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Contraceptive Pearl: Tubal sterilization regrets—Considerations for Counseling

Written by Eleanor Bimla Schwarz, MD, MS, and Kelly M. Treder, MD, MPH
Since the Dobbs decision, permanent contraception has become more common.1 While tubal sterilization aligns with the preferences of many patients, regrets do occur. To describe trends in the prevalence of tubal sterilization and subsequent desire for reversal, researchers analyzed nationally representative data collected from US women* aged 15-49 surveyed between 2006 and 2023.2 In 2022-2023, 21.3% of US individuals who had undergone tubal sterilization reported a desire for reversal. Rates of tubal sterilization and desired reversal were higher in prior years; in 2006, a desire for reversal surgery was reported by 26.8% of respondents. Desire for reversal was more likely among nulliparous individuals, those younger than 30 years, those living below the federal poverty level, and among Hispanic and Black women compared with White, non-Hispanic women.2 Importantly, people of color, people with low incomes, and people with disabilities have historically been forced or coerced into sterilization in this country. This context underscores the importance of unbiased and fully informed counseling that takes into account a patient’s desires, goals, and needs when discussing sterilization procedures. 
Comprehensive counseling includes discussion of the risks, permanence, the effectiveness of tubal surgery, and other contraceptive options that align with patients’ goals and desires. Recent research indicates that some individuals considering tubal sterilization may not be well informed about other methods, like long-acting reversible contraceptives.3 While there are many factors for a patient to consider when identifying what contraceptive method will best meet their needs, IUDs, the etonogestrel implant, and vasectomy have comparable efficacy and fewer risks than tubal surgery.4-6 Data from the National Survey of Family Growth7 reported tubal sterilization failure rates ranging from 2.9% to 5.2%8 and similarly, an analysis of California Medicaid data found rates of failure after hysteroscopic and laparoscopic tubal sterilization to be 2.61 pregnancies after laparoscopic tubal sterilization per hundred-woman years of observation.9 Bilateral salpingectomy is anticipated to be more effective than other approaches to tubal sterilization but is even less reversible. Perhaps most importantly, counseling should address the permanence of sterilization procedures to avoid confusion around reversibility. 
Every person considering permanent birth control deserves person-centered, evidence-based counseling that ensures they are well-informed and have access to all contraceptive options. Promoting autonomy and person-centered care includes ensuring that patients are well-counseled before any procedure they are considering, as regret is not only found among sterilization procedures.10 It also involves trusting patients to make decisions about their own bodies, and making sure our own biases do not create barriers for patients who have been counseled and want sterilization.

*The studies cited in this Contraceptive Pearl use the term “women.” RHAP recognizes that this language is not inclusive of all people who seek care. A person’s biology does not determine their gender.

RHAP Resources:

Your Birth Control Choices Fact Sheet

Permanent Birth Control (Sterilization)

Download and print our resources for free from our website or visit our store to buy physical copies!

Partner Resources:

Reproductive Health Hotline (ReproHH): A free, confidential phone service (1-844-737-7644) offering evidence-based clinical information for healthcare providers across the US who have questions related to sexual and reproductive health.

Belly of the Beast (Film): When an unlikely duo discovers a pattern of illegal sterilizations in women’s prisons, they wage a near-impossible battle against the Department of Corrections.

Sources:

1. Xu X, Chen L, Desai VB, et al. Tubal Sterilization Rates by State Abortion Laws After the Dobbs Decision. JAMA. Published online September 11, 2024. doi:10.1001/jama.2024.16862

2. Chiang AY, Gariepy AM, Leon-Martinez D, Treder KM, Schwarz EB. Desire for reversal after tubal sterilization in the United States, 2006-2023. F S Rep. 2026;7(2):143-149. Published 2026 Mar 23. doi:10.1016/j.xfre.2026.02.002

3. Rodowa MS, Waddington A, Pudwell J. Regret in the Modern Contraceptive Landscape: Evaluating Regret in Patients Undergoing Tubal Ligation or Bilateral Salpingectomy for Contraception. J Obstet Gynaecol Can. 2024;46(5):102362. doi:10.1016/j.jogc.2024.102362

4. Schwarz EB, Lewis CA, Dove MS, et al. Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation. J Gen Intern Med. 2022;37(16):4168-4175. doi:10.1007/s11606-022-07433-4

5. Reed S, Minh TD, Lange JA, Koro C, Heinemann K. Pregnancy and pregnancy outcomes in a prospective cohort study: Final results from the Nexplanon Observational Risk Assessment Study (NORA). Contraception. 2023;120:109920. doi:10.1016/j.contraception.2022.109920

6. Jamieson DJ, Costello C, Trussell J, et al. The risk of pregnancy after vasectomy. Obstet Gynecol. 2004;103(5 Pt 1):848-850. doi:10.1097/01.AOG.0000123246.11511.e4

7. Schwarz EB, Chiang AY, Lewis CA, Gariepy AM, Reeves MF. Pregnancy after Tubal Sterilization in the United States, 2002 to 2015. NEJM Evid. 2024;3(9):EVIDoa2400023. doi:10.1056/EVIDoa2400023

8. Peterson HB, Xia Z, Hughes JM, Wilcox LS, Tylor LR, Trussell J. The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol. 1996;174(4):1161-1170. doi:10.1016/s0002-9378(96)70658-0

9. Gariepy AM, Lewis C, Zuckerman D, et al. Comparative effectiveness of hysteroscopic and laparoscopic sterilization for women: a retrospective cohort study. Fertil Steril. 2022;117(6):1322-1331. doi:10.1016/j.fertnstert.2022.03.001

10. Thornton SM, Edalatpour A, Gast KM. A systematic review of patient regret after surgery- A common phenomenon in many specialties but rare within gender-affirmation surgery. Am J Surg. 2024;234:68-73. doi:10.1016/j.amjsurg.2024.04.021

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Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Pearls is unbiased, based on science alone.

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