Essure Tubal Sterilization

There has been a good bit of advertising recently about the Essure method of tubal sterilization. Essure is not new, and has been on the market for a number of years. The Essure method of sterilization  requires placement of a device in each tubal opening, where it opens into the uterus.  An inflammatory response by your body causes the tube to gradually scar shut. 

This process takes three to six months, sometimes longer. The Essure devices are placed into the tubal openings through the vagina using a special hysteroscope.  A hysteroscope is a thin fiberoptic scope used to look into the uterus. When placed properly, and checked by hysterosalpingogram (HSG), the method is permanent, involves no incisions, and has very few failures. 

Hysterosalpingograms are X-Ray tests most commonly used to check to see if your tubes are open, and are a part of infertility testing. With regard to the Essure, the HSG is used to check and make sure the tubes are completely blocked.

Advantages of Essure:

     1. No abdominal incisions are required.
     2. Very low failure rate (pregnancy)
     3. Can be performed in the doctor's office setting.

Disadvantages of Essure: long time for sterilizaiton, need HSG to prove effectiveness.

     1.  Failure to place the devices properly. ( up to 10% of the time)
     2.  Requires 3 to 6 months to be effective
     3.  Requires additional procedures to show the tubes are blocked. (HSG)
     4.  Basically irreversible, the corner of the uterus and beginning of the tube are damaged beyond reversal.
     
The major problem with Essure as I see it is that it requires additional painful and expensive procedures to be performed to prove that it has worked effectively.  Failure to properly place the devices in up to 10% of patients means that  those patients pay for the procedure, go through the risk of the procedure, and wake to find they are not sterilized. 

The more traditional method of sterilization involves blocking the tubes either shortly after having a baby or at any other time using a laparoscope. (A fiberoptic scope placed in the base of the bellybutton to look into the abdomen)  Failure rates (pregnancy) vary depending on the different methods used to "tie your tubes", but may be as high as 1 out of 100. Many failed laparoscopic tubals result in ectopic or tubal pregnancies. The major advantage of a laparoscopic tubal is that tubal sterilization is accomplished in virtually all patients, and that the doctor has the opportunity to examine the entire interior of the pelvis. 

This gives the opportunity to discover, diagnose and potentially treat conditions that would otherwise only be suspected. It is also often very helpful to know that those conditions are not present. The laparoscope is usualy only 5 millimeters in diameter ( 1/5 th of an inch) and two punctures are needed.  You should go home after several hours with two bandaids to cover the incisions.  Most can return to work in 48 hours. The major disadvantage to laparoscopic tubal is that it requires outpatient surgery in a surgery center or hospital, and thus is probably more expensive.
 
There are risks involved in both procedures, and the risks are different. The potential for major complications with laparoscopy is small, but is real. 

In summary, there is no perfect form of sterilization. Before considering Essure, make sure you understand the time delay involved in achieving sterility, and the expense, time and pain involved in HSG to prove that the procedure worked. Before having a laparoscopic tubal make sure your doctor considers you to be a low risk woman for laparoscopy, and has experience with performing laparoscopy.  With either method if you wake up and you are late on your period and feel pregnant... run a pregnancy test. If it is positive, call your doctor immediately.

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