Fact, fallacies and Filshie Clips

Fact, fallacies and Filshie Clips

M. Filshie

University Hospital, Queen’s Medical Centre, Nottingham, UK

Introduction: Female sterilisation is the most popular method of

contraception worldwide when a woman has completed her family1. In

1996, the CREST long-term follow up study of different methods of female

sterilisation was published in the USA. This showed a higher than anticipated

failure rate and ectopic pregnancy rate than had been otherwise expected. This

study did not include the Filshie Clip, as it was not available in the USA at

that time. Present studies have shown that the Filshie Clip has a comparatively

lower long-term failure rate and ectopic pregnancy rate. However, senior

clinicians still quote the Crest Study figures for counselling purposes despite

the fact that the Filshie Clip is being used in their units2&3.

Fact 1. The overall long-term failure rate of the Crest Study is 36.5/10004

compared with the Filshie Clip, which is 2.7/10005.

Fact 2. The ectopic pregnancy rate quoted in the Crest Study is 1/3 of

failures i.e. 1% whereas the ectopic pregnancy rate of the Filshie Clip is 1 in

10,000 (4% of 2.7/ 1000)6, which actually equates to just 0.000108%!

Fact 3. The regret rate of the Crest Study is up to 20%7 compared

to just 5% with the Filshie Clip8.

Fact 4. The Mirena IUS has been quoted as having a failure rate equivalent to

the failure rate of female sterilisation with Filshie Clips. Where as this may

be the case, the definitive study of the IUS compared to the Filshie Clip with

intention to treat has not yet been undertaken. Pregnancies associated with

patients who have had their IUS removed for pain, bleeding and side effects have

not been included in the overall failure rate. The five year ectopic pregnancies

with LNG-IUD-20 is reported to be 1 in 50009

Conclusion: In units where the Filshie Clip is used for female

sterilisation; Filshie Clip data should be used for counselling purposes not

the Crest Study.

1. Rioux JE, Daris M. Curr Opin

Obstet Gynecol 2000;13:377–381

2. Mattinson A, Mansour D. J Fam

Planning Reprod Health 2003;29:136–139;

3. Killick S. Gynaecol Forum 2002;7:3–6

4. Peterson HB et al. Am J Obstet

Gynecol 1996;174:1161–1168

5. RCOG Guidelines. Male & Female

Sterilisation: Evidenced-Based Clinical Guidelines No.4, 2004

6. King T et al. The Filshie Clip: a

summary of clinical studies sponsored by FHI, FDA Approval submission, 1996,


7. Hills SD, Marchbanks PA, Tylor LR

et al. Obstet Gynecol 1996;93:889–895

8. Filshie M Helson K, Teper S. 7th

Annual Meeting of ISGE, 1998:14155

9. Anderson K, Odlind V, Rybo G.

Contraception 1994;49:56–72.

Competing interest: Marcus Filshie is

also the Medical Director of Femcare Limited.

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