PIP: Although tubal sterilization is considered a permanent method of fertility control, pregnancy can occur after a successful procedure. In the first year after tubal sterilization, the estimated failure rate is 0.1-0.8%. Approximately one-third of these pregnancies are ectopic. Women under 35 years of age and those who are not lactating after sterilization are more likely to conceive. Incomplete coagulation or misplacement of the mechanical device also raises the risk of failure. In a study reported in this issue of "The New England Journal of Medicine," the 10-year cumulative rate of ectopic pregnancy after tubal sterilization was 7.3/1000 procedures. The frequency of ectopic pregnancy was highest after bipolar coagulation and lowest after postpartum partial salpingectomy. Tubal sterilization should be carried out with clips or rings rather than by coagulation, both because of the lower risk of ectopic pregnancy and the greater likelihood of successful pregnancy if reversal is sought.