Would you recommend the permanent sterilization procedure Essure, which involves insertion of flexible coils to create blockage of the fallopian tubes, over tubal ligation? Have there been any reports of severe infection or rejection of the coils?

Introduced in 2002, Essure consists of flexible “micro-inserts” placed in the fallopian tubes via hysteroscopy under paracervical block or minimal sedation. During the 12 weeks post placement, benign adhesions form, blocking the tubal lumen and inducing permanent sterilization (which must be confirmed by hysterosalpingography).

Published reports indicate no major complications to date from the Essure device or the placement procedure. Essure carries less overall risk than tubal ligation, as no incisions are made and general anesthesia is not required. Most tubal ligations are done laparoscopically or as a mini-laparotomy and carry a small risk of bowel, bladder, or vessel injury. Complications occur in approximately 1% of these surgeries and are usually related to anesthesia. Postsurgical infection is also a risk. For women who are already undergoing pelvic surgery (e.g., cesarean section, salpingectomy, or resection for ectopic pregnancy), concurrent tubal ligation is a convenient option that poses virtually no additional risk and can be an excellent choice for appropriately counseled women. Given the increased risk from surgery among obese patients, Essure may become an even more popular option for permanent sterilization as obesity rates rise. With Essure, the main risks are hypervolemia, perforation, and expulsion of the inserts; all occur in fewer than 3% of patients. Some women experience minor adverse effects from the hysteroscopy procedure (e.g., cramping, dizziness), but the literature reveals no reports of severe infection.

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Vasectomy may also be a low-risk and useful option for some couples and should be considered and discussed when appropriate. For some women, especially younger women who may be more likely to regret choosing permanent sterilization, such long-term reversible contraceptives as intrauterine systems and subcutaneously released hormones (Implanon) provide birth control of comparable efficacy to sterilization.
—Lisa Stern, APRN