Tubal Litigation No Better than IUD at Preventing Pregnancy

IUDs work at least as well as tubal ligation, while causing fewer side effects, according to a new study.

The analysis, based on six years of Medi-Cal claims data, is the first rigorous look at how long-term birth control methods perform in the real world.

This study overturns the widely held assumption that tubal ligation, which requires surgery and is permanent, is more effective than an IUD, which can be easily removed when pregnancy is desired.

Published Feb. 22, 2022, in the Journal of General Internal Medicine, the study found that hormonal IUDs were more effective than tubal ligation at preventing pregnancies, while copper IUDs were as effective.

“Tubal ligation is really no longer the gold standard for pregnancy prevention,” said Eleanor Bimla Schwarz, MD, professor of Medicine at UC San Francisco and chief of the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital.

Researchers examined claims data from more than 83,000 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. They found that 2.40 percent with levonorgestrel IUDs and 2.99 percent with copper IUDs got pregnant, compared with 2.64 percent of those who underwent laparoscopic tubal ligations.

“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.”

The study also found