Incisionless Sterilization Gaining Popularity
By Heather Maloney
Beth Israel Deaconess Medical Center staff
After having two kids, Kelli Nelson started thinking about a more permanent form of birth control.
"I knew I didn't want any more kids," she says. "And I had been on birth control pills for a long time. It was time to get something permanent."
Nelson did some research and decided to try the newest technique, hysteroscopic sterilization. She had the procedure done in November, and she has no regrets.
"I'm very happy with the results," she says. "I didn't have any complications, and I went to work the next day. I would definitely do it again. I recommend it to everyone."
"This is a great advancement for women, because it's the first incisionless method," says
Dr. Hye-Chun Hur, co-director of the
minimally invasive gynecologic surgery program at Beth Israel Deaconess Medical Center in Boston. "It was FDA approved in 2002, and is gaining popularity."
How does the procedure work?
Hysteroscopic sterilization works by placing tiny coils within the fallopian tubes. The coils cause scarring in the tubes, which blocks them. And, unlike other forms of female sterilization, this procedure does not require any incisions or general anesthesia.
What happens during the the procedure?
During the procedure, a doctor uses a camera attached to a narrow instrument (called a hysteroscope) that is inserted through the vaginal opening into the womb to access the tubes. With the help of the camera, the physician threads the coils into the tubes. Over time, scar tissue forms around the implants and effectively blocks the fallopian tubes.
Can I stop using other methods of birth control right after the procedure?
For the first three months after insertion, the patient must use another method of birth control to allow adequate time for the scarring process. After three months, the patient returns for a follow-up visit where dye is injected into the uterus and an X-ray is taken to make sure that the coils are appropriately placed and the tubes are blocked. If both tubes have become successfully blocked, the patient can stop using back-up birth control.
What are the chances of becoming pregnant after having the procedure?
The overall success rate for this procedure is very high, according to Dr. Hur; the chance of becoming pregnant after having the procedure is about 1% or less. The greatest failure rates occur among patients who do not use alternative birth control during the three months after the procedure.
What are the benefits?
"This procedure has many benefits," says Dr. Hur. "It is a much shorter procedure, there are no incisions, and it just requires a three-month follow-up to make sure the tubes are scarred. At BIDMC, we now offer this procedure in the office, so it's much easier for the patient."
Dr. Hur believes that with the growing number of cesarean deliveries, this approach to permanent sterilization will become more important, since laparoscopic tubal ligations may become increasingly difficult to perform due to adhesions formed after cesareans.
Are there any risks?
"Like any procedure, there are inherent risks such as a failed-procedure infection, but these risks are rare," says Dr. Hur. "This procedure is less invasive than the other (tubal ligation) procedures that exist."
Dr. Hur points out that hysteroscopic sterilization doesn't protect against STDs, and because it's considered permanent, the patient should be absolutely certain she will not want to get pregnant in the future. It is also important to know that patients with nickel or contrast-dye allergies are not candidates for this procedure.
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Posted July 2010