Trends in Sterilization Since the Introduction of Essure Hysteroscopic Sterilization

Abstract

Hysteroscopic sterilization is a minimally invasive, nonincisional method of permanent sterilization that is a valid alternative to laparoscopic sterilization, the conventional method of female sterilization. Under hysteroscopic guidance, an expanding microinsert is introduced into the proximal portion of each fallopian tube; local fibrosis and, ultimately, complete tubal occlusion occurs within 3 months. This retrospective study examined trends in sterilization in women at an outpatient surgery center and university teaching hospitals following the introduction of Essure® hysteroscopic sterilization in 2002. A chart review was conducted on women undergoing interval sterilization procedures and postpartum sterilization procedures between 2002 and 2007. Interventions evaluated included minilaparotomy tubal ligation, laparoscopic sterilization, Essure® hysteroscopic sterilization, and postpartum tubal ligation performed after vaginal delivery or at the time of cesarean section. Of the 5509 permanent sterilization procedures examined, 2484 were interval sterilization procedures and 3025 were postpartum tubal ligations. For all interval sterilizations performed during the 6-year-study period, a shift toward Essure® hysteroscopic sterilizations from 0.0% to 51.3% corresponded significantly with a decrease in laparoscopic sterilizations from 97.9% to 48.5% (P < 0.001). During the study period, the number of postpartum tubal ligations performed after vaginal delivery decreased significantly from 7.9% to 3.3% of all vaginal deliveries (P < 0.001), whereas the number of tubal ligations performed at the time of cesarean section did not change significantly (P = 0.51). These findings suggest the high likelihood that Essure® hysteroscopic sterilization will replace the laparoscopic approach as the method of choice for permanent sterilization.