Sterilization. B.K. Merritt, MD. Second most common form of birth control after pills. Surgical (tubal ligation or removal)

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1 Sterilizatin B.K. Merritt, MD Overview Secnd mst cmmn frm f birth cntrl after pills Shuld never be cnsidered reversible Mirena IUD and Nexplann implant are bth reversible and are as effective r even mre effective than sterilizatin N methd is 100% reliable Pregnancy after sterilizatin is assciated with a 30% risk f ectpic (tubal) pregnancy Tw basic appraches Surgical (tubal ligatin r remval) Hysterscpic insert Each apprach has bth advantages & disadvantages Surgical Sterilizatin Typically dne as utpatient surgery using a laparscpe Invlves tw ¼ inch incisins in abdmen May als be dne at the time f C-sectin r the day after delivery thrugh a small umbilical (belly buttn) incisin Invlves placing bands r clips arund the tubes r tying the tubes with suture plus remving part r all f each tube Requires general r spinal anesthesia Assciated with sme pstp pain

2 Immediately effective Des nt require any preperative hrmnal treatment Ten year failure rate per 1000 wmen pregnancies if dne with laparscpe 17 with Falpe ring 20 with remval f part f fallpian tube 36 with clip 7 pregnancies if dne at C-sectin r day after delivery May be surgically reversed Expensive and nt cvered by insurance Successful in 70% f wmen Grwing evidence that remval f the fallpian tubes will decrease the risk f develping the mre aggressive frms f varian cancer Hysterscpic Sterilizatin A hysterscpe is a lng, thin instrument used fr visualizing the uterine cavity Placed thrugh the vagina and cervix int the uterine cavity Used t insert a small device (Essure) int the entry f each tube Des nt require an incisin s very little pain afterwards The Essure devise is a ciled stainless steel spring cated with plyethylene fibers held within an uter cil f a nickel ally The device is placed, using the hysterscpe, and released allwing the spring t relax and expand int the inner wall f the fallpian tube

3 The plyethylene fibers stimulate grwth f tissue int the device and the tube lumen creating a permanent cclusin Requires a minimum f 3 mnths until cclusin up t 6 mnths in 5% f wmen Requires x-ray study t prve cclusin Must have reliable birth cntrl fr ne mnth befre prcedure and until cclusin is prven Dep-prvera injectin mst cmmnly used May als use pills r Mirena IUD Requires hrmne preparatin f uterine lining befre the prcedure Dep-prvera, pills r Mirena IUD May be dne in ffice withut anesthesia Much cheaper (ffice cpay vs hspital deductible) Less recvery time May be dne with an IUD in place Remved after cclusin is prven 10 year failures per 1000 wmen with prven cclusin 2.5 Cannt be reversed Has high rate f patient satisfactin Shuld avid in wmen with nickel allergy Risks f Essure methd

4 Perfratin f tube r f uterus- 1-3% Expulsin f device- less than 1% Pelvic pain &/r painful menses- may ccur but rare Infectin- assciated with wmen having Essure and ablatin at same time Risk f Regret after Sterilizatin Greater risk with yunger age 4% if sterilized when under 24 years ld 2% in lder wmen Wmen wh remarry are mre likely t have regret Shuld have Preperative Discussin Review risks and benefits f prcedure Review reversible methds f birth cntrl Screen fr risk f regret Reasn fr chsing sterilizatin Discuss permanence f prcedure & success f reversal Causes and risk f failure Ptential fr sterilizatin t reduce risk f bth varian cancer and pelvic inflammatry disease Des nt prtect against STDs Des nt change menstrual cycles Back t Acacia Ob/Gyn Website

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