Contraception and Family Planning

Laproscopic sterilization: Tubal occlusion

This involves laproscopic placement of a specially designed titanium and plastic clinp on each fallopian tube, blocking the tube, crushing a small portion of the tube. This blocks the passage of sperm, preventing contact of the sperm and egg. The ovaries, fallopian tubes and uterus are not removed.

It is a very effective form of contraception and can be relied on as soon as you have your next period. There is a risk of failure 3:1000, higher if the surgery is done soon after childbirth, at the same time of termination or in woman younger than 30. If a pregnancy does occur, one third are ectopic, that is the pregnancy develops in the fallopian tube rather than the uterus and may require emergency surgery.

This is intended to be permanent but there is a chance of regret and change of mind. It may be possible to surgically reconnect one or both tubes but there is no guarantee that reconnection will be successful and that a pregnancy will result.

It is non-hormonal and does not change your menstrual pattern but if you have been the OCP before you may notice your periods are heavier.

Done laparoscopically it has the advantage of investigating other problems at the same time.

Serious problems due to laproscopic tubal occlusion are rare but can occur

Major complications (1:1000) : haemorrhage, damage to abdominal organs near the surgical sitebowel, bladder, ureter other viscera (1:1000), laparotomy (large incision) (1:100), death (1:25 000)

Minor complication can also occur including abnormal scar formation 4%

Essure Hysteroscopic tubal occlusion

This technique uses a small metal and polyer “plug” that is inserted into each fallopian tube, permanently blocking it. No incisions are needed because each fallopian tube is accessed through the vagina and cervix with a hysteroscopy. The inserts do not contain or release any hormones.

The Essure procedure is permanent and cannot be reversed. It is very effective with a success rate of over 99%. If you change your mind there is no way of unblocking your tubes and IVF will be required but the effect of the procedure on IVF or the developing fetus is unknown.

There is a 2% chance that the procedure may be abandoned due to technical difficulties leaving only one or no tubes blocked. This means you will need an alternative procedure for permanent contraception.

As it takes time for your body to form a natural barrier around the inserts and completely block your fallopian tubes, you must use alternative contraception until you get confirmation from your doctor. Three months after the procedure you will need an x-ray and medical check, if all clear then you can stop contraception.

Complications are rare but can occur. There is a small chance of uterine or tubal perforation, which may lead to damage of internal organs. There is a small chance the devices may move or fall out after the procedure. There are two implants left in the uterine tubes that may affect future medical care.

Vasectomy – Birth Control for men

Vasectomy is a surgical procedure to cut or block the tubes that carry sperm from the testicles. After a vasectomy the man must have a follow-up test to ensure no sperm are in the seman. Whilst vasectomy does have surgical risks, the risks are fewer and less serious than for tubal occlusion in women. Reversal is possible but its success depends on the mans age and years since vasectomy.