Risk factors for strong regret and subsequent IVF request after tubal sterilisation

Abstract

A case control study was done to examine presterilisation characteristics most consistently associated with strong poststerilisation regret and subsequent request for IVF. The case group was made up of 97 previously sterilised women evaluated for IVF treatment at the Fertility Clinic or Royal North Shore Hospital in Sydney during the period 1980-1992. A Control group of 101 women apparently satisfied with their tuballigation was found from the medical records of one gynaecologist at Royal North Shore Hospital. Of the characteristics that could be objectively determined preoperatively only age, number of living children, timing of sterilisation and marital status were significantly associated with IVF request in the univariate analysis. These characteristics were, then, examined multivariately by means of logistic regression. Age at the time of sterilisation had the most pronounced effect on strong regret. Women who were younger than 30 years old at the time of sterilisation had up to 8.7 times the risk of request for IVF treatment as women 30 to 34 years old. A concurrent caesarean section was associated with a threefold risk relative to an interval procedure, but there was no significant effect associated with sterilisation performed after vaginal delivery or abortion. A strong protective effect (OR=0.07) was found for women with more than 2 children compared to childless women. There was no longer a significant effect of marital status in the multivariate analysis. Other factors not significantly associated with the request for IVF included history of abortion, education, race, the principal method of contraception used before sterilisation, and medical indications for sterilisation. The overwhelming reasons stated by women for requesting IVF were change in marital status, either remarriage or the establishment of a new de facto relationship, and the desire to have a child with the new partner.