Sterilisation

Popular ‘permanent’ method of contraception for couples who are certain their family is complete or do not wish to have children. However, many are opting instead to long-acting reversible methods of contraception e.g. implant/coils.

Female sterilisation

There are various laparoscopic and hysteroscopic methods of female sterilisation:

Laparoscopic- method of choice for most cases
- ‘Filshie clips’- a titanium clip is applied at right angles to the isthmus. Initially blocks the tubes by pressure, but then necrosis takes place and expansive rubber in the clip maintains the blockage
- Falope rings- the ring is also applied to the isthmal region, works in much a similar way
- Pomeroy technique- involves tieing off the tubes and cutting them.
- Irving technique- involves tieing off the tubes and cutting them but then suturing them into the myometrium of the uterus.
Hysteroscopic (may be better in obese patients/patients who have had previous abdominal surgery/patients who would not do well under general anaesthetic/patients who would prefer not to have major surgery)
- Essure- involves inserting a catheter up to the tubes and depositing a solution that causes a fibrotic reaction and ‘plugs’ the tubes.
- Ariana- involves inserting two small pieces of silicone into the opening of the tubes to block them.

Pros and Cons of female sterilisation

Pros
- Effective immediately
- Non hormonal
Cons
- Risk of surgery
- Risk of regret
- Cannot always be reversed (and rarely on the NHS)
- Requires specialist skills
- Relatively high failure rates compared with LARC and vasectomy
Complications
- Short-term: bleeding and infection (rare); pain (tubal ischaemia); damage to other organs e.g. bowel; very small operative mortality (1/10000)
- Long-term: ectopic pregnancy; regret/psychosocial problems

Contraception should be used until the next period.

Male sterilisation (vasectomy)

Diathermy or division of vas deferens and fascial interposition, usually under local anaesthetic.
More reliable than female sterilisation (lower failure rate- 1:2000 compared with 1:200).
Does NOT always work immediately- contraception required until azoospermia confirmed (2 negative semen samples at 12/16 weeks).
Complications include haematoma, infection, chronic pain.
Reversal is not usually successful (not available on the NHS)