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PERMANENT STERILIZATION

Sterilization is surgery performed to prevent a woman from getting pregnant. It is meant to be permanent. Sterilization often is done with a technique called laparoscopy or hysteroscopy. Laparoscopy comes from the Greek words that mean "look into the abdomen." Hysteroscopy means looking into the uterus.  For a laparoscopy, the surgeon uses a device like a small telescope, called a laparoscope, to look at the pelvic organs and to block the fallopian tubes. Hysteroscopically, special coils are used to implant into the fallopian tubes.  These methods permanently prevent a woman from getting pregnant.

Female Reproductive System

Most of a woman's reproductive system is inside her abdomen. The uterus, which is in the lower abdomen, opens into the vagina. A woman has two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg into a fallopian tube. This release of an egg is called ovulation. In a woman with a regular menstrual cycle, ovulation occurs 14 days before the start of her next period.

A woman can get pregnant if she has sex around the time of ovulation. During sex, the man ejaculates sperm into the vagina. The sperm travel up through the cervix, through the uterus, and out into the tubes.

If a sperm meets an egg in the fallopian tube, fertilization (the joining of egg and sperm) can occur. The fertilized egg then moves down the fallopian tube to the uterus. It then attaches to the uterus and grows into a fetus.

With sterilization, both fallopian tubes are blocked by tying, sealing, or attaching a ring or clip to them. The egg then cannot move down the tube and the sperm cannot reach the egg.

Making the Decision

Sterilization is a big decision. Although there is a very slight chance of pregnancy after this procedure, it should be thought of as permanent. You and your partner must be sure that you do not want to have any more children-now or in the future. If there is any chance that you might want to have children in the future, think about using another method of birth control, such as:

  • Birth control pills (oral contraceptives)
  • Intrauterine device (IUD)
  • Barrier methods:
    • Diaphragm
    • Cervical cap
    • Sponge
    • Condoms (male and female)
    • Spermicidal cream, jelly, foam, or suppositories
  • Natural family planning/periodic abstinence
  • Hormonal injection (hormone shot given every 3 months)
  • Hormonal implants (matchstick-size hormone pellets placed under the skin of the arm)

If you are sure that you do not want to have any more children, you may wish to choose sterilization as a means of permanent birth control. You and your partner also may want to discuss vasectomy. Vasectomy is a sterilization procedure performed on men.

Sterilization does not protect against sexually transmitted diseases (STDs). If you are at risk for getting an STD, you still need to protect yourself by using condoms.

Benefits and Risks

Sterilization by hysteroscopy or laparoscopy offers a number of benefits. A woman no longer needs to use birth control or to be concerned about getting pregnant. It does not affect her menstrual cycle or sexual activity. It also appears that women who have been sterilized have a slightly lower risk of cancer of the ovary.

The risk of pregnancy after sterilization by either method is low. Less than 1% of women who have it done will become pregnant. The rate of failure is about the same as with other methods of sterilization.

Those women who do get pregnant after sterilization are more likely to have ectopic pregnancy. An ectopic pregnancy is one that may be located in the tube.

Things to Consider

The hysteroscopic technique (the Essure procedure) offers the advantage of office surgery, local anethesia, no incisions, and immediate recovery with minimal to no pain. 

Laparoscopy is not right for all women. If a woman has had surgery, is very overweight, or has medical or gynecologic problems, a larger incision and a hospital stay may be required. Another method of sterilization may be a better choice for such women.

Before having the procedure, you should know the benefits, risks, and other choices. Be aware that the procedure is permanent. Think over your choices with care. You also should know the length of hospital stay (if any), cost, and time away from normal activities.

Surgical sterilization is a choice only you can make. To be able to make this decision, you must be of legal age in the state where the procedure is to be done and legally able to make decisions.

What If I Change My Mind?

Sterilization is an elective procedure. This means that it is your choice whether to have it done. If at any time you have any doubts, even after you have signed the consent papers, let your doctor know so that you can discuss your concerns. If you wish, the surgery can be canceled.

In some cases a sterilization procedure can be reversed if a woman changes her mind. The success rates of reversal vary greatly and depend on the sterilization procedure used.

Also, the reversal of any sterilization procedure requires a major operation. Your doctor instead may suggest other options, such as in vitro fertilization.

Before Hysteroscopy (the Essure procedure)

You will be prescribed a non-steroidal anti-inflammatory drug, such as ibuprofen, 24 hours before and after the surgery to help decrease the pain post-operatively.  The procedure is timed after the menstrual cycle.  This procedure is performed in the office or in the operating room if necessary for selected patients.  The procedure can be done only if both fallopian tubes are visualized hysteroscopically.  To confirm tubal closure, a dye study (hysterosalpingogram) is performed 12 weeks after the procedure.  It is recommended that women stay on birth control until the dye study is done and tubal closure is confirmed.

Before Laparoscopy

The procedure may take place in a hospital. More often, though, it is done on an outpatient basis in a surgery center.

If you have not been using birth control pills or other hormonal methods of birth control, laparoscopy may be done during or just after your menstrual period. This will help avoid the chance of a fertilized egg getting trapped in the divided or closed tube.

You will be given pain relief (anesthesia). If a local or regional anesthetic is used, you may be given medication to help you relax before it is given. If a general anesthetic is used, you will not be awake during the operation. The type of anesthesia used depends on your medical history, choice, and the advice of your doctors.

 

 





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