A. Sterilization is the most common and effective form of contraception. While tubal ligation and vasectomy may be reversible, these procedures should be considered permanent.

B. Essure microinsert sterilization device is a permanent, hysteroscopic, tubal sterilization device which is 99.9 percent effective. The coil-like device is inserted in the office under local anesthesia into the fallopian tubes where it is incorporated by tissue. After placement, women use alternative contraception for three months, after which hystero-salpingography is performed to assure correct placement. Postoperative discomfort is minimal.

C. Tubal ligation is usually performed as a laparo-scopic procedure in outpatients or in postpartum women in the hospital. The techniques used are unipolar or bipolar coagulation, silicone rubber band or spring clip application, and partial salpingectomy.

D. Vasectomy (ligation of the vas deferens) can be performed in the office under local anesthesia. A semen analysis should be done three to six months after the procedure to confirm azoospermia.

References: See page 184.

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