Couples looking for permanent contraception now have a new option other than tubal ligation or vasectomy. Doctors at the University of Maryland Medical Center are among the first in the area to offer Essure, a non-surgical procedure for women that involves placing small coils in the fallopian tubes. Over time, scar tissue develops around these coils, which blocks the fallopian tubes and prevents conception.
"This procedure will revolutionize permanent birth control because it is less invasive than tubal ligation or vasectomy," says Richard Marvel, M.D., a gynecologist at the University of Maryland Medical Center and an assistant professor of obstetrics, gynecology and reproductive sciences at the University of Maryland School of Medicine. "What's so exciting about this procedure is that you don't need to make any incision. After the procedure, patients can go home or even go back to work."
While a tubal ligation requires general anesthesia, the Essure procedure is done with local anesthetic. During the procedure, doctors use a thin, telescope-type instrument called a hysteroscope and insert it through the cervix to reach the fallopian tubes. A camera on the end of the scope allows them to see into the uterus. Doctors place a small, soft coil in the fallopian tube, where it expands and fills the tube. Doctors then move to the other side to place another coil in the other tube. The entire procedure takes less than 30 minutes.
While the procedure itself is quick, it takes longer for the scar tissue to develop and permanently block the tubes. Women must use another form of contraception for at least three months. They also need to return 12 weeks after the procedure to have a special x-ray to confirm that the tubes are closed.
"Studies of the procedure have found that at three months, 96 percent of the women's tubes were closed and 100 percent were closed at six months," explains Dr. Marvel. In clinical trials involving more than 600 women, there were no pregnancies following the procedure. As with other birth control methods, the Essure system is not expected to be 100 percent effective; however the manufacturer cites a 99.8 percent effectiveness rate in two years of follow up.
Tubal ligation remains the most popular form of contraception in the United States with an estimated 700,000 procedures every year. The procedure involves cutting, sealing, or placing bands or clips around the fallopian tubes. Each operation requires cutting into the abdomen and a four to six day recovery period. Even laproscopic surgery with just small incisions carries a small risk of damage to the bowel, bladder, blood vessels and nerves. Many women express concerns about tubal ligation because of the anesthesia, the incision and recovery time.
The new Essure method, which received FDA approval in November 2002, provides a less-invasive alternative for these women: there's no incision and it will eventually be performed in a doctor's office. Costs will likely be the same as a tubal ligation, and most insurance companies will cover the procedure as they do with other sterilization procedures for both women and men.
For couples considering vasectomy as a form of permanent birth control, Essure may be considered a less-invasive alternative because it does not require an incision. More than 400,000 men have a vasectomy each year in the United States. During a vasectomy, doctors clamp, cut or seal off each vas deferens tube (the tube through which sperm passes) in order to prevent the release of sperm.
Women who choose the Essure system must understand that it is irreversible, so they need to be certain in their decision to have permanent contraception. Essure does not protect against HIV and other sexually transmitted diseases. It will not affect menstruation or menopause.
"I honestly think Essure will revolutionize permanent contraception for women," says Dr. Marvel. "This is a procedure that can be done in an office setting in under 30 minutes using local anesthesia without an incision."
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