Dr. B posted a few weeks ago regarding his vasectomy experience, and I’ve heard from several patients that it’s helped give their partners the final push to schedule the procedure. Kudos to Dr. B for this! If your partner doesn’t desire vasectomy (even after reading about the extra hours he may have to watch ESPN), but you yourself are thinking about something permanent, I wanted to write a few words about the other options.
Permanent birth control for women involves removing all or part of the fallopian tube, or blocking the fallopian tube, so that when an egg is released from the ovary it does not travel to the uterus. There are 3 ways to do this:
1) Tubal ligation
2) Salpingectomy
3) Essure
Option 1, tubal ligation, is the method that’s been around the longest. It means removing a portion of the fallopian tube, or blocking the fallopian tube with cautery or a titanium clip. This can be done at the time of C-section, or outside of pregnancy through a laparoscopic procedure. If done at the time of C-section, it doesn’t add much time or risk to the procedure. If done at another time, it’s usually done through a single incision in the belly button as an outpatient surgery. The chance for failure is low at about 1/300… after all no form of contraception is guaranteed except abstinence!
Option 2, salpingectomy, is removing the fallopian tubes entirely. There is now research showing that some ovarian cancers actually begin in the end portion of the tube, which is the part not touched during traditional tubal ligation. When the tube is removed with salpingectomy, there is a decreased risk for ovarian cancer later in life. Removing the whole tube also decreases the risk for failure, and risk for future surgery, especially since if a tubal ligation fails the pregnancy could occur in the end part of the tube that remains. Salpingectomy can be done at the time of C-section with an only slightly increased risk for bleeding (sometimes the surrounding blood vessels are just too big to do it safely), and can be done outside of pregnancy through outpatient laparoscopic surgery with three tiny incisions.
Option 3, Essure, is the only female permanent birth control procedure that we perform in the office (with the help of our mobile anesthesia colleagues). Instead of incisions on the abdomen, a camera is placed through the cervix into the uterus (hysteroscopy) and a small coil is positioned into each tube. Over the next 3 months, scar tissue builds up around the coils so that the tubes are permanently blocked. Patients who have undergone Essure need to use another form of birth control for these 3 months, and an X ray dye test, called HSG, is done at the end of the 3 months to ensure that the tubes are closed off.
None of these options should change your hormones, sex drive, or the nature of your periods. Of course, you should only proceed if you are absolutely certain that you don’t want future pregnancy. No permanent birth control option, including vasectomy, is reliably reversible, and probably the biggest “risk” is regret! You should know that IUDs have about the same failure rate as BTL or Essure, and are reversible. Every body and circumstance is different, and we’d be happy to help you decide which option would be best for your family.
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