Permanent Birth ControlHeather Beal M.D.

OB/GYN

Overview of Seminar

• Permanent birth control options– Vasectomy– Laparoscopic tubal ligation– Essure

• Long term birth control options– Mirena– Paraguard

Seeking a PermanentBirth Control Method

Familiescomplete

Unintendedpregnancies

• 40% of US pregnancies (>2M)are unintended– In women ≥40y the

rate is 51%– About a third of

unintended pregnancies occur in women who consider their families complete

What is Permanent Birth Control?

• Permanent birth control provides protection against pregnancy

• There are currently three permanent birth control options– Vasectomy– Tubal ligation– Essure

• No method of permanent birth control is 100% effective and none protect against STDs

Vasectomy - Overview

• How it is performed: An incision is made in the scrotum and the two vas deferens are tied in two places, then separated by burning, cutting, or blocking with clips or clamps

• Procedure time: 20-30 minutes• Recovery time: 2-3 days

– Swelling, bruising, pain

Vasectomy - Benefits

• 98.87% effective• Does not interfere with erection, ejaculation,

or hormone production• Quick and relatively simple procedure that can

be done in a physician’s office• Performed on him

Vasectomy - Risks

• Pain• Bleeding• Local irritation• Bruising• Infection• Sperm granuloma• Chronic pain

Vasectomy - Considerations

• It may take three months or longer before it can be relied upon– An alternate form of birth control is necessary

until a test is performed to confirm the absence of sperm.

• Temporary side effects– Swelling, bruising, pain

• How long are you willing to wait for him?

Tubal Ligation - Overview

• How it is performed: Surgery is performed under general anesthesia. Two incisions are made in the abdomen to reach the fallopian tubes. The tubes are burned or clamped with clips or rings.

• Average surgical time: 30-40 minutes• Recovery time: 4-6 days, cramping, abdominal

bloating, bruising

Tubal Ligation - Benefits

• 99.82% effective• Effective immediately• Does not affect libido• Does not affect normal monthly cycles

(stopping hormonal contraceptive may)• Does not utilize hormones

Tubal Ligation - Risks

• Pain• Infection• Bleeding• Organ damage• Pregnancy and risk of ectopic pregnancy• Risks of anesthesia

Tubal Ligation - Considerations

• Performed under general anesthesia• Previous surgery• Body habitus• Temporary side effects

– Difficulty with general anesthesia– Cramping, bloating, bruising

• If pregnancy does occur, there is an increased risk of an ectopic pregnancy

The Essure Procedure

• Essure is permanent birth control without hormones, cutting, or the risks of surgery

• The Essure procedure works with your body to create a natural, permanent barrier against pregnancy

• Essure has been trusted by women and physicians since 2002 with ~500,000 procedures performed.

Essure - Overview

• How it is performed: Soft, flexible micro-inserts are placed in the fallopian tubes through a hysteroscope.

The Essure Micro-insert

• Soft and flexible

• Biocompatible

• Hormone-free

• Tube permanently blocked– Occlusion is

reliable and localized

Essure - Overview

• Average procedure time: 10 minutes• Recovery time: 1-2 days

– Cramping– Spotting

Essure - Benefits

• 99.80% effective• No hormones• Minimal recovery time• No cutting/surgery/anesthesia• No impact from previous surgery or body

habitus• In-office procedure/simple co-pay• Peace of mind – confirmation test

Essure - Risks

• Mild cramping• Nausea• Dizziness• Spotting• Chance of tubal perforation, expulsion, or

unsuccessful placement

Essure - Considerations

• Patients must continue to use another form of birth control for three months after the procedure, until the confirmation test verifies that the tubes are blocked.

• Not all women will be able to have both micro-inserts placed.

Essure

What to Expect

• Before the procedure– A relaxant may be offered to keep you calm and

comfortable

• During the procedure– A small scope is gently inserted into the vagina– The micro-inserts are inserted and released into

each fallopian tube

Essure Procedure is Well Toleratedwith Local Anesthesia

Procedural discomfort similar to menstrual cramps

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Confirmation Test

• 3 months later you will return for a test to confirm that you tubes are blocked

Essure - Cost

• Covered by most insurance providers• May be as low as an office co-pay• Verify your plan’s benefits prior to the

procedure and specify the location of your procedure

Essure is more effective than temporary methods of birth control

Percentage of women that will become pregnantin the first 12 months of typical use

Comparing Effectiveness:Five-Year Failure Rates

Essure has the highest effectiveness of long-term birth control methods

Five-Year Failure Ratesper 1000 women

Is Essure Right For You?

An Essure Candidate Is a Woman Who Is:

• Certain her family is complete– Considering tubal ligation or vasectomy– Considering or has had endometrial ablation– Contraindicated for laparoscopic surgery– Dissatisfied with her current birth control

method

Is Essure Right For You?

An Essure Candidate Does Not Want:

• To wait for partner to have a vasectomy

• Surgery that involves incisions

• To remember to take or use temporary birth control methods

• A birth control that contains hormones

Is Permanent Birth Control Right for You?

• Yes, if:– You know that your family is complete– You no longer want to take hormones– You worry about an unplanned pregnancy

Long Term Birth Control Options

• Intrauterine Device (IUD)– Mirena– Paragard

Mirena

• Placed within the uterine cavity• In-office procedure• Minimal cramping• Does contain hormones• Lessens menstrual bleeding• 5 years

Paragard

• Placed within the uterine cavity• In-office procedure• Minimal cramping• No hormones• May increase menstrual flow• 10 years

What Option Is Right For You?

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