One of the most important and often difficult decisions a woman must make is whether or not permanent contraception or sterilization is the right choice for her. Frankly, I have never cared for the word ‘sterilization. It has always sounded so cold and austere, so permanent. It is, of course, permanent and that really is the point. In order for a woman or couple to consider permanent contraception they really must be 100% sure they have completed their family and that their desire for future fertility is gone for good.
In one study, anywhere from 2 to 2.7% of women in the United States expressed regret following tubal ligation at 1 and 2 years post-operatively and approximately 2 per 1000 will undergo tubal reanastomosis. The main factors associated with regret 2 years after tubal sterilization were age less than 30 and sterilization performed at the time of cesarean section. It is also important to note that rates of success following reanastomosis vary greatly depending upon the method used for sterilization. It is, therefore, extremely important that a couple undergo counseling about the permanence of the procedure. Proper counseling should include a complete discussion which includes information about all available methods of contraception both permanent and temporary.
Once a patient decides that permanent contraception is right for her she must then decide on the method she finds most desirable. Options include vasectomy for the male partner and tubal ligation or interruption for the female partner. There exists a seemingly never-ending list of procedures available all of which are provided through one of three approaches: open, laparoscopic and, now, incision-free. Open procedures include tubal interruption performed at the time of cesarean section as well as post-partum tubal ligations performed following vaginal delivery. These procedures require an umbilical incision through which the tubes are accessed and include methods with sometimes ‘catchy’ names like the Pomeroy or the Uchida.
Numerous procedures are available through the laparoscopic approach, as well. The laparoscopic approach generally requires 1 to 3 small incisions in the abdomen depending upon the surgeon’s skill and technique as well as the procedure chosen. The methods utilized with this approach include various forms of cautery or ‘burning’ as well as a variety of methods utilizing clips, bands or rings. Some of these methods sport equally ‘catchy’ names like the Hulka clip or the Filshie clip.
Of all of the current methods of tubal interruption, however, the one which most would consider most desirable would utilize an incision-free approach, for obvious reasons. The Essure method provides just such an approach.
The Essure tubal sterilization technique is an incision-free method of sterilization that utilizes a hysteroscopic approach. Hysteroscopy is a surgical technique which utilizes a camera placed through the cervix thus providing visualization of and surgical access to the uterine cavity without the need for a surgical incision. Specifically, with the Essure technique, the hysteroscope is used to access the tubal ostia where the fallopian tubes enter the uterine cavity. Then, under direct visualization, an extremely small, soft and flexible micro-insert is placed at each tubal ostia thus causing a tissue in-growth reaction resulting in tubal occlusion and thus, sterilization.
The Essure technique provides many advantages over other more traditional techniques. Essure can be performed in-office with minimal anesthesia and has virtually no down-time. Because it is incision-free there is usually no discomfort and patients can easily return to work or to caring for their families the following day. And because the Essure procedure can be performed in-office, a hospital stay or visit is unnecessary, saving the patient both time and money as well as being a more cost-effective option for our healthcare system as a whole.
If you are considering permanent contraception please consult with your healthcare provider to learn if Essure is right for you.