Guest Author - Denise Howard, M.D., M.P.H.

Permanent sterilization should be considered as a birth control option in those who have completed their childbearing or in those who have no desire for fertility. The word “permanent” must be emphasized. Even though there are cases where permanent sterilization has been reversed it is important to have the expectation that this is not reversible. There are methods available that are equally effective but not permanent if there is any doubt.

Permanent sterilization entails the cutting or blocking of the fallopian tubes to prevent the egg and sperm from meeting. This avoids fertilization. This is an option in men also. It is called a vasectomy. In women there are many different techniques which have evolved and become more refined over time. Currently this is done laparoscopically, immediately post partum and there is a new hysteroscopic technique.

Immediately following delivery a small incision can be made underneath the umbilicus. The uterus is still enlarged, so the fallopian tubes can be grasped through this small incision. A portion of the tube is cut and it is then tied to control bleeding. Laparoscopy is a technique using a camera and a small incision in the umbilicus and in the lower abdomen. Clips or bands can be placed on the tube to obstruct it. The tubes can also be burned using laparoscopy.

Permanent sterilization is attractive because it is simple, effective and minimally invasive. There aren’t any long-term side effects. The success rate is generally greater than 99% but various depending on the technique. A failure of 5.5 per 1000 procedures in the first year is one reported rate. If failure occurs then the risk of a tubal or ectopic pregnancy is approximately 32%. Overall the risk of an ectopic pregnancy is much lower in a sterilized woman than a nonsterilized one. Failure of tubal sterilization maybe attributed to different causes. Unidentified pregnancy at the time of the sterilization procedure is one explanation. Tubal reanastomosis can also occur especially when suture is used to perform the procedure. Failure of equipment and surgical error are also other possibilities.

The newest method is performed using hysteroscopy. The Essure procedure, approved for use in 2002, entails placement of a coiled microinsert in the proximal portion of each tube by going through the uterine cavity. Over time the body scars leading to complete obstruction of the tube. At 3 months 96% of women will have complete obstruction and 100% by 6 months. This procedure is done without an incision and can be performed in a doctor’s office. It is just as effective as the traditional sterilization techniques as long as appropriate follow up is completed. The major disadvantage is the need for radiologic confirmation of obstruction 3-6 months after the procedure. Interval contraception is required. This procedure is indeed permanent as tubal reversal is impossible.

Tubal sterilization is an excellent choice for women who have completed their childbearing, especially in those who may not be good candidates for other birth control methods. It is important to discuss the risks and benefits of permanent sterilization with your health care provider. Discussion of other available contraception should be apart of this counseling visit. Being informed will allow you to make the choice that is most appropriate for you.