Hysteroscopic Sterilization

Abstract

After a brief history of sterilization, this article is devoted to hysteroscopic techniques and instrumentation, and a presentation of hysteroscopic sterilization techniques: electrocoagulation techniques, hysteroscopic injection of chemicals, and hysteroscopically directed placement of intratubal mechanical devices (ceramic plugs, polyethylene plugs, preformed silicone plugs, nylon intratubal plugs, and formed-in-place silicone rubber plugs. Problems are identified that are common to all hysteroscopic sterilization techniques. There are also practical considerations which limit the development of hysteroscopic sterilization techniques, and these considerations are presented. Various means have been used historically to block the tubal ostia, including the insertion of nitric acid in 1984, but it was not until 1927 that the hysteroscope was used for sterilization. Hysteroscopy itself was discovered in 1869 for diagnosis of intrauterine diseases. Even with the hysteroscope and the 1934 procedure of using an electric current in the tubal ostia, hysteroscopic sterilization was little used. In 1973 a convention was convened to discuss the use of the procedure and the ramifications. Currently, the hysteroscope is a modified cytoscope with a 4 mm wide telescope with a fore-oblique lens, a 7 mm wide metallic sheath, a fiberoptic bundle for transmission of light, and additional instruments for intrauterine manipulation or surgical intervention. Under local anesthesia, sterilization is effected by 1) destruction of the interstitial portion of the oviduct by thermal energy, 2) injection techniques for the delivery of sclerosing substances or tissue adhesives, or 3) mechanical occlusive devices or plugs to block the oviduct. Recent uterine, cervical, or adnexal infections and pregnancy prevent the performance of sterilization, because infections are exacerbated by the procedure. Uterine perforation is a complication. Other complications involve allergic reactions to the solutions. The problems involved in performing the procedure are uterotubal spasm; inadequate intrauterine visualization resulting from mucus, blood, and endometrial fragments; and unsuspected uterine pathology. Carbon dioxide is inappropriate for longer procedures and can create diaphragmatic irritation in the peritoneal cavity and edema. 5% dextrose in water impairs visualization. Hyskon has been used for procedures up to 80 minutes. Other problems are discussed. Reversibility is dependent on the extent of tubal destruction. This procedure is unlikely to be as widely applicable ass are traditional procedures.