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The Essure microinsert has a stainless steel inner coil, a nitinol superelastic outer coil, and polyethelene fibers. The device expands from 0.8 mm to between 1.5 and 2 mm when placed in the fallopian tubes.

Until recently, U.S. women seeking permanent methods of birth control had no other choice but to have a tubal ligation. Eleven million women aged 15 to 44 — 25% of this population — have undergone this surgical procedure,¹ making it the most common form of contraception among U.S. women, according to the national Centers for Disease Control and Prevention.

Tubal ligation is also the most common form of birth control in the world.² Every year, more than 700,000 women in the U.S. undergo the procedure. Tubal ligation is effective immediately in preventing pregnancy and can be done using local, general, or spinal anesthesia.

Although it has an effectiveness rate higher than 99%, it is an invasive surgical procedure with risks inherent to surgery and the use of anesthesia. And it is expensive for patients, costing an average of $1,200 to $2,500.³

This cost, however, is covered by Medicaid and some private health insurance policies.

The two most common procedures for performing a tubal ligation are the lap aroscopic procedure and the minilaparotomy. In the laparoscopic procedure, a laparoscope is inserted through a small incision near the navel to allow visualization of the fallopian tubes. Either an instrument is inserted through the laparoscope or another incision is made in the abdomen, through which the fallopian tubes are surgically closed.⁴

When tubal ligations are performed immediately after childbirth, as is most often the case, the procedure used is the minilaparotomy. In this procedure, only one incision is made in the patient’s abdomen, just above the pubic bone, to access the fallopian tubes.

More women complain of pain and cramping for a few days following a minilaparotomy than those who undergo the laparoscopic procedure.5 But either procedure can be done on an outpatient basis, and most women go home the same day the surgery is performed.⁴

Less invasive

In November 2002, the U.S. Food and Drug Administration approved a new method of permanent birth control that requires no incisions. The EssureAE method, developed by Conceptus, Inc., is a form of transcervical sterilization.6 Essure is the first and only FDA-approved transcervical sterilization method available to women in the U.S.

Transcervical sterilization differs from traditional tubal ligation in that it is an incision-free procedure in which a catheterlike instrument is guided through the cervix and uterus and then into the fallopian tubes (facing page, top illustration). The Essure method uses a small-diameter trans cervical access cath eter to place a mi cro insert (a soft, springlike coil made of polyester fibers and nickel titanium alloy) in each fallopian tube.

The microinsert has a stain less steel inner coil, a nitinol superelastic coil, and polyethylene fibers that are 0.8 mm long in a tightly wound configuration. Once in place, the outer coil expands to between 1.5 mm and 2 mm to anchor the microinsert (facing page, center image). Then tissue grows in and around it, blocking the fallopian tube^7,8 (facing page, bottom illustration.)

In clinical studies of women who had un dergone the Essure method, both fallopian tubes had closed in 96.5% of the women within three months and in 100% of the women within six months of the procedure.⁹