by Jeffrey M. Wentworth, MD
Within recent years, the field of operative gynecology has seen many changes. These include outpatient laporoscopic hysterectomies, new suburethral incontinence procedures and advances in pelvic floor reconstruction. Now, women seeking permanent sterilization have an option that may soon be the new standard of care. In-office hysteroscopic sterilization offers an innovative alternative to traditional tubal ligation with a number of advantages and benefits, both to patients and physicians. The Group For Women is now offering this option to its patients.
In this new in-office procedure, a 5 mm hysteroscope is inserted through the cervical canal into the endometrial cavity and micro-inserts are placed into the proximal fallopian tube. The micro-inserts are spring devices made of titanium, stainless steel and nickel, which induce an inflammatory response at the point of deposit. This natural inflammatory response occludes the fallopian tubes. The procedure takes approximately 1⁄2 hour to complete and the patient is in the office for about 1 hour.
The benefits of in-office hysteroscopic sterilization are numerous. The procedure is safer, cheaper, more efficacious, with an easier recovery and quicker return to normal function. Because it is an incision-less procedure, it is obviously safer than tubal ligation. Patients generally report minimal levels of pain: levels of 1 – 2 on a 10-point scale (as compared with menstrual pain reported at level 3 on the same scale). The pain associated with the procedure is managed with a paracervical block and NSAIDS.
Recovery time is less than 1 day, with most patients returning to work and routine activity the day after the procedure. Failure rate with in-office hysteroscopic sterilization is approaching 0%, based on current studies; this supercedes any other existing method of sterilization! Compared to laporoscopic tubal ligation, the in-office procedure is 30 – 50% less expensive.
This non-surgical procedure may be especially appealing to certain patients: those who have had prior pelvic surgeries or those who are obese (and would therefore be subject to greater surgical risk). The only patient population that may not be suitable for the in-office procedure are those who have difficulty with basic office procedures, i.e. Pap smears. These patients may require additional medication or hospital-based anesthesia.
A hysterosalpingogram (HSG) is scheduled approximately 3 months following the procedure to ensure that the tubes have occluded. Prior to this confirmatory HSG, another form of birth control is required. One effective way of managing this variable is the administration of a Depo- Provera (DMPA) 1 – 2 weeks prior to the in-office sterilization. Not only does this provide the necessary 3 months of birth control, but also the progesterone effect of Depo Provera relaxes the fallopian tubes, facilitating the procedure.
Clearly, the aforementioned benefits are quite significant. For patients, being treated in a comfortable office setting by trusted, familiar staff members reduces anxiety. For physicians, we can take comfort by providing a safer, cheaper, less invasive and more convenient method of sterilization. What more could we (or our patients) ask for?! Dr. Jeffrey M. Wentworth joined The Group For Women in 2000. Dr. Wentworth is board certified and is a Fellow of the American College of Obstetrics and Gynecology. In his work at The Group For Women, Dr. Wentworth is regularly involved in the implementation of clinical trials with various pharmaceutical companies.