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QUESTIONS & ANSWERS
ABOUT TRANSCERVICAL STERILIZATION
A New Choice in Permanent Birth Control
Choosing a Birth
Control Method
Women and their partners now have more birth control
choices than ever. How do you choose the birth control method that is
best for you? Comparing how safe the methods are, how much they cost,
and how well they work may help you decide.
You also need to decide
between temporary and permanent methods of birth control. The factors
that influence this decision can change throughout your life. For a
woman who is very certain she will never want to have a child in the
future, a permanent birth control method may be a good choice. If a
woman is unsure about whether she may want to become pregnant at some
point—even though she doesn’t want to now—a temporary
method makes sense.
This brochure describes
permanent birth control, including a new permanent method for women.
It may help you decide if permanent birth control is right for you.
To make this decision,
you may find it helpful to talk with your partner, health care provider,
or both.
New Options in
Permanent Birth Control: Transcervical Sterilization
If you use a permanent birth control method, you cannot become pregnant
for the rest of your life. For women, permanent methods involve blocking
the fallopian tubes, which carry eggs from the ovaries to the uterus.
Once the tubes are blocked, the sperm cannot reach the egg to create
a pregnancy. For men, the permanent method is an operation called a
vasectomy, in which a doctor blocks the tube through which sperm passes.
Until recently, women who
wanted permanent birth control had only one choice: a surgical procedure
called a tubal ligation, also known as having their “tubes tied”.
In this procedure, the doctor cuts into the abdomen to reach the fallopian
tubes. Nearly onequarter of US women between the ages of 15 and 44 rely
on tubal ligations to prevent pregnancy.
Now a permanent birth control
method that does not require surgery is available—transcervical
sterilization. Transcervical means “through the cervix” (opening
of the uterus). Sterilization is another name for permanent birth control.
With transcervical sterilization, a doctor goes through the cervix and
into the uterus to reach the fallopian tubes. The tubes are then blocked
permanently to prevent pregnancy.
 Transcervical
sterilization has advantages over a tubal ligation. For many women,
it is very convenient because it is usually done in an outpatient setting,
which means most women will be able to return home within a couple of
hours, rather than spend the night in a hospital or other health care
facility. And the procedure takes only about 30 minutes.
In 2002, the Food and Drug
Administration (FDA) approved the first transcervical sterilization
method—micro-insert tubal occlusion (brand name Essure®)—in
the United States. Other methods are being developed and tested.
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“I
wanted to be sure I would not regret my decision about permanent
birth control. So I took a lot of time to look at other choices.
And then I talked to my health care provider. I knew I did not
want to have to remember to take a pill every day or change a
patch. I did find out that there are good long-term, temporary
birth control methods, such as the IUD, to consider. These methods
work just as well as sterilization if you
are unsure about permanent birth control.”
— MARIA K.,
AGE 34
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Questions and Answers
About Permanent Birth Control
Is permanent birth
control right for me?
When deciding about permanent birth control, it’s a good idea to:
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Discuss birth control
choices with your health care provider. Explore all your choices
for birth control, both temporary birth control methods—such
as the pill, patch, contraceptive vaginal ring, contraceptive injections,
and newer intrauterine devices (IUDs)—and permanent birth control
methods. Your partner may want to consider a vasectomy.
-
Avoid making the
decision in stressful times. A recent divorce or miscarriage and
other stressful events can lead to a decision you may regret later.
-
Choose a temporary
birth control method if there is any chance that you may want children
in the future. It is highly
unlikely that a permanent birth control method can be reversed.
-
Be aware that women
age 30 or younger are more likely than older women to regret having
had a permanent birth control method.
Ask yourself these questions:
- Do I know for sure I do not want children
or have all the children I want?
- Can I use or do I want to use temporary
methods of birth control?
- Do I want a permanent, one-time method?
- Do I have health problems that make
pregnancy unsafe?
- Do I want to enjoy sex without the
fear of accidentally getting pregnant any time in the future?
Does permanent birth control
affect female hormones?
No. Female hormones, which control a woman’s
menstrual cycle and sexuality, will not change. Your ovaries will continue
to make eggs until menopause; your body absorbs the unfertilized eggs.
Your menstrual cycle—and your desire for sex—will not change.
Also, permanent birth control does not cause an early menopause. 
Does permanent birth control
protect against sexually transmitted diseases or infections, such as chlamydia,
HIV infection, and gonorrhea?
No. If you are at risk for sexually
transmitted diseases or infections, you should ask your partner to use
a latex condom every time you have sex.
Transcervical Sterilization
With transcervical sterilization, the
doctor inserts a device or material into the fallopian tubes to block
them. To reach the tubes, the doctor uses a hysteroscope, which is like
a thin telescope. The hysteroscope is inserted into the vagina, then through
the cervix (the opening to the uterus), and into the uterus to the openings
of the fallopian tubes.
What are the advantages of transcervical
sterilization compared with tubal ligation?
- There are no incisions. With most
tubal ligations, the doctor makes one or two small cuts into the woman’s
abdomen to reach the two fallopian tubes and blocks or cuts them.
- Women generally have less discomfort.
- Women recover faster (some women even
return to work the same day). It often takes four to six days before
women can return to their normal activities after a tubal ligation.
- Women with certain medical conditions,
such as heart disease or obesity, can safely have this method. A tubal
ligation is often unsafe for women with these conditions.
- It can be performed in an outpatient
procedure.
- It is usually done with local rather
than general anesthesia.
- Most women receive general anesthesia
for the tubal ligation.
What are the
disadvantages of transcervical sterilization compared with tubal ligation?
- Women need to use another method of
birth control until their fallopian tubes are completely blocked. This
takes about three months. After this period, dye is injected into the
uterus and an X-ray is taken to make sure the tubes are blocked. NOTE:
The only type of birth control you cannot use during these three months
is an intrauterine device, also called an IUD.
- Because the method is new, it is not
known if there are long-term risks.
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“After
I decided on permanent birth control, I chose transcervical sterilization
over tubal ligation. I needed to recover from the procedure quickly.
I had three young children to take care of.”
— LUCY S., AGE
40
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How do I know if transcervical sterilization
is a good choice for me?
It may be a good choice if:
- You are willing to use another birth
control method for the
first three months after the transcervical procedure.
- You are willing to return to where
you had the method done to find out if your fallopian tubes are fully
blocked.
- You have a medical condition, such
as diabetes or a heart condition, and you have been told to avoid general
anesthesia or surgery where you have to be cut open.
- You have had more than one abdominal
surgeries, including c-sections.
However, this may not be the best method
for you if:
- You have uterine or tubal disease.
- You are uncertain about never becoming
pregnant again or ever becoming pregnant.
- Feel uncomfortable about having a device
or materials inserted into your fallopian tubes.
- Your health care provider has told
you that there is something unusual in the way your fallopian tubes
or other organs are shaped.
- You have been told you are allergic
to the contrast dye that is used to make sure the method is working.
Micro-Insert Tubal Occlusion—a
Transcervical Sterilization Method
Micro-insert tubal occlusion
is the first transcervical sterilization method approved by the FDA. Micro-insert
refers to a very tiny spring the doctor puts into the fallopian tubes.
Tubal occlusion means blocking the fallopian tubes. With this transcervical
method, the doctor puts a micro-insert into each of the fallopian tubes.
This method takes about 30 minutes. Scar tissue then develops around the
micro-insert and completely blocks the tubes over the next three months.
What does
it feel like to have the micro-insert tubal occlusion method?
Before the doctor inserts the micro-insert, medicine is injected around
the area of the cervix to make this part of your body numb, so you do
not feel discomfort or pain except some minor cramping in your abdomen.
After the doctor has inserted the micro-insert, you may continue to feel
cramping, have some mild nausea or vomiting, and feel lightheaded.
How is the
micro-insert tubal occlusion method done?
Step 1: The doctor inserts a
thin, telescope-type instrument called a hysteroscope into the vagina,
through the cervix,  and
into the uterus to reach the fallopian tubes. A camera is on the end
of the hysteroscope to let the doctor see into the uterus.
Step 2: The doctor places the
micro-insert into the opening of the fallopian tube through the hysteroscope.
The coil expands and fills the opening. The doctor then does the same
thing to the other tube.
 Step
3: The lining of the tubes grows into the material in the coils,
completely and permanently blocking the tubes. This takes about three
months, so you need to use another method of birth control (except an
IUD) during this time.
Step 4: After about three months,
your doctor will do a special X-ray test to make sure the microinserts
are in the right position and that your tubes are blocked, which means
the method is working. With the test, dye is injected into your uterus
so an X-ray picture can be taken.
What is the
recovery time for the micro-insert tubal occlusion method?
Most women leave the medical facility about 45 minutes after having
this method and return to their normal activities the same day or within
one to two days.
Very rarely, usually because of an unusual
shape or position of the uterus or fallopian tubes, or because of technical
problems during the procedure, placement of the micro-insert may be difficult
or impossible.
How well does
micro-insert tubal occlusion protect women from becoming pregnant?
To date, no pregnancies have been reported from any of the women who were
studied in the United States for one to two years after having this method.
As with other types of tubal sterilizations, there is a slight risk that
the method may not work even if the X-ray shows that the tubes are totally
blocked, so you could become pregnant. Women who do become pregnant after
having the micro-insert method may be more likely to have an ectopic pregnancy
(a pregnancy that occurs outside of the uterus, usually in the tubes).
How safe is
micro-insert tubal occlusion?
Studies have shown that this method is safe. However, as with most birth
control methods, there are risks. There is the possibility that the doctor
may not be able to place the coils in the fallopian tubes the first time
and may need to try it again at a later date. After the coils are placed
in your tubes, you may have some pain and light bleeding.
Who should not
have any transcervical sterilization method?
A woman should not have any transcervical
sterilization method if she:
- Is pregnant or thinks she may be pregnant.
- Has had a baby, a miscarriage, or
an abortion within six weeks before the transcervical method.
- Has an active or has had a recent
pelvic infection.
- Has a uterus or fallopian tubes that
are an unusual shape or in an unusual position.
- Has had a previous tubal ligation.
A woman should not have the micro-insert
occlusion method if she:
- Is allergic to the dye that is used
for the X-ray.
- Is sensitive or allergic to nickel.
If you do not know, you can have a skin test to find out.
- Does not want to or cannot use another
method of birth control for at least three months after this method
is started.
- Does not want to or cannot return to
have a special X-ray test about three months after having the procedure
done.
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