Permanent Contraception

Leaps and bounds have been made in permanent contraception for women. We now have simple permanent procedures that can be done in the office in less than 10 minutes, gently and comfortably.

Options for permanent birth control include:

Essure

Trusted by hundreds of thousands of women and their doctors for over five years, Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in a doctor's office in less than 10 minutes.

Essure is covered by most insurance providers, and if the Essure procedure is performed in a doctor's office, depending on your specific insurance plan, payment may be as low as a simple co-pay.

Essure offers women what no birth control ever has:

  • No surgery, burning or anesthesia
  • No hormones
  • No slowing down to recover
  • Performed in less than 10 minutes
  • Peace of mind - your doctor can confirm when you can rely on Essure for birth control
  • Trusted by hundreds of thousands of women and doctors for over five years

With Essure, you'll never have to worry about unplanned pregnancy again. Essure is 99.74% effective with zero pregnancies*, making it the most effective form of permanent birth control available.

The Essure procedure is permanent and is NOT reversible. Therefore, you should be sure you do not want children in the future.

About the Procedure

Unlike other permanent birth control, the Essure procedure does not require cutting into the body or the use of radiofrequency energy to burn the fallopian tubes. Instead, an Essure trained doctor inserts soft, flexible inserts through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes. The very tip of the device remains outside the fallopian tube, which provides you and your doctor with immediate visual confirmation of placement.

During the 3 months following the procedure, your body and the inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, you must continue using another form of birth control (other than an IUD).

After three months, it’s time to get an Essure Confirmation Test to verify you’re protected from the worries of unplanned pregnancy. The test uses a dye and special type of x-ray to ensure both that the inserts are in place and that the fallopian tubes are completely blocked.

Unlike birth control pills, patches, rings, and some forms of IUDs, Essure does not contain hormones to interfere with your natural menstrual cycle. Your periods should more or less continue in their natural state.

Laparoscopic Tubal Ligation with Filshie Clips

We still do a few of these but they have really been largely over taken by the simpler office procedures.

Laparoscopy is an outpatient surgery, unlike Essure and Adiana, which are fairly simple office procedures.

As outpatient surgery goes, laparoscopic tubals are usually fairly straightforward. There are a variety of ways to occlude the tubes laparoscopically. Of all the available methods, cauterizing, or "burning," the tubes has the highest failure rate, so we avoid it. Instead we use Filshie clips, which are about 99.9% effective long term. Unlike with Essure and Adiana, there is some chance of reversing (reanastomosing) the tubes if you ever change your mind, but you really shouldn't enter into any of these permanent procedures if there is any chance you are going to change your mind.

Laparoscopy has small risks of bleeding, infection, anesthetic risk and injury to other organs. The risk of a significant complication is about 1/1000. Two incisions are required for laparoscopic tubals - one in your belly button (umbilicus) and one just above your hairline. Both are under 1 cm.

Filshie Clips are made of titanium lined with silicone rubber. They are a hinged clip lick over the Fallopian tube using a special applicator.

Laparoscopic tubals usually require about 4-5 days to recover, sometimes up to a week. They must be done in hospital with a general anesthetic. We are not set up to do these in our office ASC at this time.

Vasectomy

When our only permanent contraception option for women was laparoscopic tubals, we used to always encourage women to have their partners do a vasectomy instead. That's because vasectomy was safer, easier, less expensive and has a lower failure rate than laparoscopic tubals (with the possible exception of the Filshie clip, which has a high success rate).

That conventional wisdom is changing. Essure have lower complication rates and higher success than vasectomy and can be done in the office in under 10 minutes. There have been no reported pregnancies after the 3 month HSG test is negative with Essure, in over 10 years of use.

The main complications of vasectomies are hematomas and infections. Urologists and family physicians who do a lot of them have less complications than those who do fewer.

Prostate cancer has been reported to be increased in several cohort and case-control studies, but other studies say there is no effect.

Debra Ravasia, updated 2017