October 7, 2010

Female sterilization procedures now available in clinic

Female sterilization procedures now available in clinic

A close-up view of the Essure sterilization device. (Photo by Joe Howell)

A close-up view of the Essure sterilization device. (Photo by Joe Howell)

Unlike traditional laparoscopic tubal ligation procedures, which require abdominal incisions to block or remove portions of the fallopian tubes, the two non-reversible procedures – Essure and Adiana – rely on a small scope passed through the cervix and into the uterus to block the tubes. The procedure can be performed as early as six weeks postpartum.

In the Essure procedure, approved by the Food and Drug Administration in 2002, a soft, flexible coil is placed partially into the fallopian tubes.

The Adiana technique, approved by the FDA last year, uses radiofrequency and a tiny silicone plug, about the size of a grain of rice. Vanderbilt’s Ted Anderson, M.D., Ph.D., associate professor of Obstetrics and Gynecology, was involved in Adiana’s clinical trials.

Both can be performed in clinic procedure rooms instead of operating rooms and usually take less than 12 minutes.

Tamara Callahan, M.D., M.P.P.

Tamara Callahan, M.D., M.P.P.

“Laparoscopy has been great, but it’s a bigger deal. There are 350,000 laparoscopic tubals done in operating rooms every year with up to a 3 percent complication rate – that’s 10,000 complications every year that could potentially be avoided. The bottom line, now, is we have something that’s highly effective, safer, and more convenient for the patient. There’s less down time – a day at the most, compared to four or five days.”

Prior to the procedure there is an injection of a local anesthetic into the side of the cervix to numb the area. There is minimal discomfort and most women can resume normal activities within a day.

Women who undergo the office sterilization must use another form of birth control during the three months following the procedure.
Three months after, an X-ray using dye is done to make sure the fallopian tubes are blocked.

Callahan said that although no birth control method is 100 percent effective, Essure is believed to be 99.74 percent effective and Adiana, 98.4 percent effective in preventing pregnancy.

The Centers for Disease Control and Prevention has estimated there are approximately 25 million women in the United States who have completed childbearing and would be candidates for permanent sterilization, Callahan said.

The Women’s Health Center also gets referrals from other specialties for women for whom pregnancy is considered to be life-threatening.

There are subtle features of each procedure that might lead a patient to choose one over the other. However, when either is done in the office, most insurance companies will only require an office visit co-pay for the procedure.

“These sterilizations get you up, out the door and going home usually only on ibuprofen,” Callahan said. “Most of the discomfort happens within a couple of hours after the procedure. There aren’t many things in life that are a win/win, but this is. You’ve just addressed a major issue in your life in an effective manner, and in most cases, you’re back to work the day after.”

Callahan said that it’s important to note that Ob/Gyn residents who are trained at Vanderbilt will leave their residency knowing how to do both procedures.

“As a teaching institution, this is huge. Here, many of our graduates go out into private practice. They want this skill set. We are creating leaders in women’s health.”