• Clinical and Experimental Reproductive Medicine
• /
• v.10 no.2
• /
• pp.13-23
• /
• 1983

In recent days, family planning is not only a problem limitted to our country but an important problem for the while world to solve. Up to present, various methods of sterilization have been developed for population control. When a patient with a previous tubal sterilization by operative method develops any symptoms and signs of pregnancy, we strongly consider it ectopic pregnancy and intrauterine pregnancy. As the cause of sterilization failure, we think that the tubal loop sloughs away and tubal ends either unite and recanalization results or heal and failure of union results in fistula. This present study considered of the 34 cases of ectopic pregnancies and 2 cases of intrauterine pregnancies after tubal sterilization by laparoscopy and Pomeroy's method, at the Dept. of Gynecol. in Kyung Hee University Hospital, during 6 years from Jan. 1977 to Dec. 1982. Authors take result in this study retrospectively. 1. Mean age was 33.7 years for the laparoscopic tubal sterilization group, 31.5 years for the Pomeroy tubal sterilization group. 2. The number of mean gravida and parity at the sterilization was 4.9, 2.8 for the laparoscopic tubal sterilization group, 4.2, 2.2 for the Pomeroy tubal sterilization group, :respectively. 3. The number of mean artificial abortion at the sterilization was all 2.2 for the laparoscopic and Pomeroy tubal sterilization groups. 4. Mean intervals from the tubal surgery to the incidental pregnancy was 3.2 years for the laparoscopic tubal sterilization group, and 3.8 years for the Pomeroy tubal sterilization group. 5. 63.3% of the laparoscopic tubal sterilization group had problem of inadequate tubal ligation, in comparison to having no inadequate problem in the Pomeroy tubal sterilization group. 6. The previous tubal sterilized scar was found to be 6 cases (17.6%) of inner portion, 15 cases (44.4%) of midportion, 13 cases (38.2%) of outer portion at the time of operation. The tubal site of ectopic pregnancy was found to be 23 cases (67.6%) of ampullary portion,S cases ( 4.7%) of isthmic and fimbrial portion, respectively. 7. The causes of table sterilization failure were, in order of frequency, technical error (19 cases), fistula formation (6 cases) and recanalization (5 cases) for the laparoscopic tubal sterilization group and fistula formation (2 cases), technical error (l case), recanalization (l case) fo the Pomeroy tubal sterilization group. 8. As the new applicated contraceptive method in incidental pregnant patient, Authors used 2 gravigard insertion for the two intrauterine pregnancy and 34 Pomeroys' tubal ligation, 2 total abdominal hysterectomy (due to associated pelvic inflammatory disease) for the 36 tubal pregnancy.

• Clinical and Experimental Reproductive Medicine
• /
• v.25 no.3
• /
• pp.341-348
• /
• 1998

Objective: To determine the reproductive outcomes of women undergoing microsurgical reversal of tubal sterilization at age 36 years or older. Materials and Methods: A series of 133 patients who received microsurgical reversal of the previously sterilized fallopian tubes at Seoul National University Hospital from July, 1980 to January, 1992 was reviewed and evaluated for clinical characteristics, pregnancy rates, and factors influencing the outcome of tubal reversal. Results: Of 133 patients, 78 (58.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading cause for tubal reversal. The mean interval from tubal sterilization to tubal reversal was 65.0 months. The overall pregnancy rate was 52.6% (70/133), and the mean interval was 9.4 months from tubal reversal to pregnancy. Excluding 7 patients who were lost to follow-up, 76 pregnancies were confirmed in 63 patients with the delivery rate per patient of 66.7% (42/63). There were no significant differences in age, duration of tubal sterilization, postoperative tubal length between pregnant and non-pregnant groups. Conclusions: Microsurgical reversal of tubal sterilization could be a justifiable method in women 36 years age or older.

• Research in Community and Public Health Nursing
• /
• v.7 no.1
• /
• pp.138-153
• /
• 1996

Intending to offer basic information for a prospective health services in Korea, this study is to investigate the complication caused by sterilization in goverment family planning program from 1962 to 1995. The results are as follows: 1. Total number of sterilization performed during the period from 1962 to 1995 were 1.367,772 cases of male sterilization and 2,889,635 cases of female sterilization. 2. Incidence of the complication caused by sterilization operation from 1980 to 1995 were 1,883(0.20%) out of 925,801 cases in vasectomies and 15,866(0.70%) out of 2,256,020 cases in tubal sterilizations. 3. Major complications in vasectomy were epididymities of 658 cases (34.9%), vas recanalization of 326 cases(17.3%), hematoma of 266 cases(14.1%), scrotal abscess of 184 cases(9.8%), sperm granuloma of 76 cases(4.0%),and other of 373 cases(19.8%). On the other hand, in tubal sterilization, ectopic pregnancy was the most significant complication of 15,078 cases (95.0%) among 15,866 total complications, followed by pelvic inflammatory diseases of 155 cases(0.9%), peritonities of 96 cases(0.6%), ovarian & tubal bleeding of 31 cases(0.2%), intestinal perforation of 16 cases (0.1%), uterine bleeding of 14 cases(0.1%), uterine cervix laceration of 1 case (0.1%), and other of 271 cases(1.7%), while 161 pregnancies(0.1%) were terminated and 43 cases(0.3%) with normal delivery. 4. The occurrence rate of the complication for each period showed that most of the complication cases by vasectomy occurred in a year after the operation -the cases were 1,256 (66.7%). 254 cases(13.5%) occurred between the next year and the 2nd year, 138 cases (7.3%) between the 2nd year and the 3rd year, 73 cases(3.9%) between the 3rd year and the 4th year, 52 cases(2.8%) between the 4th year and the 5th year, 31 cases(1.6%) between the 5th year and the 6th year, 79 cases(4.2%) over the 6th year. Tubal sterilization indicated that the occurred complication cases in a year were 2,175 cases(13.7%), 2,113 cases(13.3%) occurred between the next year and the 2nd year, 2,082 cases(13.1%) between the 2nd year and the 3rd year, 2,049 cases (12. 9%) between the 3rd year and the 4th year, 1,819 cases(11.5%) between the 4th year and the 5th year, 621 cases(10.2%) between the 5th year and the 6th year, 4,007 cases(25.3%) over the 6th year. 5. For the cost of complication treatment, total \7,928,229,000 were paid as medical expenditure in which \609,438,000 for vasectomy and \7,318,791,000 for tubal sterilization. Accordingly per capita expenses were \345,000 for vasectomy and \467,000 for tubal sterilization. As the proportion of government sterilization program was decreased after 1988, that of private sterilization program would be increased. So it is recommended to set a guideline for the private sterilization program and to continue government sterilization program for the lower class.

• Clinical and Experimental Reproductive Medicine
• /
• v.14 no.1
• /
• pp.37-42
• /
• 1987

The purpose of this study is to evaluate the incidence of endometriosis and tuboperitoneal fistula in remaining tubal segments after tubal ligation. We reviewed 936 tubes which were obtained from 474 patients who received tubal reanastomosis in the Department of Obstetrics and Gynecology in Seoul National University from June, 1980 to June, 1986. The results were as follows: 1. The incidence of tuboperitoneal fistula was 9.31% of the total 936 tubes (87 tubes) and cautery was the most frequent technique of sterilization in fistula formation (15.20%). 2. The incidence of tubal endometriosis was 2.03% of the total 936 tubes (19 tubes) and cautery was the most frequent technique of sterilization in the development of tubal endometriosis (2.73%). 3. The incidence of tuboperitoneal fistula in the remaining proximal tubal segment within 4 cm was 11.25% and the incidence of endometriosis in the remaining proximal tubal segment above 4cm was 5.54%. 4. The incidence of tuboperitoneal fistula within 3 yrs after tubal ligation was 11.92% and the incidence of endometriosis over 6 yrs after tubal ligation was 5.73%.

• Clinical and Experimental Reproductive Medicine
• /
• v.28 no.4
• /
• pp.307-315
• /
• 2001

Objective: To evaluate the clinical outcomes and influencing factors of in vitro fertilization and embryo transfer (IVF-ET) in patients with failed pregnancy after microsurgical reversal of tubal sterilization. Materials and Methods : From January, 1997 to December, 2000, IVF-ET was performed in two groups; the study TR (tubal reanastomosis) group consisted of 147 cycles in 66 patients with failed microsurgical reversal of tubal sterilization, and the control group of 115 cycles in 67 patients with bilateral tubal occlusion (BTO). The two groups were evaluated and compared for clinical characteristics, clinical pregnancy rates, and factors influencing the outcomes of IVF-ET. Results: Compared with the control BTO group, age and the previous parity were significantly higher ($36.3{\pm}2.7$ vs. $33.6{\pm}2.0$ years, p<0.05; $1.6{\pm}0.7$ vs. $0.2{\pm}0.4$, p<0.05), and the clinical pregnancy rate per cycle was significantly lower (23.8% (35/147) vs. 29.3% (34/115), p<0.05) in the TR group. Difference in the clinical pregnancy rates was age-related, since there was no significant difference between the two groups, except for the previous parity ($1.6{\pm}0.7$ vs. $0.1{\pm}0.3$, p<0.05), when the patients aged 37 years or older were excluded. No difference was found in terms of the following: the proportion of controlled ovarian hyperstimulation (COH) cycles with GnRH agonist ultrashort protocol, the duration of COH, the dosage of gonadotropins used, and the numbers of oocytes retrieved and of embryos transferred, irrespective of age correction. Conclusions: The outcomes of IVF-ET following the failed microsurgical reversal of tubal sterilization depend upon patient age. The previous fertility of patients does not seem to be a factor of better IVF-ET prognosis.

• Clinical and Experimental Reproductive Medicine
• /
• v.12 no.1
• /
• pp.71-81
• /
• 1985

A clinical analysis has been made on 717 cases of tubal sterilization which had been performed at the Dept. of Obstet. & Gynecol., Kyung Hee University Hospital from Jan. 1, 1976 to Dec. 31, 1980. The results are as follows: 1) Prominant age group consisted of those 26-30 years old with frequency of 43.9%, the average being 30.6 years old. 2) Women having 2 living children represented 52.4% of the total and the average No. of living children was 2.5. 3) According to the sex of their children, 29.7% of all cases had one son and one daughter. 12.1% of cases had no son, while 25.7% of cases had no daughter, which showed a trend of male preference. 4) 47.7% of total cases had not experienced artificial abortion before sterilization and the mean No. of artificial abortion was 1.8. 5) With respect to interval between last delivery and tubal sterilization, 76.1% of cases was sterilized within postpartum period (including-c-section) and 12.4% of cases was sterilized within 3 years. 6) The contraceptive methods prior to sterilization were 42.8% with no method used, 17.7% by condom, 16.6% by oral pills, 14.9% by IUD method. 7) 84.5% of puerperal sterilization operation was performed within 48 hours after bearing. 8) Sterilization procedures were coincidentally performed with appendectomy (36.7%), D&E (15.8%), perineorrhaphy (5.0%), salpingectomy (1.8%), and ovarian cystectomy (1.5%). 9) General anesthesia was performed in the majority cases (88.4%). 10) Complications after the procedure were encountered in 7.8% (56 cases), but no intensive medical care was required for these complications. 11) The failure (0.3%) resulting in intrauterine pregnancies occured after the laparoscopic sterilization.

• Clinical and Experimental Reproductive Medicine
• /
• v.39 no.2
• /
• pp.81-86
• /
• 2012

Objective: Sterilization (tubal sterilization and vasectomy) is a widely applied contraceptive method worldwide. Although most studies have described sterilization as a safe method, there are reports of tubal ligation (TL) and vasectomy complications. The aim of this study was to evaluate the effects of TL and vasectomy on the serum oxidative stress, specifically prooxidant-antioxidant balance (PAB) and malondialdehyde (MDA) levels, over time. Methods: Male and female rats were classified into vasectomy, sham-vasectomy, TL, and sham-TL groups, respectively. The PAB and MDA levels were measured on days 15 and 45 and months 3 and 6 after the intervention. For female rats, blood sampling was performed during the diestrous phase and estradiol and progesterone were also measured. Results: Serum PAB and MDA increased after TL (p<0.05). Vasectomy increased serum MDA remarkably after 45 days, 3 months, and 6 months (p<0.05). After vasectomy, serum PAB also increased although not significantly. Serum estradiol and progesterone decreased remarkably in the TL group compared to the sham group (p<0.05). Conclusion: Bilateral TL and vasectomy both increase the serum oxidative stress; however the imbalance after TL was very noticeable. As for the TL, the reduction of serum estrogen levels can be involved in this imbalance. Complications followed by TL or vasectomy could be due to increased levels of oxidants. Thus, prescribing antioxidants during and or after surgery may be a solution.

• Clinical and Experimental Reproductive Medicine
• /
• v.17 no.2
• /
• pp.107-113
• /
• 1990

To evaluate the factors affecting the incidence of ectopic pregnancy following tubal reversal, the clinical characteristics of ectopic pregnancy group (N=28)and intrauterine pregnancy group (N=316)were compared in 344 cases of pregnancy following tubal reversal using microsurgical technique at the Department of Obstetrics and Gynecolgy from July 1980 to May 1989. We found no significant relationship between the incidence of ectopic pregnancy and the duration of sterilization. Although the incidence rate (11.2%) of ectopic pregnancy following laparoscopic cautery appeared to be the highest among tubal sterilization methods, none showed statistically significant differences. There was a fourfold difference in the incidence rate of ectopic pregnancy between post-reversal tubal length less than 7cm (12.7%)and greater than 7cm (3.5%). The mean interval from tubal reversal to conception was 15.7months in ectopic pregnancy group, and 9. 3months in intrauterine pregnancy group, the difference reaching statistical significance. While most(80%)of the pregnancies were achieved within the first 12months following tubal reversal in intrauterine pregnancy group, 50% of the pregnancies occured in the same period, and the cumulative pregnancy rate is related in a linear fashion to the duration after reversal in ectopic pregnancy group. The incidence rate of ectopic pregnancy was found to be higher after cornual-ampullary anastomosis and cornual-isthmic anastomosis.

• Clinical and Experimental Reproductive Medicine
• /
• v.21 no.2
• /
• pp.215-220
• /
• 1994

We have reviewed the pregnancy rate and outcome of 130 patients who underwent tubocornual anstomosis for correction of proximal tutal occlusion at Dong San Medical Center between September 1983 to May 1994. Tubal occlusion was the result of previous tubal sterilization in 115 patients(99 laparoscopic electrocautery, 16 laparoscopic ring, 1 tubal ligation with partially segmental resection and previous tubal infection in 14. Sixty four of the patients conceived(61.5%). Viable pregnancy was achieved in fifty patients (48%), tubal pregnancy in six (5.7%) and spontaneous abortion in eight(6.1%). No significant difference in pregnancy rates was found between patients with diseased cornua and those previously sterilized by either electrocautery or tubal ligation. We conclude that tubocornual anastomosis still remains the treatment of choice for patients with proximal tubal obstruction.

• Clinical and Experimental Reproductive Medicine
• /
• v.15 no.1
• /
• pp.35-39
• /
• 1988

In these past 2 decades, dramatic improvement in technology have greatly expanded the scope of female and male surgical sterilization in Korea. Female and male surgical sterilization are readily accepted because those are simple, in expensive, effective and apparently without serious postoperative complications and the failure rates are very low. In 1986, 92,000 cases of vassectoncy and 312,000 tubal sterilization were taken by the financial support of government in Korea. In this important appraisal the Ministry of Health and Social Affairs provided the guideline for the physicians on the medicoethical problems of surgical sterilization for men and women. The various medicoethical consideration that may give arise to the physicians as well as family planning workers in connection with surgical sterilization are also reviewed and discussed.