Permanent Birth Control Methods

by Darren Housel M.D.

When discussing permanent birth control methods available to women, there are several options to consider.

“Tubal Ligation” is one of the most well-known. The term “ligation” indicates “tying” something. It was originally given this name because the procedure was done using a suture to “tie off” a segment of the fallopian tube. Now days, there are many other methods used to accomplish the same end result — which is, to cause an interruption in the tube so sperm cannot meet the egg and cause fertilization and pregnancy.

The most common methods currently in use for tubal ligation are mechanical clips and cautery, particularly while using laparoscopy; thus, they are called “laparoscopic tubal ligation”. These techniques are often performed at the time of C-section (when the tubes are very accessible). “Tying” the tubes with suture material can also be done at the time of a C-section, or perhaps, using a very old-school procedure of “postpartum tubal ligation” (where a small incision is made in the belly button area immediately following vaginal delivery). Postpartum tubal ligation is much less common these days, due to the availability and ease of laparoscopy. Postpartum tubals have been shown to have greater risk and higher failure rates. For all types of tubal ligation, there is some variation in the reported failure rates. Failure/pregnancy rate for laparoscopic tubals, and tubals performed with C-section, is usually quoted in the range of 2 to 4 per 1000. For postpartum tubals, this number can be as high as 1 per 100.

The newest procedure in female permanent sterilization is the Essure procedure. This is a no-incision, transvaginal/transcervical placement of an insert into the fallopian tube from inside the uterine cavity. The device then blocks the tube. The advantage of this technique is the non-invasiveness and the lack of need for general anesthesia. Essure can be done in the office setting with sedation and local anesthesia. (Laparoscopic tubals require general anesthesia with breathing tube placement and an operating room). Since there are no incisions, recovery from the Essure procedure is typically very brief; hours, rather than days as would be typical with the more invasive laparoscope. Perhaps, the one drawback to Essure is the need to continue an additional birth control method for 3 months, until after a hysterosalpingogram (an x-ray of the uterus and tubes) is performed to confirm tubal blockage. There is some controversy concerning Essure. There are reports (particularly blog/forum based) of pain and other side effects after Essure. Thorough studies, after FDA approval, have not shown the devices or procedure to have any direct correlation to these problems.

When considering permanent birth control options, a reasonable understanding of the anatomy and the way the techniques work is essential. Concordantly, every patient should evaluate the risks and expected outcomes of the different procedures and discuss them with her doctor.

By Darren Housel M.D.

* You can find more information about the Essure Procedure at their website: