Think getting your tubes tied is better at preventing pregnancy than an IUD? California researchers debunked that long-held belief by reviewing pregnancy statistics for more than 83,000 women who used one of the two methods of birth control.
"Tubal ligation is really no longer the gold standard for pregnancy prevention," said Dr. Eleanor Bimla Schwarz, chief of the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital.
This finding — and data on the difference in complications and infections — surprised the research team, they noted in a news release on the study results.
Women who used intrauterine devices were less likely to develop side effects such as infections or procedural complications, the researchers said. Additionally, more than six months after receiving their IUD's, women using them had less pelvic, abdominal, genital and urinary pain than those who had tubal ligations, the researchers reported.
To evaluate the effectiveness of the two methods of contraception, the researchers looked at claims data on Medi-Cal recipients who received either a tubal ligation or an IUD between 2008 and 2014 to see how many became pregnant within a year. What they found is data that pregnancy occurred among:
— 2.4% who used IUD that employed the female hormone levonorgestrel;
— 2.99% using copper IUDs;
— 2.64% who underwent laparoscopic tubal ligations in which the fallopian tubes are severed and tied.
"Women are told the chance of pregnancy with these contraceptives is one in 1,000 but we found much higher rates of pregnancy," Schwarz said. "This real-world data is really important for clinical decision-making."
Schwarz, a professor of medicine at the University of California, San Francisco, said patients should be encouraged to try an IUD before having a permanent procedure,
"Tubal ligation is permanent," Schwarz said, "and regrets following these procedures are hard, especially when coverage of infertility treatment is limited, as it is for Medicaid clients."
She and the other researchers undertook their study after receiving a request from a patient advisory group.
"Our stakeholders wanted to know, 'When women have permanent contraceptive procedures, how safe and effective are they?'" Schwarz said. "That question grew to, 'How do these surgical procedures compare to alternative long-acting contraceptives such as IUDs?'"
