Sterilisation — DFSRH MCQ

Correct answer: B — Retain the IUS and arrange removal no earlier than 7 days after sterilisation

Explanation lettering: B = shown as A · D = shown as B · A = shown as C · C = shown as D

The IUS should remain in situ until at least 7 days after laparoscopic tubal occlusion. A negative same-day urine pregnancy test excludes most established pregnancies but cannot reliably exclude a very early luteal-phase pregnancy. If ovulation and fertilisation occurred before surgery and the conceptus has already passed the site subsequently occluded, tubal occlusion will not prevent that pregnancy. Removing intrauterine contraception during the operation therefore creates an avoidable risk. A is attractive because tubal occlusion appears immediately definitive, but it disregards perioperative luteal-phase pregnancy. B does not resolve this problem: condoms used after surgery cannot prevent a pregnancy initiated before the procedure. C retains contraceptive cover initially but removes it earlier than the recommended minimum interval. E is unnecessarily restrictive in a patient without an identified pregnancy risk requiring separate assessment; routine repeat pregnancy testing at 4 weeks is not required before IUS removal. This advice differs from management of a progestogen-only implant, which may be removed during the sterilisation procedure when it remains within its licensed duration.

Reference: FSRH Clinical Guideline: Male and Female Sterilisation (September 2014) — https://www.fsrh.org/Common/Uploaded%20files/documents/cec-ceu-guidance-sterilisation-cpd-sep-2014.pdf Recovering after female sterilisation (Last reviewed 14 February 2024) — https://www.nhs.uk/contraception/methods-of-contraception/female-sterilisation/recovery/