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Article
May 8, 1987

The Relationship of Tubal Infertility to Barrier Method and Oral Contraceptive Use

Author Affiliations

From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School (Drs Cramer and Schiff), and the Department of Epidemiology, Harvard School of Public Health, Boston (Dr Goldman); the Department of Obstetrics and Gynecology, Centre Hospitalier, Universite de Sherbrooke, Sherbrooke, Quebec (Dr Belisle); the University of Colorado Health Sciences Center, Denver (Dr Albrecht); the Contraceptive Evaluation Branch, Center for Development, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md (Dr Stadel); the Department of Obstetrics and Gynecology, University of Vermont,; Burlington (Dr Gibson); the Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington (Dr Wilson); the Department of Obstetrics and Gynecology, George Washington University Medical Center, Washington, DC (Dr Stillman); and New England Fertility and Gynecology Associates Department of Obstetrics and Gynecology and Charles A. Dana Research Center, Beth Israel Hospital, Boston (Dr Thompson).

From the Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School (Drs Cramer and Schiff), and the Department of Epidemiology, Harvard School of Public Health, Boston (Dr Goldman); the Department of Obstetrics and Gynecology, Centre Hospitalier, Universite de Sherbrooke, Sherbrooke, Quebec (Dr Belisle); the University of Colorado Health Sciences Center, Denver (Dr Albrecht); the Contraceptive Evaluation Branch, Center for Development, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Md (Dr Stadel); the Department of Obstetrics and Gynecology, University of Vermont,; Burlington (Dr Gibson); the Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington (Dr Wilson); the Department of Obstetrics and Gynecology, George Washington University Medical Center, Washington, DC (Dr Stillman); and New England Fertility and Gynecology Associates Department of Obstetrics and Gynecology and Charles A. Dana Research Center, Beth Israel Hospital, Boston (Dr Thompson).

JAMA. 1987;257(18):2446-2450. doi:10.1001/jama.1987.03390180064024
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.

(JAMA 1987;257:2446-2450)

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