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 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 a very effective and entirely incisionless method of sterilization that enables women to recover quickly,” Dr. Hye-Chun Hur, Director of the Division of Minimally Invasive Gynecologic Surgery at Beth Israel Deaconess Medical Center. “It was FDA-approved in 2002, and is gaining popularity.”


Hysteroscopic sterilization works by placing tiny coils within the fallopian tubes. The coils cause scarring in the tubes, which permanently blocks them. And, unlike other forms of female sterilization, this procedure does not require any incisions or general anesthesia.


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.


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 hysterosalpingogram, where dye is injected into the uterus and an X-ray is taken to make sure that the coils are appropriately placed. If the hysterosalpingogram confirms that both coils are appropriately placed, the patient can stop using back-up birth control.


The overall success rate for this procedure is very high, according to Dr. Hur; the chance of becoming pregnant after having the procedure is less than one percent. The greatest failure rates occur among patients who do not use alternative birth control during the first three months after the hysteroscopic sterilization procedure.


“This procedure has many benefits,” says Dr. Hur. “It is a much shorter procedure with a faster recovery, there are no incisions, and it does not require general anesthesia. 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 vaginal incision-less approach to permanent sterilization may become a more valuable option to patients. Patients can avoid another abdominal procedure, and laparoscopic tubal ligations may pose greater risk to the patient due to adhesions formed after multiple cesareans.


Are there any risks?


“Like any procedure, there are inherent risks, such as a failed procedure, uterine perforation, infection, and other procedure-related risks, but these 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 is 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.


Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.