• What points in her history do you want to know?
• How are you going to counsel her?
• Tell me about pros & cons of each & failure rate of each
• After counselling she is insisting for sterilization. What are you going to do?
• After meeting with Counsellor and Consultant, she is still insisting.

• The Reason Behind Her Request of Sterilization
• If She Knows about LARC as an Alternative
• If She has Been Offered PIL
• Previous Contraception History (Needs Protection Now)

Previous Obstetric History

• Number & Mode of Deliveries
• Number & Sex of Living Children

Gynecological History

• Periods Regularity, Amount & LMP
• History of STIs

Medical History

• Details about the Degree of Epilepsy & Its Control
• Other Medical Condition that Contraindicate Pregnancy
• Medication History, Drug Allergy & BMI

Surgical History

• For Expecting Difficulties During The Procedure

Social History

• To assess The Possibility of Relationship Difficulties
• Why She is Not Willing to Inform The Partner?!!
• Safe Guarding Issues for Her & Child

Mental History

• To Assess her Capacity to Consent For The Procedure
• To assess if Unsure or Under Stress. For Example, After Birth, Miscarriage, Abortion or During Family or Relationship Difficulties.

• By Law No Need For Partner’s Permission.
• It is Recommended That They Should be Counseled about the Procedure Together.
• Some Doctors Prefer Both Married Partners To Agree To a Sterilization after Proper Information & Counselling.

Female Sterilization: An Operation to Permanently Prevent Pregnancy. The Fallopian Tubes are Blocked Or Sealed to Prevent The Eggs Reaching the Sperm & Becoming Fertilized.

Benefits (Pros):

• More Than 99% Effective at Preventing Pregnancy.
• Does Not Interrupt The Sexual Life or Sex Drive.
• Does Not affect Hormone Levels & Periods.

Risks (Cons):

• Not Immediately Effective & Need Use of Contraception Until The Operation & Until The Next Period Or for 3 Months After The Operation (Depending on The Type of Sterilization).
• Small Risk of Complications, Such as Internal Bleeding, Infection Or Damage to Other Organs.
• Small Risk of Failure (1:200). This May Increase The Risk of Ectopic Pregnancy.
• High Incidence of Regret, Especially If Done in Young age <30 Years With No Children.
• Sterilization Reversal Is Very Difficult & Not Usually Available On the NHS.
• Sterilization Does Not Protect Against STIs, So You May Need to Use Condoms as well.

• This is a Fairly Minor Operation & One Day Case Surgery.
• It Can be Done On the NHS In Most areas, But Waiting Lists Can be Long.
• Can be Done Either Under General or Local Anaesthesia Depending On The Method Used.
• Contraception Use Until The Operation Day & Right Up Until Your Next Period after Surgery.
• Pregnancy Test On The Surgery Day to rule out Pregnancy.
• Sterilization Can be Performed At Any Stage in the Menstrual cycle.

Surgical Methods for Female Sterilization

• A Laparoscopy is Usually Used Because It’s Faster & With Rapid Recovery. (Failure Rate 2-5:1000)
• Mini-Laparotomy May be Recommended for Women Who:
  • Have had Recent Abdominal or Pelvic Surgery
  • Are Obese
  • Have a History of Pelvic Inflammatory Disease
• The Surgeon Will Block The Fallopian Tubes by Either:
  • Applying Clips: Plastic or Titanium Clamps are Closed Over the Fallopian Tubes (Failure Rate 3:1000)
  • Applying Rings: A Small Loop of the Fallopian Tube is Pulled Through a Silicone Ring, Then Clamped Shut
  • Tying, Cutting and Removing a Small Piece of the Fallopian Tube
  • Complete Removal of The Tube (Salpingectomy) has a Protective Effect On Ovarian Cancer

1. IUCD (Copper Coil)

• A Small Plastic & Copper Device
• Acts by:
  • Prevents the Sperm from Surviving
  • Alters the Cervical Mucus & Endometrial Lining to Prevent Sperm from Reaching The Ovum
  • Prevents Implantation of the Fertilized Egg
• It Can be Uncomfortable or Painful & Can be Offered Under Local Anesthetic to Prevent Fits
• Failure Rate: 6:1000 (>99% Effective)
• Works for 5 or 10 Years
• Periods May be Heavier, Longer or More Painful
• Fertility returns as soon as it is removed

2. IUS (Mirena)

• T-shaped Plastic Device, Which Releases the Hormone Progestogen
• Acts by:
  • Thinning The Endometrium
  • Thickening The Cervical Mucus
• Failure Rate: 2:1000
• Works for 5 Years
• Periods Become Lighter, Shorter & Often Less Painful
• Fertility returns as soon as it is removed

3. Injectable Contraception (Depo-Provera)

• IM Injection Given Every 3 Months
• Releases The Hormone Progestogen Which:
  • Prevents Ovulation
  • Thickens the Cervical Mucus
  • Thins the Endometrium
• Failure Rate: 2:1000
• May Delay Return of Fertility by Up to 1 Year
• Periods May Stop, Be Irregular or Longer
• Suitable for Epileptic Patients On Enzyme Inducers

4. Progestogen Only Subdermal Implants

• Most Effective Method (Failure Rate: 5:10000)
• Not Suitable for Women on Enzyme Inducers like Carbamazepine

5. Male Sterilization (Vasectomy)

• Failure Rate: 1 in 2000
• Less Risk, Done Under Local Anaesthesia
• Not an Option in This Case

• IUCD & IUS Should be Inserted in a Hospital Setting with Local Anesthetic and Precautions
• No Contraindication for IUCD in Women With History of Ectopic Pregnancy
• Condom Should be Offered for STI Protection but Not as Sole Contraceptive (High Failure Rate 2:100)