Abstract：
Female sterilization is one of the most common contraceptive methods. A small number of women, however, opt for reversal of sterilization procedures after they experience regret. Procedures can be performed by laparotomy or laparoscopy, with or without robotic assistance. Another commonly utilized alternative is IVF. The choice between surgery and IVF is often influenced by reimbursement politics for that particular geographic location.
We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.
Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness.
We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated.
In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.
We evaluated the fertility outcomes of different surgical methods available for the reversal of female sterilization, compared these to IVF and assessed the prognostic factors for success.
Two search strategies were employed. Firstly, we searched for randomized and non-randomized clinical studies presenting fertility outcomes of sterilization reversal up to July 2016. Data on the following outcomes were collected: pregnancy rate, ectopic pregnancy rate, cost of the procedure and operative time. Eligible study designs included prospective or retrospective studies, randomized controlled trials, cohort studies, case-control studies and case series. No age restriction was applied. Exclusion criteria were patients suffering from tubal infertility from any other reason (e.g. infection, endometriosis and adhesions from previous surgery) and studies including <10 participants. The following factors likely to influence the success of sterilization reversal procedures were then evaluated: female age, BMI and duration and method of sterilization. Secondly, we searched for randomized and non-randomized clinical studies that compared reversal of sterilization to IVF and evaluated them for pregnancy outcomes and cost effectiveness.
We included 37 studies that investigated a total of 10 689 women. No randomized controlled trials were found. Most studies were retrospective cohort studies of a moderate quality. The pooled pregnancy rate after sterilization reversal was 42-69%, with heterogeneity seen from the different methods utilized. The reported ectopic pregnancy rate was 4-8%. The only prognostic factor affecting the chance of conception was female age. The surgical approach (i.e. laparotomy [microscopic], laparoscopy or robotic) had no impact on the outcome, with the exception of the macroscopic laparotomic technique, which had inferior results and is not currently utilized. For older women, IVF could be a more cost-effective alternative for the reversal of sterilization. However, direct comparative data are lacking and a cut-off age cannot be stated.
In sterilized women who suffer regret, surgical tubal re-anastomosis is an effective treatment, especially in younger women. However, there is a need for randomized controlled trials comparing the success rates and costs of surgical reversal with IVF.
摘要：
女性绝育是最常见的避孕方法之一。少数女性,然而,在经历后悔之后，选择逆转灭菌程序。手术可以通过剖腹手术或腹腔镜检查进行，有或没有机器人的帮助。另一种常用的替代方案是IVF。手术和IVF之间的选择通常受到该特定地理位置的报销政治的影响。
我们评估了可用于逆转女性绝育的不同手术方法的生育结果，将这些与IVF进行比较，并评估成功的预后因素。
采用两种搜索策略。首先,我们检索了截至2016年7月绝育逆转生育结局的随机和非随机临床研究.收集以下结果的数据：妊娠率，异位妊娠率,手术成本和手术时间。符合条件的研究设计包括前瞻性或回顾性研究，随机对照试验，队列研究，病例对照研究和病例系列。没有年龄限制。排除标准是由于任何其他原因（例如感染，子宫内膜异位症和以前手术的粘连）和包括<10名参与者的研究。然后评估了可能影响绝育逆转程序成功的以下因素：女性年龄，BMI和灭菌的持续时间和方法。其次,我们搜索了比较绝育逆转与IVF的随机和非随机临床研究,并评估了它们的妊娠结局和成本效益.
我们纳入了37项研究，共调查了10689名女性。没有发现随机对照试验。大多数研究是中等质量的回顾性队列研究。绝育逆转后的合并妊娠率为42-69％，从使用的不同方法可以看出异质性。报告的异位妊娠率为4-8%。影响受孕机会的唯一预后因素是女性年龄。手术方法(即剖腹手术[显微镜]，腹腔镜检查或机器人)对结果没有影响，除了宏观腹腔镜技术，结果较差，目前尚未使用。对于年长的女性来说，IVF可能是逆转灭菌的更具成本效益的替代方案。然而,缺乏直接的比较数据，无法说明截止年龄。
在遭受后悔的绝育女性中，手术输卵管再吻合是一种有效的治疗方法,尤其是年轻女性。然而,有必要进行随机对照试验,比较IVF手术逆转的成功率和费用.
我们评估了可用于逆转女性绝育的不同手术方法的生育结果，将这些与IVF进行比较，并评估成功的预后因素。
采用两种搜索策略。首先,我们检索了截至2016年7月绝育逆转生育结局的随机和非随机临床研究.收集以下结果的数据：妊娠率，异位妊娠率,手术成本和手术时间。符合条件的研究设计包括前瞻性或回顾性研究，随机对照试验，队列研究，病例对照研究和病例系列。没有年龄限制。排除标准是由于任何其他原因（例如感染，子宫内膜异位症和以前手术的粘连）和包括<10名参与者的研究。然后评估了可能影响绝育逆转程序成功的以下因素：女性年龄，BMI和灭菌的持续时间和方法。其次,我们搜索了比较绝育逆转与IVF的随机和非随机临床研究,并评估了它们的妊娠结局和成本效益.
我们纳入了37项研究，共调查了10689名女性。没有发现随机对照试验。大多数研究是中等质量的回顾性队列研究。绝育逆转后的合并妊娠率为42-69％，从使用的不同方法可以看出异质性。报告的异位妊娠率为4-8%。影响受孕机会的唯一预后因素是女性年龄。手术方法(即剖腹手术[显微镜]，腹腔镜检查或机器人)对结果没有影响，除了宏观腹腔镜技术，结果较差，目前尚未使用。对于年长的女性来说，IVF可能是逆转灭菌的更具成本效益的替代方案。然而,缺乏直接的比较数据，无法说明截止年龄。
在遭受后悔的绝育女性中，手术输卵管再吻合是一种有效的治疗方法,尤其是年轻女性。然而,有必要进行随机对照试验,比较IVF手术逆转的成功率和费用.
