Permanent Contraception

 

PERMANENT CONTRACEPTION

This choice can be made by men or women. Men can have a vasectomy and information regarding this is best obtained from your General Practitioner, a general surgeon or a specialist urologist. There are circumstances where this procedure can be reversed but this is not always successful.

Ken offers a range of options for women who wish to have permanent contraception.

Laparoscopic Sterilisation

This procedure is done under general anaesthesia as day surgery in hospital. A small 10mm incision is made through the belly button and a camera introduced into the abdomen. Gas is then used to inflate the abdomen so that a space is created through which other instruments can be passed.  A second small 7mm incision is made approximately 3‐5cm above the pubic bone. Through this incision, a clip is applied to each fallopian tube. The clip effectively blocks the fallopian tube so that sperm and eggs are unable to meet.

This should be considered as a permanent procedure. Reversal may be attempted but this requires several hours of microsurgery and Medicare and Health Funds offer no financial rebate in these circumstances and the chances of a normal conception following are low. Laparoscopic sterilisation is therefore for someone who is absolutely certain that their family is complete. It is wise to consider unpleasant scenarios such as death of a partner, divorce from a partner, disaster occurring in family members such as childhood malignancy or Sudden Infant Death Syndrome. There is also a certain degree of regret associated with permanent forms of contraception and this will obviously vary with the individual circumstance. The likelihood of falling pregnant even after this procedure has been successful is approximately 1:300 during the first 10 years after the procedure is performed. This is comparable to the pregnancy rate following an apparently successful vasectomy.

Laparoscopic Bilateral Salpingectomy

This procedure is done under general anaesthesia as day surgery in hospital. A small incision is made through the belly button and a camera introduced into the abdomen. Gas is then used to inflate the abdomen so that a space is created through which other instruments can be passed.  A further two 5mm incisions are made low on the abdominal wall. Instead of the fallopian tubes being clipped, they are completely removed. Although similar to the operation described above, salpingectomy can be more technically difficult and is completely irreversible.

There is some emerging evidence that the development of ovarian cancer is due to some precancerous cells forming at the very tip of the fallopian tube.  Women who have had their tubes removed, for whatever reason, have a slightly lower risk of ovarian cancer in future.  Therefore, a salpingectomy may be preferred to laparoscopic sterilization as it reduces the risk of ovarian cancer.  

Essure

This technique involves the placement of a metal and fabric device into the fallopian tubes where they join the uterine cavity. It is performed under general anaesthesia using a technique called hysteroscopy. Hysteroscopy does not require an incision in the abdomen as the Essure device and camera are passed through the vagina and cervix into the uterus. There are occasionally technical difficulties where the opening of the tube cannot be negotiated by the fine instruments and the procedure can’t be performed (2% of all patients). During the initial three months after insertion, dense scar tissue will be forming around the Essure device, occluding the fallopian tube in order to prevent the egg and sperm from meeting. During these initial three months other forms of contraception must be used and must not be stopped until an x‐ray is done to confirm that the devices have not migrated from their original location. This procedure is totally irreversible and is associated with a subsequent pregnancy rate of approximately 1:500.