This page contains information on:

• Introduction
• History of Contraception
• Oral Contraceptives
• Contraceptive Patches
• Contraceptive Rings
• Depo-Provera "The Shot"
• IUDs
• Mirena 
• ParaGard
• Implanon
• Barrier methods
• Condoms
• Diaphragms
• Permanent Sterilization 
• Hysteroscopic Tubal Occlusion(HTO) with Essure System
• Laparoscopic Tubal Ligation(BTL)

Introduction
The development of modern contraceptives offers women the ability to avoid unwanted pregnancies with a degree of reliability and safety unmatched in human history.

Until the 1960s few contraceptive options were available aside from condoms and diaphragms. These methods, unfortunately, had one common flaw—their lack of spontaneity. Because the use of condoms and diaphragms requires some degree of discipline and planning many couples find them annoying and elect to occasionally "skip" their use—often resulting in an unplanned pregnancy. The reality is simple-- the "heat" of the sexual act isn't a good time to "plan" anything. Remember, the "plans" you make at your doctor's office in the midst of an anxiety-provoking office visit might not reflect the reality of how you'll behave on Friday night with a few beers and the "man of my dreams".

The introduction of oral contraceptives in 1960, the intrauterine device in 1962, Depo-Provera (1992), the contraceptive patch (2001), the contraceptive ring (2001) and relatively simple and safe methods of permanent sterilization now offer women a vast array of contraceptive options that are reliable, safe and spontaneous.

No method of contraception is risk free. However, one must consider that whatever the risks of a particular method of contraception might be, those risks are small compared to the risks of an unplanned pregnancy. Sexual activity is not risk free. The safe and responsible management of those risks requires a commitment to understanding what these methods can and cannot offer.

Remember that contraceptives are designed to protect against pregnancy. By and large they do not guarantee safety against sexually transmitted disease or spare you the emotional pain of making poor decisions about sexual relationships.

One last thought. Once you enter the arena of sexual activity you assume certain risks. Your job, along with the guidance of a knowledgeable health care provider, is to minimize those risks. Over the years I've crossed paths with hundreds of women who stopped their birth control pills because a "friend" told her that they were dangerous or her mother told her that she shouldn't take birth controls pills and smoke cigarettes. However well-meaning the advice might have been it was generally the wrong advice because it didn't consider the "cost" of not using a reliable method of contraception. It isn't ideal for a woman over 35 years old who smokes to also take oral contraceptives—but before you stop those pills use another method or consult a health care provider who can help you avoid an unplanned pregnancy! Remember that your well-meaning friend won't have to live with the outcome of poor advice—you will.

Looking at "risk"

Experience has shown that when it comes to judging risk, people often focus on the "wrong" things. Studies have shown that parents often believe that having their child visit a friend whose parent keeps a firearm in their home is prohibitively dangerous. But the very same parents might not think twice about sending their daughter or son to the neighbor's home with an outdoor pool. The reality, however, is that each year 12 times more children die of drowning than accidental gun accidents!

Women often avoid the use of a particular method of contraception – intrauterine device, Depo-Provera, birth control pills—because of their perceived "risk" of that method of contraception. Often the conversation begins with "I heard that they cause cancer", "I heard they cause infertility", or "I heard there are risks of heart attacks". My personal favorite is "I heard that smoking while taking the birth control pill is bad for you".

Here's the point. The reality is that smoking and the birth control pills isn't good for you—the real danger being smoking! The problem isn't the pill. The combined risk of taking birth control pills and smoking, however, is far less than the risk of an unplanned pregnancy which includes the risk of continuing a pregnancy or having it terminated.

In other words the risk of any form of contraception must be weighed against the risk of not using a reliable method of contraception and becoming pregnant.

We all need help in assessing the best possible choices for our health care. Please seek that advice from a qualified professional.

Oral Contraceptives

In 1960, after more than a decade of research, the US Food and Drug Administration (USFDA) approved the first birth control pill (BCP)marketed by G.D. Searle and Company-- Enovid-10. That pill contained 9.85 milligrams (mg) of the progestational hormone norethynodrel and 150 micrograms (µg) of the estrogenic hormone mestranol—about 10 times the progestin and 5-6 times the estrogen contained in most of today's pills. The "pill" of almost half a century ago was very different from today's oral contraceptive. The original oral contraceptives caused tremendous bloatedness, breast swelling, nausea, vomiting and was associated with a small incidence of dangerous and life threatening blood clots. The early pills required high doses of estrogen because they worked primarily by suppressing a woman's ability to ovulate. Today's pills, by contrast, work by a variety of means that are quite effective while allowing much lower doses.

Just consider some of the more common pills used today and their estrogen content

For a more complete listing Click Here 

Throughout the 1960s and 70s the dose of pills diminished dramatically—from 150 mcg to 80 mcg, to 50 mcg and then to 35 micrograms. Today, many pills contain 20 micrograms of estrogen. Scientists discovered that while the lower dose pills did not necessarily prevent ovulation they were still effective because of their ability to inhibit fallopian tube motility, cause thinning of the uterine lining and make cervical mucous impenetrable by sperm..

Many, many formulations of pills have occurred since then--among them:

• Pills that contain a fixed amount of estrogen for half the cycle and another fixed amount for the other half of the cycle (biphasic pills).
• Pills that divide the cycle into 3 parts with differing amounts of estrogen in each of the 3 parts (triphasic pills)
• Progestin only birth control pills (mini-pills)
• Ultra-low dose pills (20 micrograms of estrogen)
• Pills that offer a menstrual period only 4 times a year.

Advantages of Oral Contraceptives

One of the most important advantages of oral contraceptives is the simple fact that it is a spontaneous form of contraception. The others "spontaneous" methods of contraception include contraceptive patches or rings, intrauterine devices, Depo-Provera, Implanon, and permanent sterilization. Unfortunately, while the barrier methods of contraception – condoms and diaphragms –offer excellent protection against pregnancy and many STDs they often go unused unless couples are diligent in their efforts. In addition, there are many "non-contraceptive benefits" that are listed below.

Effectiveness

Today's pills are about 97-98% effective. About 2-3 women out of a hundred will become pregnant each year despite proper use of the pill. Pill failures are seen disproportionately in greater numbers in very young women (ages 15 – 25). For that reason it may be worthwhile avoiding ultra-low-dose pills in this age group.

Non-contraceptive benefits

Women who take the pill often report lighter menses, associated with less cramping. The decreased bleeding helps to prevent or improve iron deficiency anemia. Many women report an improvement in overall moods, though some women clearly experience depression and agitation while taking OCPs. Women who experience painful ovarian cysts often find that these symptoms also improve on the birth control pill. Long term studies also suggest that women who take OCPs have a lower incidence of ovarian cancer later in life. Some other non-contraceptive benefits include a decrease in uterine (endometrial) cancer and a decrease in postmenopausal hip fractures. Many women report significant improvement of facial acne and even the pain associated with endometriosis. Lastly, the pill is often used to control migraine headaches and appears quite effective in selected women. Nonetheless, there are also women whose headaches worsen while taking OCPs.

The oral contraceptive as a "morning after pill"

One of the lesser known yet important effects of the birth control pill is that it can be taken in a special "off-label" use – not approved by the FDA – in order to prevent a pregnancy if taken within 72 hour of unprotected sex. If you plan on using the pill for this purpose you definitely need to discuss it with your health care provider.

Unwanted side-effects

Women often attribute weight gain to the pill. In fact, many studies have shown that modern birth control pills are responsible for minimal (1-2 pounds), if any, weight gain. Many women discontinue their oral contraceptives and switch to another non-hormonal method of contraception only to discover that they continue to gain weight—clearly the result of something other than the pill.

Some women experience mild-nausea in the first few weeks of taking oral contraceptives. Other women have scant or absent periods (amenorrhea) and find this troubling as it raises a concern about whether or not they're pregnant. Still others have inter-menstrual spotting or bleeding.

Major side-effects

Although the incidence of major pill-related side effects is small it is worthwhile mentioning that the pill can, rarely, cause blood clots in the veins of the lower extremities, pelvic veins and even the brain. Women who have known disorders that increase the likelihood of a clot should not take the pill. This includes women with:

• a history of a deep vein thrombosis or pulmonary embolus
• Protein S deficiency
• Protein C deficiency
• antithrombin deficiency
• Factor V (Leiden) mutation
• a smoking history who are over 35 years of age.

http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601050.html

http://www.fwhc.org/birth-control/thepill.htm

Is it okay to take a pill in such a manner that I only get 3 or 4 periods a year?

Although only two contraceptive pills—Seasonale and Seasonique have been approved for use in this manner, the same can be achieved with most contraceptive pills. Seasonale contains 91 pills—84 pink pills that contain 30 mcg of ethinyl estradiol and 0.15 mg of levonorgestrel each; the remaining 7 white pills are inert. Seasonique also contains 91 pills—84 light blue-green tablets that contain 30 mcg of ethinyl estradiol and 0.15 mg of levonorgestrel each; the remaining 7 pills contain 10 mcg of ethinyl estradiol. If you check the table below you'll see that Seasonale is nothing more than a re-packaging of the exact same hormones in the exact quantities found in Levora, Levlite and Nordettes—all of which are available as a generic!

These pills work well. The only concern is that if you only have a period 4 times a year you could potentially be pregnant and be entirely unaware of it for an additional 2 months compared to a pill that allows you 13 menstrual periods a year.

Contraceptive Patches                             

         

The contraceptive transdermal patch was approved by the FDA in 2001 (Ortho Evra). The "patch" offers a different means of obtaining the hormones that are contained in birth control pills. Its main advantage lies in the fact that it can be placed on the skin and requires only a weekly patch change. Each patch is equivalent to a week of oral contraceptives—typically 3 patches are required per cycle. The patch allows for the release of approximately 20 microgram per day of ethinyl estradiol and 150 micrograms/day of norelgestromin or about the same as a low dose birth control pill.

The side effects of the patch are similar to that of oral contraceptives. Any weight gain associated with the patch is minimal. Most women experience a decrease in menstrual flow and associated cramps while using the contraceptive patch.

The contraceptive patch has been shown to be less effective in women who weigh more than 200 pounds. If you are approaching or have exceeded this weight you should consult your health care provider before relying on it.

                         
Contraceptive Ring

The NuvaRing is the only contraceptive ring approved by the FDA (2001). It is a two inch diameter ring that is worn in the vagina for 3 weeks. The ring contains a combination of hormones similar to what is found in oral contraceptives or patches. The ring releases ethinyl estradiol 0.015 mg/day and etonogestrel 0.12 mg/day. Its advantage is that one ring lasts 3 weeks and is then removed for one week before inserting another one. The menstrual period will usually occur during the week when the ring isn't being worn.

How does the ring work?

The mechanism of action, contraceptive benefits, non-contraceptive benefits, side-effects and effectiveness is equivalent to most oral contraceptives and patches. The only real difference is that the hormones are absorbed directly through the vaginal lining (mucosa) into the blood stream without having to be taken orally or by a skin patch.

Are there any benefits of using NuvaRing?

The real benefit is that it is very discreet and private (unlike a patch) and requires only once a month administration (unlike a pill). Insertion and removal of the ring require that a woman insert her finger inside the vagina and therefore she must be comfortable touching her genitals and vagina. Like the oral contraceptive and patch, the contraceptive ring does not offer any protection against any of the sexually transmitted diseases. If for any reason, the ring is removed or slips out, it may be rinsed in cool water and reinserted. If it is out for three hours or more, there will be reduced contraceptive protection and an alternative method of birth control must be used until the ring has been in place for seven consecutive days. Emergency contraception is available if it is out three hours or longer.

Depo-Provera "The Shot"- Long Acting Progestin Contraception

     
Depo-Provera has been produced in the United States since 1969 but was not approved as a method of contraception until 1992. DMPA is a very safe and well-studied method of contraception whose major advantages are that it contains no estrogen and can be administered only 4 times a year eliminating some of the compliance issues associated with pills, patches and rings.

How does it work?

Depo-Provera works primarily by inhibiting ovulation. It also causes thinning of the uterine lining (endometrium) and thickening of the cervical mucus causing it to be less penetrable by sperm.

Non-contraceptive benefits

There are several non-contraceptive benefits of DMPA which include a decreased risk of endometrial cancer and pelvic inflammatory disease. Women who receive DMPA generally become amenorrheic (stop having their menstrual periods). Some women, especially those that have had a history of heavy and painful periods, select DMPA for this benefit alone.

Another non-contraceptive benefit of DMPA lay in its ability to reduce pain that may be caused by endometriosis. DMPA, in fact, is one of the oldest effective medical treatments for endometriosis.

Administration

Depo-Provera is only available as an injectable method of contraception. Some women can be taught to self-inject every three months—most, however, will require a visit to a health care provider.

Side effects

-Return to fertility is delayed—after discontinuing Depo-Provera it may take 6-10 months after the last injection to begin ovulation again making it possible to conceive.

-Irregular bleeding—most women taking Depo-Provera will stop having periods entirely (amenorrhea). Some women experience light but continuous spotting or bleeding. This is an uncommon but very annoying side effect.

-Weight gain—there is considerable debate about whether or not DMPA causes weight gain. Most controlled studies show its use is not associated with weight gain. However, many women do associate its use with considerable weight gain. Unfortunately, the vast majority of these women continue to gain weight long after discontinuing the use of DMPA suggesting that something else is at play.

-Bone loss—the prolonged use of DMPA may contribute to bone loss in some women. Women who are at risk for osteoporosis (click here) should be aware of this problem and may request testing for osteopenia or osteoporosis.



Intrauterine Device(IUD)

The "modern" IUD has been around since the early 1960s when the first plastic devices became available for the sterile insertion of a plastic or combination plastic and metal device into the uterus. These IUDs were in widespread use for about 15 years.

All of that changed with the 1970 introduction of the Dalkon Shield—an IUD introduced with the purpose of lowering the spontaneous expulsion rate associated with some of the earlier models. In 1973 the first reports began appearing associating the Dalkon Shield with an increased rate of pelvic infection. Despite the fact that the IUD was removed from the market in 1975 many that had already been placed were not removed until years late.

Many lawsuits followed and A.H. Robbins, the company that marketed the Dalkon Shield, was bankrupted. The unfortunately effect of all the publicity, however, was that a very good method of contraception was blamed for many problems—many of them undeserved.

How do IUDs work?

How IUDs function is not perfectly understood. The majority of researchers however believe that IUDs work by inhibiting sperm transport rather than acting to prevent a fertilized egg from implanting in the uterine cavity. The best available scientific information dispels the myth that the IUD is an abortifacient.

Are all IUDs the same?

There are two choices available today. 

             
The first, the Mirena IUD (Berlex Pharmaceuticals, Inc), is a plastic device embedded with the hormone, levonorgestrel. This particular IUD is designed to last 5 years (although it contains 7 years of hormone) but can be easily removed any time prior to that should a woman wish to conceive. The advantage of the Mirena IUD is that after 2 or 3 cycles women experience lighter and lighter periods—many women stop having periods altogether. The Mirena IUD is ideal for a woman who would like a spontaneous and safe method of contraception that is also seeking relief from otherwise heavy or painful menses and who wishes to avoid the inconvenience of a daily pill, a weekly patch or a monthly ring. Importantly, the Mirena contains no estrogen whatsoever! What little progesterone is in the IUD (about 20 micrograms per day) is largely confined to the uterus and causes only minimal levels of the progestin, levonorgestrel, in the blood stream.
www.mirena.com

The second IUD available today--ParaGard (Duramed Pharmaceuticals, Inc)—which is a device made of plastic and copper. This is a non-hormone containing IUD that can be left in place for 10 years.
www.paragard.com

Both IUDs are highly effective though the ParaGard does tend to cause an increase in menstrual blood flow.

Are there women who should not use the IUD?

There are very few women who cannot use the IUD. However, since the IUD can aggravate or incite pelvic inflammatory disease it should be avoided in women who have had a history of chronic pelvic inflammatory disease or a recent history of multiple sexual partners. A history of bacterial vaginosis is not a contraindication to its placement. There are very few absolute contraindications to the use of an IUD.

Is it painful to insert?

Many women have the IUD inserted without anything more than a small amount of local anesthesia. Many of our patients, however, elect to have some conscious sedation making this a completely painless procedure. You can discuss this choice with your health care provider.

Are there risks associated with the IUD insertion?

There a few risks associated with IUD insertion in experienced hands. All IUD insertions performed at our office are done under ultrasound guidance making uterine perforation a very rare occurrence. Infections can rarely occur after IUD insertion—particularly if a woman has an undiagnosed Chlamydia or gonorrhea infection. These risks are minimized by taking prophylactic antibiotics immediately after its insertion.

Can the IUD perforate the uterus once it's inserted?

There are many urban legends in medicine—one of them is that IUDs can move and perforate the uterus. Once an IUD in inserted it will not move through the uterine wall. A small percentage will be expelled through the cervix without causing harm.

How effective is the IUD?

IUDs are extremely effective. About 1 woman out of 100 using an IUD will become pregnant after the first year. The likelihood of pregnancy is somewhat lower in Mirena users than ParaGard users. The IUD is somewhat protective against an ectopic (tubal) pregnancy.

How soon after its removal can I get pregnant?

After removal of either the ParaGard or Mirena IUD return of normal fertility occurs within a cycle.

Summary

Intrauterine devices are among the safest methods of spontaneous contraception available to a woman who is in a mutually monogamous sexual relationship. The Mirena IUD has an added advantage inasmuch as it can be used to assist women who suffer heavy and painful periods. Both IUDs are very cost-effective. Presently the most expensive IUD averages out to 5 – 7 dollars a month--compare that to birth control pills that can cost between 20 and 45 dollars a month!   

Implanon (Implantable Single-rod Etonorgestrel-ENG)
                           

Implanon is a single-rod progestin implant that will be available in 2007. It is inserted through a small ¼" skin incision (generally the inside of the upper arm near the bicep) and allows for the slow release of a progestin (no estrogen)—etonogestrel. Protestion against pregnancy occurs within the first 24 hours and fertility returns rapidly after removal of the rod. There have been rare failures reported with this device. The manufacturer claims that 1 pregnancy will occur for every 300 women using this device per year—this compares very favorably with the intrauterine device, the patch, the ring or the birth control pill.
www.implanon-usa.com

The major "side effect" is abnormal menstrual bleeding or spotting. Since the device is relatively new it will take some time before it can be adequately evaluated by women and their health care providers.

Barrier Methods of Contraception

    

Barrier methods, condoms and diaphragms (though there are others), are an effective method of contraception that also offers some protection against a variety of STDs. Condoms are readily available at most pharmacies and even "specialty stores". Diaphragms do require a prescription for a proper "fit".

The major "drawback" of these methods is the fact that they do require some planning. Some couples find their use easy to adjust to while others use these methods sporadically risking an unplanned pregnancy. The decision to use these methods, like any method of contraception, is a very personal one. Diaphragms do require the use of a spermicide which some couples find onerous.

Permanent Sterilization

Female sterilization (or 'tubal ligation') should be regarded as a permanent decision. While it is possible to reverse many kinds of female sterilization procedures, such 'reversals' are financially expensive, time consuming, often unsuccessful, and require weeks of recovery. A sterilization procedure should only be carried out if you are sure that you have completed (or don't wish to start) your family.

Keep in mind that there are many excellent alternatives available to women in the 21st century who wish to limit their family size. In the above-captioned section entitled "Contraceptive Counseling" we offer a variety of proven methods, both hormonal and non-hormonal that offer spontaneity, safety and efficacy for a woman who does not wish to undergo permanent sterilization.

For the woman who chooses to undergo permanent sterilization, she should be aware that this is a time-tested operation that has been available for over 140 years. Permanent sterilization does not change your ovarian, sexual function or your normal hormone production.

There are many methods of permanent sterilization available for women. For the first time, female sterilization has become a true "office procedure", simpler and safer than vasectomy. Traditional female sterilization was performed by laparotomy –requiring a 2-3 inch incision in the abdomen—until the late 1970s.

Beginning 30 years ago this was changed by the introduction of the laparoscope which allowed sterilization procedures to be performed through two ¼" to ½" abdominal incisions. Laparoscopy was a great step forward in terms of safety and recovery but still required a general anesthetic in a hospital or outpatient department and 3-10 days of recovery.

In September 2006 we began offering hysteroscopic sterilization (see below). This is a method of permanent sterilization that requires no incisions. The entire procedure is performed through a hysteroscope—a lit telescope that goes through the cervix into the uterus—allowing for the placement of a permanent plug into the openings of the fallopian tubes. Each of these methods is discussed in detail.

Hysteroscopic Tubal Occlusion (HTO) with the Essure System—An office procedure. No incisions necessary!

The "gold standard" in the 21st century is hysteroscopic sterilization with the Essure contraceptive system. This system, in my opinion, is the safest and most effective method of permanent sterilization available (for women or men). It does not require an incision, a major anesthetic or hospitalization. It is an office procedure!



The Essure "plug" placed in the opening of the fallopian tube

In November 2002 the Food and Drug Administration approved the Essure Contraceptive System as the first major advance in female sterilization in almost 35 years. This technique called Hysteroscopic tubal occlusion, or HTO, is a permanent method of female sterilization that can be performed in a doctor's office, with a mild sedative in approximately 10 minutes and allows someone to return to their normal routine within a few hours.


A hysteroscope is a thin telescope that can be inserted into the uterus through the natural offices of the birth canal---the vagina and cervix. The telescope, equipped with a light source and is connected to a video monitor, allows us to inspect the entire interior of the uterus including the openings (ostium) of the fallopian tubes. We can also look for any abnormalities such as polyps or fibroids. Once we identify the tubal opening we can insert a "tubal plug" or "micro insert".


The micro-insert, or plug, consists of a stainless steel inner coil, a nitinol super-elastic outer coil, and polyethylene (PET) fibers. The plug is about 1 ½ inches long and about thickness of a single toothbrush bristle. When released, the outer coil expands so that it becomes anchored to the fallopian tube and blocks it. The beauty of this procedure is that it requires no incisions!

The procedure is performed in our office and takes between 5 and 10 minutes to perform. We will observe you for about 30 minutes before discharging you.

Hysteroscopic tubal occlusion (HTO) can be performed under a local anesthesia or with a mild sedative. Some women prefer deeper sedation, which is also available. Since there is no incision and no need for general anesthesia you may return to work and normal physical activity as soon as the sedative wears off completely---about 4 hours.

Although the plugs are placed into the fallopian tubes, the scarring process takes 2-3 months to complete. Therefore, a temporary method of contraception MUST BE USED until a test is done to confirm that the tubes are blocked. The confirmation test is performed in our office and involves the use of an ultrasound to determine if the tubes are blocked. If the test confirms that the tubes are blocked the procedure is over 99% effective in preventing a pregnancy

This is a permanent method of contraception and should not be performed unless you are 100% certain that you've completed your family.

Are there any other advantages to this procedure compared to standard tubal ligation?

There are least three very important advantages of this procedure!

First. Since this procedure involves no incisions and no abdominal entry it is by far the safest method of permanent sterilization for women and is even safer than vasectomy. Previous methods of female sterilization require deep general anesthesia and also carry a small but real risk of perforation of other organs---bowel, bladder and blood vessels. This method does not require a general anesthetic and by virtue of the fact that it does not involve an abdominal incision there is no risk of bowel, bladder or blood vessel perforation.

Second. Because the procedure is performed inside the uterus (hysteroscopically) it allows other procedures to be performed simultaneously if they are necessary. Examples would include the simultaneous removal of intrauterine polyps or fibroids.

Third. One of the biggest advantages of this procedure is that hysteroscopic tubal occlusion (HTO) allows us to preemptively treat women with underlying menorrhagia (heavy periods) and dysmenorrhea (painful periods) by permanently removing uterine lining tissue in those specific women with a pre-existing history of heavy menstrual bleeding.

Please let me illustrate what I mean.

It is not uncommon for a woman to request a tubal sterilization procedure who has been taking birth control pills for several years in order to provide contraception and control of her heavy and painful periods. Now that this hypothetical woman has completed her family she may wish to undergo permanent sterilization. Previously this would have been with the use of a laparoscope and would have required an abdominal incision.

After the tubal ligation this hypothetical woman discontinues her oral contraceptives and, to her dismay, begins experiencing her previous pattern of painful and heavy periods. She is then faced with a variety of decision that include accepting her symptoms, taking hormones, surgery for her heavy periods (endometrial ablation or resection) or even hysterectomy.

This situation was entirely foreseeable!

By using hysteroscopic technology we have the ability not only to block the fallopian tubes but also to remove the uterine lining tissue at the same time (under the same sedative) in a simple procedure called EMR (endomyometrial resection). Performing this procedure simultaneously and preemptively eliminates the issue of continued and persistent vaginal bleeding for those women with a history of abnormally heavy periods.

Is the procedure covered by most insurance?

In most cases the answer is yes. We are happy to assist you in checking with your insurance company.

When can I return to work?

Generally you can return to your normal schedule within 3-4 hours.

How painful is the procedure?

You should experience no pain during the procedure if you receive a mild sedative and short-acting narcotic agent. If you wish to be awake during the procedure there may be some slight cramping that will vary from one woman to the next.

Is Sedation Necessary?

We do not require our patients to have sedation in order to undergo this procedure. However, our experience has shown that the majority of our patients prefer to have conscious sedation for hysteroscopic tubal occlusion. We encourage conscious sedation for the following reasons.

How effective is it in preventing pregnancy?

Once we confirm that the tubes are blocked (by a test done at 3 months) the procedure is 99.8% effective.

Can it be reversed?

No. This method is permanent.

What if I want more information? 

You can call our office and arrange for a consultation. You can also check out one of these websites: www.Essure.com, www.webmd.com, www.afwomensmed.com.

Laparoscopic Tubal Ligation

Although laparoscopic sterilization, in my opinion, is no longer a first-line approach to female sterilization there are reasons why it may still be preferable in a small number of patients. These include patients with cervical stenosis (a cervix that does not permit the passage of even small instruments into the uterus), a uterine cavity that is very distorted by either fibroids, scar tissue or congenital anomalies, a history of pelvic inflammatory disease, a nickel allergy or simply because a particular woman may prefer this method. Women who require a diagnostic laparoscopy for other reasons, such as endometriosis, or even the removal of a gall bladder (cholecystectomy) may opt for this method of sterilization since it adds little to the procedure.

Laparoscopic sterilization is performed in an outpatient setting and requires several days of recuperation.


What is laparoscopy?

Laparoscopy is a technique that uses a lit telescope placed into the abdominal cavity through a small 1cm (10mm, 3/8 inch) incision. Laparoscopy generally requires two incisions: one for the laparoscope (telescope) and one for the instrument that accomplishes tubal ligation. Laparoscopy telescopes are generally attached to a video camera that allows the surgeon to visualize the entire procedure on a television screen. These incisions are approximately 5 mm (1/4 inch) each.




Using this visualization technique, a second instrument can be placed into the abdominal cavity through a quarter-inch incision just above the pubic hairline. Through this second incision a special device called a "tripolar" forceps is inserted which will cauterize and cut each of the fallopian tubes.

In our experience, the pregnancy rates following a tubal ligation by any method is less than 1/200 cases. Recent data from the Centers for Disease Control reveal that tubal ligations performed in the United States have a failure rate as high as 2% (1 out of 50). We are proud of our data and feel that our failure rates are far better than the national average
Laparoscopic sterilization procedures are performed in the Highland Hospital Outpatient Department. The procedure itself is a 10-15 minute operation performed under general or spinal anesthetic. You can expect to spend about 4 hours at the hospital. Most of this time is spent preparing you for surgery, accomplishing your admitting physical and lab work, and allowing you to recover following surgery and prior to discharge.
During your brief stay in the outpatient department, you will meet nursing personnel that will care for you before, during, and after your procedure. You will also have an opportunity to meet and speak with your anesthesiologist.

Frequently Asked Questions (FAQs) about Laparoscopic Sterilization

Is it safe?

No operative procedure is complication-free. However, the rate of complications in the hands of a skilled and experienced surgeon is minimal. Rarely, the procedure is associated with injury to the bowel (1 per 1000). Minor complications such as nausea and vomiting or shoulder pain are much more common.

How long does the procedure take?

Tubal sterilizations generally take from 10-15 minutes to perform. The actual time at the hospital outpatient department will be about 4 hours.

How painful is it?

The use of smaller instruments creates less gas in the abdomen, making this a much simpler and less painful procedure. For most women, the pain is easily controlled with Ibuprofen, Tylenol, or aspirin (minor analgesics). Women are, generally, pain-free by the 3rd day after surgery.

How long will I be out of work?

We advise woman to take 2 days off from work following the procedure. Many women return to limited activity the next day and normal activity in 3-4 days.

How long will it take to feel "back-to-normal"?

About three days.

How effective is it in preventing pregnancy?

The failure rate of tubal ligations in our hands is approximately 0.5% (1 out of 200 women). Failure rates, according to the most recently published CDC study (1996), reveal an average failure rate across the U.S. of 2%. Failure rates are probably diminished with the coagulation methods (burning and cutting the tubes).

How long before it is effective in preventing pregnancy?

Immediately.

Can it be reversed?

Some methods are potentially "reversible". These include the use of clips and rings. However, this procedure should be viewed as one that is not intended to be reversed. The truth is that with the modern use of in vitro fertilization (IVF), pregnancies can be achieved even after tubal ligations with very good success rates. However, IVF is expensive and not covered by insurance.

Is female sterilization covered by my health insurance?

Most medical insurers do cover sterilization procedures.

If I want more information, how can I get it?

Just call the office at 585-473-8770, or toll free at 1-888-272-7990 and ask for our videotape or a consultation with Dr. Wortman.