Contraception, Sterilization

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

• 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