Published in UAB Insight, Summer 2008
Procedure Offers Safe, Effective, Permanent Birth Control
Essure hysteroscopic sterilization provides permanent birth control via placement of a small, flexible micro-insert device into each fallopian tube. "The Essure procedure offers women a viable alternative to traditional permanent sterilization," says UAB gynecologist Todd R. Jenkins, MD. Essure requires no general anesthesia or incision, can be performed in an office setting, and has a short recovery time, with most women able to resume normal activities within 24 hours, he says.
Jenkins began performing the procedure in March 2003. UAB Division of Women's Reproductive Health physicians Kimberly H. Hoover, MD, Laura Lee Joiner, MD, Dee R. Denson, MD, and Cheré L. Stewart, MD, also are skilled in use of the technique. Available worldwide since the 1990s, Essure was approved for use in the United States by the Food and Drug Administration in 2002.
The Procedure
The Essure micro-insert is composed of a stainless steel inner coil, a nitinol, super-elastic outer coil, and polyethylene fibers. Physicians use a hysteroscope to insert the device through the uterus into the fallopian tube. When released the micro-insert expands to conform to the anatomy of the tube. The procedure takes less than 20 minutes, Jenkins says.
Patients must use an alternative form of birth control for the first 3 months after the procedure. "During this time a benign inflammatory response occurs that results in fibrous tissue ingrowth that anchors the device in place and fully occludes the fallopian tube," he says.
Patients return 3 months postprocedure for a low-pressure hysterosalpingogram to confirm correct micro-insert placement and complete occlusion of the fallopian tube.
Clinical outcomes reported in studies of women using the Essure sterilization method found 96% of participants with correctly placed devices achieved bilateral tubal occlusion at 3 months, with 99.5% reaching tubal occlusion at 12 months (Curr Opin Obstet Gynecol. 2007;19:325-330). Device placement has a 5% failure rate that is usually caused by scarring from previous tubal infections or surgery, Jenkins says.
"The procedure is effective in women who adhere to the placement protocol, including using an alternative form of birth control for the first 3 months and undergoing a confirmatory hysterosalpingogram," he says. "Contraceptive failures usually result from poor adherence with the protocol rather than device failure."
Possible side effects include irregular spotting or mild cramping. The Essure device is not recommended for women with sensitivities to the hysterosalpingogram contrast medium or nickle, those with an active or recent pelvic infection, or women who have undergone tubal ligation.
"The Essure device is a safe, effective procedure for women seeking permanent sterilization," says Jenkins. "Because surgery and general anesthesia are not needed, it is an excellent option for obese women, for patients with significant pulmonary problems, and for those taking anticoagulants or immunosuppressive drugs."
FOR MORE INFORMATION:
Dr. Todd Jenkins
1.800.UAB.MIST
mist@uabmc.edu