Study objective To compare hysteroscopic female sterilization procedures performed in-office versus a hospital operating room (OR) among newly trained physicians. Design Multisite hospital operating rooms and physician offices. Patients Women desiring permanent hysteroscopic sterilization. Intervention Hysteroscopic female sterilization with the Essure system. Measurements and main results Procedure time (scope in/scope out time), device placement rates, and incidence of complications and adverse events were compared. There was no significant difference in scope time between the 2 settings. There was no significant difference in placement rates, although the placement rate was somewhat higher in-office (91% vs 88%). There were no complications among any of the procedures, and the incidence of minor adverse events was extremely low in both settings (OR = 2%, in-office = 1%). Conclusion There is no clear advantage to performing hysteroscopic sterilization in a hospital OR. Hysteroscopic sterilization can be performed safely and efficiently in an office setting.