The relationship of tubal infertility to barrier method and oral contraceptive use.

TLDR

We examined past contraceptive use in 283 nulliparous infertile women with tubal adhesions or occlusion and 3,833 delivery admissions from 1981–1983, estimating relative risks of tubal infertility with multivariate logistic regression that adjusted for region, age, religion, education, smoking, number of partners, time since menarche, and other contraceptive use. Barrier contraceptive users had a significantly lower risk of tubal infertility (RR = 0.6), especially those using diaphragms or condoms plus spermicides, while oral contraceptives showed no overall effect but may differ by estrogen dose and progestogen type, indicating that combined mechanical and chemical barrier methods offer the greatest protection against tubal damage.

Abstract

We studied past contraceptive use in 283 nulliparous infertile women who had a diagnosis of tubal adhesions or occlusion and in 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with barrier contraceptive use or oral contraceptive use was calculated using multivariate logistic regression to control for confounding by region, age, religion, education, smoking, number of sexual partners, time since menarche, and use of other contraceptive methods. Women who had ever used barrier methods of contraception were at a significantly decreased risk of tubal infertility (relative risk = 0.6; 95% confidence limits, 0.5 and 0.8). When type of barrier method used for the longest time was evaluated, those who used the diaphragm or condoms plus spermicides were at lower risk than those who used condoms or spermicides alone. Overall, past use of oral contraceptives neither increased nor decreased a woman's risk of tubal infertility, but there was evidence that the association between oral contraceptives and tubal infertility may vary by the amount of estrogen and type of progestogen in the oral contraceptive used. We conclude that contraceptive users who use barrier methods that combine both a mechanical and chemical barrier, such as diaphragms, cervical caps, and condoms plus spermicides, have the clearest protection against tubal damage.