Birth Control Options

Hysteroscopic Tubal Occlusion (HTO) with Essure®

An office procedure. No incisions necessary!

The “gold standard” in the 21st century is hysteroscopic sterilization with the Essure contraceptive system. This system, in our 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.

Hysteroscopic Tubal Occlusion (HTO) with Essure®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.

  • Local anesthesia is not effective in eliminating all of the discomfort or pain associated with the procedure. Most of the pain comes from the slight cervical dilation that is necessary, not from the insertion of the plugs. Conscious sedation is extremely safe.
  • It can be tailored to meet the needs of the patient. Some women like to feel very sedated while others prefer “just something to take the edge off” any pain or discomfort they might experience.
  • Your relaxation is contagious—when you are comfortable the procedure goes smoother and more quickly. Conversely, if you are anxious or in pain it is often upsetting to those around you who are trying to help you through this fairly simple procedure. Anxiety and pain can unnecessarily prolong this procedure

However, if you feel that you’d like to try this procedure without conscious sedation please do. You can always change your mind and decide you want some medication to help you through this brief procedure. Regardless of whether you chose to have conscious sedation please understand the following:

  • You will still need to have someone with you – in the event you change your mind.
  • You will have a device called a heparin lock (an “I.V.”) so that we can administer medication if it is required.

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.

Many of you may already know that our office began performing office-based sterilization years ago—in 2006—to date, in fact, we’ve done over 150 of these procedures. As the only fully-accredited office-based gynecology office in Western New York we offer several advantages to our patients. First, we undergo constant monitoring by AAAHC (Accreditation Association for Ambulatory Health Care) to assure you the highest standard of care. Also, since we are an accredited office, we can administer conscious sedation. Conscious sedation allows you complete comfort during the procedure. Although some women don’t wish to be sedated for an office procedure it’s still nice to know that it’s available if you should require it.