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The future

While the Essure method is the only FDA-approved transcervical sterilization procedure now available for patient use, several other sterilization methods are in various stages of development.

> Adiana Inc., has developed a technology for permanent transcervical contraception using electrothermal energy.14 The system, which now is in clinical trials, uses a catheter to deliver 60 seconds of temperature-controlled radiofrequency energy to the fallopian tube. Then a porous implant is placed into the lesion left by the electrothermal energy. Over a few weeks, tissue grows into the implant and occludes the tubes. Adiana reported that of the first 100 women who had undergone the procedure in the EASE (evaluation of the Adiana system for sterilization) trial, the tubal implants were successfully placed on the first attempt. No pregnancies have been reported to date.14
> The use of two antibiotics, quinacrine and erythromycin, as sterilization drugs is also in pretrial status. The method for using each of the drugs is similar, in that the drug in pellet form is placed in the fallopian tubes to cause scarring and eventual occlusion of the tubes.1
> The intratubal ligation device, which is also in pretrial status, uses the transcervical method to place a ring over the fallopian tubes to create a mechanical blockage.1
> In addition, several transcervical methods of female sterilization are under investigation in Europe, including Ovabloc, P-block, the Hamou tubal plug, the Microsulis tubal occlusion method, and an intrauterine balloon.1 The intrauterine balloon works by inserting a tissue adhesive into the fallopian tubes.1

Transcervical sterilization could very well replace traditional tubal ligation as the most common sterilization method in the future.

The FDA’s approval of the Essure procedure is an important first step in the move toward a safe, effective, and economical method of transcervical sterilization.

On the horizon are even more options for women seeking a minimally invasive method of permanent contraception.

Kimberly A. Johnston, RN, EdD, is chairperson of the Department of Nursing at Kutztown University, Kutztown, Pa.

References

1. Farrington A. Permanent Contraception for Women in the United States. Association of Reproductive Health Professionals Website. Available at: www.arhp.org/healthcareproviders/onlinepublications/healthandsexuality/
permanentoptions/ PermanentOptionfor WomenintheUS.cfm. Accessed January 8, 2004.

2. Study demonstrates improvements with new coil catheter for Essure. Women’s Health Weekly. August 14, 2003:29-30.

3. Hatcher RA, Nelson AL, Zieman M, Darney PD, Creinin MD, Stosur HR. A Pocket Guide to Managing Contraception. 4th ed. Tiger, GA: Bridging the Gap Foundation; 2001.

4. Kolander CA, Ballard DJ, Chandler CK. Contemporary Women’s Health: Issues for Today and the Future. Boston, MA: McGraw-Hill Publishing; 1999.

5. The Boston Women’s Health Book Collective. Our Bodies, Ourselves. For the New Century. New York: Simon & Schuster; 1998.

6. Planned Parenthood Federation of America Inc. FDA approves innovative non-incision permanent birth control procedure for women. Available at: www.plannedparenthood.org/ about/pr/021105_birthcontrol.html. Accessed January 8, 2004.

7. Key milestone reached with Blue Cross/Blue Shield coverage of the Essure. Women’s Health Weekly. July 24, 2003:29-30.

8. Scalpel-free permanent contraception slashes recovery time. Health. 2003;17(1):105.

9. Cooper JM, Carignan CS, Cher D, Kerin JF. Microinsert nonincisional hysteroscopic sterilization. Obstet Gynecol. 2003;102(1):59-67.

10. Essure [patient information booklet]. San Carlos, CA: Conceptus Inc.; 2003:10.

11. Rosen DMB. ANZJOG. 2004;44:62-64.

12. Minkin MJ, Hanlon T. New: Permanent birth control. Prevention. 2003;55(9):109.

13. Essure Permanent Birth Control: Clinical Testing. Available at: www.essure.com/consumer/c_clinical_testing.aspx. Conceptus, Inc., Website. Accessed January 8, 2004.

14. Adiana Inc. Reports Treatment of First 100 Women in EASE Transcervical Sterilization Trial. July 17, 2003. PR Newswire Association, Inc., Website. Available at: www.findarticles.com/ cf_dls/m4PRN/2003_July_17/105511185/p1/
article.jhtml. Accessed February 24, 2004.