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Permanent Birth Control by Roberta Greenwood

According to a report released in May 2010 from data gathered during the 2006-08 National Survey of Family Growth, female surgical sterilization is second only to the birth control pill as the most commonly used method of contraception among women in the United States. Its popularity reflects the fact that for women who have decided that a permanent form of birth control is the best choice for them, sterilization is not only safe and effective, it is now much less invasive than it used to be.

Traditionally, female sterilization has required surgery, the most common procedure being laparoscopic tubal ligation, in which surgical instruments are inserted through a small incision in the abdomen with an endoscope to either cut, tie, cauterize or clamp the fallopian tubes to prevent fertilization. Now, a less invasive procedure, known as hysteroscopic sterilization, can be performed transcervically (through the opening of the cervix), to block the fallopian tubes.

Essure, a method approved by the FDA in 2002, and Adiana, FDA-approved in 2009, are two such methods of permanent birth control that do not require surgery. With Essure, a small, flexible coil (called a micro-insert and made of polyethylene fibers encased in another coil of titanium/nickel alloy) is inserted into each fallopian tube using a hysteroscope. Over a period of approximately three months, scar tissue forms around the coil and eventually blocks the tubes. In the Adiana procedure, minor thermal heating delivered by radiofrequency is applied to the fallopian tubes, removing a thin layer of cells and creating a superficial lesion. Small, smooth inserts, approximately the size of a grain of rice, are placed at the lesion site. Also over a period of approximately three months, healthy, new tissue grows around the inserts and eventually blocks the tubes.

Both procedures can safely be completed in a doctor’s office without general anesthesia and are considered quick, low-risk methods of permanent contraception with rapid recovery time and minimal discomfort. However, sterilization is not immediate, and whether the patient has chosen Essure or Adiana, after three months she must undergo a special X-ray, called a hysterosalpingogram (HSG), to have visual proof that both fallopian tubes are blocked. Until then, a backup method of contraception must be used.

Dr. Peter Brandon, OB/GYN and cofounder of Ballard Women’s Health, performs both procedures at his clinic. His patients appreciate the ability to choose an “in-office” treatment and he views the availability of Essure and Adiana as a positive step in women’s reproductive health. “Both methods result in lower risks, faster recovery time and less discomfort,” explains Brandon. “When it comes to making a choice of which procedure to use, my patients tend to weigh the concept of the type of insert used and the rate of success. Although Essure is slightly more successful in preventing pregnancy, some women don’t like the idea of a “metal coil” remaining in their bodies, so Adiana has been a very good alternative for many of my patients.”

Fredrica Elliott works at a medical clinic and is on her feet most of the day — which is one of the reasons she selected Adiana. She says that the pain she felt during the quick procedure in Brandon’s office was over in a matter of two to three minutes, and she was able to go to work the next day. “I liked the idea that I didn’t have to go into the hospital,” she says. “It’s quick, my insurance covered the cost, and I’m at an age where I no longer wanted to pump hormones into my body for birth control. And I preferred the smooth ceramic insert to the metal coil.”

Karen Jones, MD, performs the Essure procedure at HealthCare for Women/ Swedish Hospital, First Hill, and says it offers her patients a procedure that is both effective and safe. “This procedure is a good choice for women who want permanent sterilization but who aren’t good candidates for a laparoscopic surgical procedure,” she explains. “Poor candidates for abdominal surgery may have considerations such as morbid obesity, poorly controlled diabetes, high blood pressure or a history of blood clots. Additionally, those with multiple abdominal surgeries may have scar tissue that would make the laparoscopic surgery riskier due to an increased chance of organ injury.” Jones adds that Essure is 99.7 percent effective and of benefit to women who have medical reasons that don’t allow them to use hormonal forms of birth control.

While both Essure and Adiana offer a hormone-free form of permanent birth control with minimal discomfort and downtime, Jones cautions that women who can’t wait three months to be sterilized, women with a history of tubal infections, or, in the case of Essure, women with a nickel allergy, aren’t good candidates for the procedure. “I have anyone with skin reactions to jewelry tested by an allergist or dermatologist,” says Jones. “If they test positive, they can’t have Essure.” Patients of both doctors tolerate the procedure well, with some reporting mild symptoms immediately afterward that include nausea, lightheadedness and spotting.

Occasionally during the Essure procedure, one of the micro-inserts can’t be placed correctly or is expelled during the first weeks after treatment; Brandon reports that in a very small number of cases (approximately 2 percent), the coil can perforate the fallopian tube. He advises that although seldom serious, the perforation would be a factor to consider in future medical procedures.

Both Brandon and Jones believe these procedures offer women a chance to select an effective, permanent form of contraception with minimal risks, but they caution that Essure and Adiana are only suitable choices for women who have positively made the decision to end their childbearing years. “This procedure isn’t reversible,” Jones warns. “Women need to be sure they don’t want additional children.”

It’s important to remember that neither procedure offers protection from sexually transmitted diseases and, until the fallopian tubes are completely blocked, additional birth control must be used to prevent pregnancy. “My patients are very satisfied with this procedure,” reports Jones.

According to a study published by the U.S. Department of Health and Services, hysteroscopic sterilization provides an effective and less invasive approach to sterilization that is also less costly than tubal ligation. Performing Essure or Adiana in a doctor’s office eliminates hospital charges and reduces the potential for injury from general anesthesia or the incision required for tubal ligation. Patient satisfaction approaches 96 percent, and most women return to their normal daily activities within twenty-four hours.

“I’m very positive in my approach to these procedures,” concludes Brandon. “These are psychologically more attractive options for my patients, offering much lower risks. We’re refocusing our practice to provide complete, beneficial techniques in our office — and I believe that’s the way that health care is headed in the future.”

Roberta Greenwood is a regular contributor to Seattle Woman.

©Copyright 2010, Caliope Publishing Company