Choosing a Birth Control Method – Female Sterilization

(Published September 2011)

Operative Sterilization

Description

Female surgical sterilization via tubal occlusion has been used for many years, is highly successful and safe, and has a low risk of complications. The fallopian tubes are occluded by ligation, blocking with clips or rings, or cauterization.

Use

Surgical tubal occlusion may be done as a laparoscopic procedure or as mini-laparotomy or laparotomy. The second two procedures are usually selected for sterilization after childbirth. These procedures can be performed on an outpatient basis as ambulatory surgery. After the procedure, women may resume having sexual intercourse as soon as they feel comfortable.

Effectiveness

This method is extremely effective and is effective immediately. The failure rate is very low (0.5 percent).¹⁸

Risks

Potential complications associated with anesthesia and surgery

Side Effects

None. Because the hormonal milieu is unaffected by these surgeries, women continue to have normal menstrual cycles.

There is no evidence that the timing of menopause is affected in older women who undergo surgical sterilization.

Contraindications and Precautions

• Known allergy or hypersensitivity to any materials used for procedure.
• Uncertainty about desire to end fertility
• Pregnancy or suspected pregnancy
• Inaccessible, technically difficult uterus and fallopian tubes
• Allergy to contrast medium

Advantages

• Highly effective
• Long-term method
• Discreet
• Low risk of side effects
• After up-front cost, no ongoing cost to maintain method
• No effect on hormonal milieu
• Immediately effective; no back-up contraception necessary

Disadvantages

• Requires surgical procedure
• No protection against STIs

Counseling Messages

• Tubal occlusion should be considered a permanent end to a woman’s fertility and should not be performed if there is a chance that the patient might desire childbearing in the future.
• Approximately 20 percent of women who undergo sterilization before age 30 experience regret.⁹⁷
• Although procedures for reversal of surgical tubal occlusion exist, reversal is costly and has a low rate of success.
• This method does not protect against STIs.

Non-operative Sterilization

Description

Tubal microinserts are products for permanent female sterilization. Two tubal microinsert products were available: Essure^® and Adiana^®. However, Adiana was discontinued April 2012. Essure consists of two small metal coils around a mesh of polyethylene terephthalate (PET) fibers. When placed in the fallopian tube, the coils expand to hold the device in place and the PET fibers induce an inflammatory reaction. The inflammation stimulates tissue growth in the tubal walls, which occludes the lumen over the following 3–6 months.⁹⁸

Adiana is a tubal occlusion technique in which the health care provider directs radiofrequency energy to the fallopian tube, creating a superficial lesion in the tubal wall. Next, the provider introduces silicone polymer microinserts into each tube at the lesion site. Over the next 3 months, tissue lining the fallopian tubes grows into the microinserts to occlude the tubes.⁹⁹

Use

A trained health care provider places the tubal microinserts, usually under local anesthesia or sedation. The hysteroscopic procedure takes about 15 minutes. Hysterosalpingogram is used to verify tubal occlusion about 3 months after the procedure.

Effectiveness

This method is extremely effective:

• Essure has a failure rate of less than approximately 0.2 percent.¹⁰⁰
• Adiana’s failure rate is about 1.1 percent.¹⁰¹

Risks

Because these sterilization products are relatively new, the long-term effects are not known. Risks include perforation of the uterus and/or tube during insertion and improper placement of the device.

Side Effects

Side effects of non-surgical tubal occlusion include cramping, pain, and bleeding or spotting on the day of the placement procedure.

Contraindications

• Uncertainty about desire to end fertility
• Pregnancy or suspected pregnancy
• Taking immunosuppressive medication
• Previous delivery, miscarriage, or abortion within 6 weeks for Essure or 3 months for Adiana
• Current pelvic infection
• Inaccessible, technically difficult uterus and fallopian tubes
• Allergy to contrast medium
• Unwillingness to use another birth control method for the first 3 months
• Unwillingness to return 3 months later to check for tubal occlusion
• Previous tubal ligation

Advantages

• Highly effective
• Long-term method
• Discreet
• Low risk of side effects
• After up-front cost, no ongoing cost to maintain method
• No effect on hormonal milieu
• No surgery required

Disadvantages

• Requires visits to trained clinician for insertion and follow-up hysterosalpingogram
• Limited data on effectiveness, risks, and side effects
• No protection against STIs

Counseling Messages

• Microinserts are not designed for removal.
• Tubal occlusion should be considered a permanent end to a woman’s fertility and should not be performed if there is a chance that the patient might desire childbearing in the future.
• Back-up contraception is needed for 3 months or until tubal occlusion is verified.
• Patients should notify any health care professionals about their microinserts before any intrauterine procedures to avoid damaging the microinserts and other possible risks.
• Definitive data on effectiveness and risks are not yet available.
• This method does not protect against STIs.