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Reviewed by the Faculty of Harvard Medical School

Female Sterilization: Micro-Insert Tubal Occlusion

The U. S. Federal Drug Administration (FDA) approved this female sterilization procedure for women in the United States in 2002. In this procedure, "micro-inserts," tiny coils made of nickel, are visually guided into position inside the fallopian tubes by hysteroscopy (insertion of a small scope into the uterus). Once in place, these micro-inserts stimulate growth of tissue that blocks the tubes. This blockage prevents sperm from making contact with an egg. This is considered a permanent, irreversible method of birth control.

This procedure can be performed by a gynecologist in the office or as day surgery in an operating room. General anesthesia is not necessary in most cases. This surgery may last between 30 to 50 minutes, followed by a short stay in the recovery room before you go home. It's possible to return to work and resume normal activities within a day or so after the procedure.

The micro-inserts, also sold under the brand name Essure, are 99.8% effective in preventing pregnancy once your doctor has confirmed that your fallopian tubes are blocked.

Advantages

  • This procedure is quick and can be performed in your doctor's office.
  • There are no concerns about remembering to use birth control.
  • Sexual relations can be spontaneous and worry-free.
  • Female hormone levels and menstrual cycles remain normal and are not affected.

Disadvantages

  • This procedure is considered to be permanent and not reversible. It is important to be sure of your decision to have a tubal occlusion before the surgery is performed. If the decision is made with doubt, haste, or under pressure, you may have feelings of regret leading to depression or attempts to have the procedure reversed.
  • Essure cannot be used by women who are allergic to nickel, previously had a tubal ligation, may possibly have a pelvic infection, may possibly be pregnant or are less than six weeks from having had a baby or an abortion or miscarriage.
  • A hysterosalpingogram — an X-ray procedure in which dye is injected inside the uterus to outline the cavity to see if the tubes are open or blocked — must be performed three months after the Essure is placed to be sure the tubes are completely blocked. Another birth control method must be used during these three months to prevent accidental pregnancy.
  • Essure has only recently been available so there is no information about its safety, performance, risks and benefits beyond four years.
  • Tubal occlusion reversal is not advised because the micro-inserts block the tubes where they join the main body of the uterus. In-vitro fertilization procedures would need to be considered if pregnancy is desired. The risks of the micro-inserts to the patient, to her fetus and the course of the pregnancy are unknown.
  • This method provides no protection from sexually transmitted diseases. Women at risk for STDs need to use latex condoms.

Last updated October 8, 2010




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