PIP: This review of the evolution of tubal sterilization covers: indications for sterilization; methods of tubal sterilization; outpatient sterilization; and sterilization reversal. Tubal sterilization, as a fertility control method, is a 20th century technique. During the first half of this century, most sterilization procedures were associated with term deliveries and were recommended following a 3rd cesarean section or for multiparous women who had delivered 8 or more living children. Permanent prevention of pregnancy was also considered to be appropriate for most conditions justifying a therapeutic abortion, i.e., medical and psychiatric illnesses and genetic abnormalities. Sterilizations performed solely for contraceptive purposes in healthy individuals who simply chose to terminate childbearing were subjected to a complex formula of age and parity. A change occurred in the late 1960s in both the US and the UK, so that an increasing number of sterilization procedures were performed for contraceptive purposes. As a result of abortion reform laws in the US and the liberalization of family planning concepts that were inherent in it, voluntary sterilizations were performed upon request, the only absolute restriction being a minimum age of 21 years. Data from the sterilization surveillance reports of the Centers for Disease Control show that, between 1970-77, there was a steady increase in the number of sterilizations performed in hospitals in the US. The liberalization of tubal sterilizations during the 1970s shifted the timing of sterilizations away from the puerperal period. This has resulted in an increase in the number of interval sterilization procedures that were performed in hospitals on nonpregnant women. Prior to the late 1960s, most sterilizations were performed via the abdominal route and entailed a 5-7 day hospitalization to allow for wound healing. The most frequently utilized technique was the Pomeroy procedure, in which absorbable suture and excision of a loop is employed. With the introduction of laparoscopic electrocautery tubal sterilization by Steptoe in 1967, prolonged hospitalization became unnecessary. The techniques now being used in the US for laparoscopic sterilization are unipolar electrocautery, bipolar coagulation, and silastic ring and spring clip application. When the nonlaparascopic approach is chosen, the most frequently used procedure is that of minilaparotomy, in which the techniques of Pomeroy ligation, silastic ring, and spring clip applications are used. The sterilization technique offering the greatest potential as an office procedure is that of tubal occlusion with silicone rubber injected through a hysteroscope. Due to the fact that it will not always be possible to recognize those women who may come to regret their sterilization, it is essential to use a procedure that has potential for reversal. Available evidence indicates that the sterilization techniques producing the least tubal damage offer the greatest likelihood of successful reversal.