhD. of UC Davis. Diana Zuckerman, PhD. and Claudia Nunez Eddy, MS. of National Center for Health Research. Raegan McMosley, MD., MPH. of Planned Parenthood of Maryland. Sarita Sonalkar MD. MPH. of University of Pennsylvania.

    Funding: Patient-Centered Outcomes Research Institute(r) (PCORI) Award 1609-36359.

    Disclosures: None.

    University of California, San Francisco (UCSF), is a university that is solely focused on health sciences. It is committed to promoting global health through biomedical research, graduate education in life sciences and health professions, as well as excellence in patient care. UCSF Health is the primary academic medical center of UCSF. It includes top-ranked special hospitals and other clinical programs and has affiliations all over the Bay Area.

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