The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of the "Major Recommendations" field
The following recommendations are based on good and consistent scientific evidence (Level A):
- Tubal sterilization may be recommended as a safe and effective method for women who desire permanent contraception. Women should be counseled that tubal ligation is not intended to be reversible; therefore, those who do not want permanent contraception should be counseled to consider other methods of contraception.
- Patients should be advised that neither tubal sterilization nor vasectomy provides any protection against sexually transmitted diseases, including human immunodeficiency virus (HIV) infection.
- Patients should be advised that the morbidity and mortality of tubal ligation, although low, is higher than that of vasectomy, and the efficacy rates of the 2 procedures are similar.
- Patients should be counseled that tubal sterilization is more effective than short-term, user-dependent reversible methods.
- Patients should be counseled that failure rates of tubal sterilization are comparable with those of intrauterine devices (IUDs).
The following recommendations are based primarily on consensus and expert opinion (Level C):
- If a patient has a positive pregnancy test result after a tubal ligation, ectopic pregnancy should be ruled out.
- Indications for hysterectomy in women with previous tubal sterilization should be the same as for women who have not had tubal sterilization.
Definitions:
Grades of Evidence
I: Evidence obtained from at least one properly designed randomized controlled trial.
II-1: Evidence obtained from well-designed controlled trials without randomization.
II-2: Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.
II-3: Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence.
III: Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.
Levels of Recommendations
Level A — Recommendations are based on good and consistent scientific evidence.
Level B — Recommendations are based on limited or inconsistent scientific evidence.
Level C — Recommendations are based primarily on consensus and expert opinion.