Tubal Ligation

Traditional tubal occlusion can be accomplished by the lapa-roscopic placement of clips or Silastic bands or by tubal cautery. Alternatively, a mini-laparotomy may be performed for a partial salpingectomy. The Essure device was approved for use in the United States in 2002. This is a coil device made of stainless steel and nickel-titanium that is inserted transcervi-cally into the tubal ostia, avoiding the need for general anesthesia. Placement causes an inflammatory response in the tubes, leading to dense fibrosis and tubal occlusion (Ogburn and Espey, 2007).

Advantages

Tubal ligation is a permanent, highly effective form of contraception that requires little to no follow-up.

Disadvantages

Tubal ligation requires a surgical procedure; some women may be poor surgical candidates. It does not protect against STIs and carries an increased risk of ectopic pregnancy if ligation fails. It is irreversible; achieving pregnancy after sterilization is costly and involves either additional surgery or in vitro fertilization. The Essure device requires use of another contraceptive for 3 months, or until tubal occlusion is confirmed by hysterosalpingogram. Regret rates are 20% for women 30 and younger at the time of sterilization, but only 6% for those over 30 (Pollack et al., 2007). Counseling is key.

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