Hysteroscopic Sterilization Explained

Surgical sterilization is a safe, highly effective, permanent, and convenient form of contraception. The most common surgical sterilization procedure for women is called a tubal ligation or having the “tubes tied.” The fallopian tubes are the passageway for the egg to travel from the ovary to the uterus.

This is where the egg becomes fertilized by the male’s sperm prior to traveling to the uterus. In tubal sterilization, the fallopian tubes are either cut and separated or they are sealed shut. This prevents the egg and sperm from meeting and thus prevents pregnancy.

Sterilization may be performed in one of several ways, depending upon where the procedure is done (office versus operating room) and when it is done (after childbirth or at another time).

  • Laparoscopic sterilization is done in the operating room any time other than after childbirth. It requires general anesthesia. (See ‘Laparoscopic sterilization’ below.)
  • Minilaparotomy is performed in an operating room, using general or regional anesthesia, often one to two days after a woman gives birth. (See ‘Minilaparotomy’ below.)
  • Hysteroscopic sterilization may be done in the office or operating room and is done at a time other than after childbirth. Hysteroscopic sterilization is often done with only local anesthesia, though sometimes sedation is also given.

What is tubal sterilization?

Sterilization procedures for women are called tubal sterilization. Tubal sterilization involves closing off the fallopian tubes. Tubal sterilization prevents the egg from moving down the fallopian tube to the uterus and prevents the sperm from reaching the egg.

Does tubal sterilization protect against sexually transmitted diseases?

Sterilization does not protect against sexually transmitted diseases, including human immunodeficiency virus (HIV) (see the FAQ How to Prevent Sexually Transmitted Infections (STIs)).

What is hysteroscopic sterilization?

Hysteroscopic sterilization is a type of tubal sterilization procedure that uses the body’s natural openings to place small implants into the fallopian tubes. These implants cause tissue growth that blocks the tubes. No surgical incision is needed.

How effective is hysteroscopic sterilization in preventing pregnancy?

Less than 1 woman out of 1,000 will become pregnant within 5 years of having the procedure.

How is hysteroscopic sterilization performed?

Hysteroscopic sterilization involves inserting a tiny device into each fallopian tube with a hysteroscope. The hysteroscope is an instrument that is inserted through the vagina and cervix and then into the uterus.

It allows the inside of the uterus and the tubal openings to be seen. Once the devices are in place, scar tissue forms around them.

Is hysteroscopic sterilization effective right away?

No. It takes about 3 months after the procedure for the tubes to become completely blocked by the scar tissue. While the scar tissue is forming, it is possible to become pregnant.

After 3 months, an X-ray procedure called hysterosalpingography (HSG) is done to make sure that the fallopian tubes are blocked. A backup birth control method should be used until an HSG test result confirms that the fallopian tubes are blocked.

Advantages and Disadvantages of Hysteroscopic Sterilization:

Advantages of hysteroscopic sterilization over sterilization via laparoscopy or laparotomy are:

  • No incision;
  • Can be performed in an office setting so it is more cost- and time-effective;
  • Minimal to no anesthetic requirements;
  • Less post-operative pain;
  • Can be performed in women with extensive pelvic adhesions;
  • Can be performed in women with co-morbidities that preclude laparoscopy or laparotomy.

Disadvantages

  • Need for contraception for 12 weeks post-procedure (until tubal occlusion is confirmed);
  • Expense of device and imaging study to confirm tubal occlusion;
  • Higher risk of unilateral tubal occlusion;
  • Electrical conductivity of micro-insert limits the use of electrocautery during subsequent pelvic procedures (eg, endometrial ablation);
  • Need for adequate vaginal surgical training to minimize potential complications.

Hysteroscopic Sterilization Device

The only form of transcervical sterilization approved for use in the United States is the Essure® micro-insert device; it is also used in many other countries.

The device is a metal and polymer micro-insert 4 cm long and 1 to 2 mm wide when deployed. It consists of an inner coil of stainless steel and polyethylene terephthalate (PET) fibers and outer coil of nickel-titanium (nitinol). It comes loaded in a single-use delivery system.

The device is placed under hysteroscopic guidance in the proximal fallopian tube. The coil initially is in a tightly wound state and then is deployed to an expanded state that anchors the insert in the tube.

After placement, the PET fibers stimulate benign tissue growth that surrounds and infiltrates the device over the course of several weeks, resulting in tubal occlusion.

Twelve weeks after placement, a hysterosalpingogram (HSG) is performed to confirm tubal occlusion. Contraception must be used until satisfactory micro-insert location and bilateral tubal occlusion are confirmed.

Contraindications

Contraindications to hysteroscopic sterilization include:

  • Pregnancy or suspected pregnancy;
  • Less than six weeks from a delivery or abortion (spontaneous or induced);
  • Uncertainty about non-reversible sterilization;
  • Active or recent pelvic infection;
  • Uterine or tubal pathology that impedes access to one or both tubal ostia;
  • Hypersensitivity to nickel confirmed by skin-test;
  • Known allergy to contrast media (not able to undergo HSG to confirm tubal occlusion).

Where is hysteroscopic sterilization performed?

This type of sterilization often can be performed in your health care provider’s office with local anesthesia. A drug to make you drowsy may be given as well. It also can be done in an operating room with general anesthesia.

What are the benefits of hysteroscopic sterilization?

Hysteroscopic sterilization uses your body’s natural openings and does not require incisions in your skin. It can be done with local anesthesia. For these reasons, recovery from hysteroscopic sterilization usually is quicker than from other types of sterilization.

What are the risks of hysteroscopic sterilization?

Hysteroscopic sterilization has the following risks:

It may not be possible to place the devices in one or both fallopian tubes. Even when the devices are placed in both tubes, there is a risk that one or both tubes will not become completely blocked.

In either case, the procedure cannot be relied on for birth control.

There is a risk of injury to the uterus or fallopian tubes injury during the procedure. If this happens, the device can move out of place and embed itself in the abdomen.

Surgery may be needed to remove the device.
Pregnancy is uncommon after any type of sterilization procedure.

However, if it does occur, there is a higher risk that it will be an ectopic pregnancy. Ectopic pregnancy can be a medical emergency.

In rare cases, women report pain that does notgo away after having hysteroscopic sterilization. If this happens, the devices can be removed using hysteroscopy or laparoscopy.

What can I expect after hysteroscopic sterilization?

Most women are able to resume normal activities within 24 hours. Some women do have discomfort during the procedure or for up to 1 week afterward. Side effects may include the following:

  • Pain (similar to that of menstrual cramps)
  • Nausea and vomiting
  • Dizziness and light-headedness
  • Bleeding and spotting

Source & More Info: Women’s Health Section, Up To Date and acog.org

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