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For further information, see CMDT Part 18-21: Contraception

Key Features

  • In the United States, sterilization is the most popular method of birth control for couples who want no more children

  • Vasectomy is a safe, simple procedure in which the vas deferens is severed and sealed through a scrotal incision under local anesthesia

  • Female sterilization is performed via

    • Laparoscopic bipolar electrocoagulation

    • Salpingectomy

    • Plastic ring application on the uterine tubes

    • Minilaparotomy with tubal resection

    • Hysteroscopic transcervical sterilization

  • The cumulative 10-year failure rate for all methods combined is 1.85%, varying from 0.75% for postpartum partial salpingectomy and laparoscopic unipolar coagulation to 3.65% for spring clips

  • Two methods of transcervical sterilization, Essure and Adiana, can be performed as outpatient procedures

  • Essure

    • Involves the placement of an expanding microcoil of titanium into the proximal uterine tube under hysteroscopic guidance

    • Efficacy rate at 1 year is 99.8%

  • Adiana

    • Involves hysteroscopically-guided superficial radiofrequency damage to the tubal lumen and immediate placement of a nonabsorbable silicone elastomer matrix in the tube to allow tissue in-growth

    • Efficacy rate at 1 year is 98.9%

  • Both procedures should have tubal occlusion confirmed at 3 months with a hysterosalpingogram

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