The relationship of tubal infertility to barrier method and oral contraceptive use
D. W. Cramer, M. B. Goldman, I. Schiff, S. Belisle, B. Albrecht, B. Stadel, M. Gibson, E. Wilson, R. Stillman and I. Thompson
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.
