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Hysteroscopic Sterilization

Figs 7A and B: The Ovion System: (A) The Ovion system is 1 mm in outer diameter and can be placed through 3F working channels found
in small rigid or flexible hysteroscopes. (B) The micro-insert is made up of a self-expanding nitinol frame embedded with PET fibers, which
support tissue ingrowth

2 cm. It is permanent contraceptive device consisting of • Transcervical methods. Essure is safe and effective.
expandable metal tube containing an inner matrix that induces No major adverse events are reported. Strict inclusion
fibrosis and blockage of the intramural part of tube. FDA criteria and follow-up is essential to optimize the
approval has not yet sought. The micro-insert is composed outcome. Alternative contraception practice is mandatory
of self-expanding nitinol frame embedded with PET fibres. for improved success rate. HSG is advocated after 12
No portion of device trail to uterine cavity. Ovion system is weeks to assess the outcome.
1 mm in outer diameter and can be placed through 3F • In the Adiana method, the procedure is safe and well
working channel found in small rigid or flexible tolerated. Cost data is not yet known.
hysteroscopes. Both micro-inserts are loaded simultaneously • Quinacrine is studied in poorer nations where medical
so they could be deployed in succession. The ovion device technology is less. It is a mutagen. It is implicated as a
can be loaded to flexible hysteroscope as office use. It is potential carcinogen although not established. It is cost
easier, faster and could have potential benefit of IVF or effective.
endometrial ablation.
ACKNOWLEDGMENT
Intratubal Ligation Device(USA) I thank Professor Dr RK Mishra without whose exceptional
and admirable guidance I would not have gone through this
The occlusion is achieved by ligation of intravaginal portion DMAS course and wonderful training which carve a niche
of tubal epithelium by an elastomeric band which leads to in my career and professional development.
scar formation and creates permanent damage. This is under
phase 1 trial. BIBLIOGRAPHY
1. Cooper JM, Carignan CS, Cher D, Kerin JF. Selective Tubal
SUMMARY Occlusion Procedure 2000 Investigators Group. Microinsert
nonincisional hysteroscopic sterilization. Obstet Gynecol.
After 100 years of seeking safe and effective methods for 2003;102(1):59-67.
female sterilization that avoid entry into the abdomen, trans- 2. Cooper JM. New approaches to hysteroscopic sterilization.
cervical sterilization is today's reality. Essure appears to be Contemp Ob Gyn 2003;48:8-20.
equal or superior to laparoscopic sterilization. It offers 3. Essure (package insert). San Carlos, CA: Conceptus Inc.; 2002.
4. Estridge TD, Feldman DS. Quantification of vascular ingrowth
benefits of an office procedure under local anesthesia. It is into Dacron velour. J Biomater Appl 1991;6(2):57-169.
cost-effective and better resource utilization. Hysteroscopic 5. Kerin JF, Carignan CS, Cher D. The safety and effectiveness of
sterilization is alternative in women with severe a new hysteroscopic method for permanent birth control: Results
cardiopulmonary disease, obesity or a history of prior of the first Essure pbc clinical study. Aust NZJ Obstet Gynaecol
2001;41(4):364-70.
abdominal or pelvic surgery where laparoscopy is 6. Kerin JF, Cooper JM, Price T, et al. Hysteroscopic sterilization
contraindicated. Adequate audit and women counseling is using a microinsert device: Results of amulticentre phase II study.
essential. Future insight to develop reversible device is Hum Reprod 2003;18:1223-30.
challenging. 7. Kerin JF, Munday DN, Ritossa MG, Pesce A, Rosen D. Essure
hysteroscopic sterilization: Results based on utilizing a new coil
catheter delivery system. J Am Assoc Gynecol Laparosc
Points to Remember 2004;11(3):388-93.
8. MacKay AP, Kieke BA (Jr), Koonin LM, Beattie K. Tubal
• Method of tubal occlusion using electrocautery or sterilization in the United States 1994-1996. Fam Plann Perspect.
ND: YAG laser is abandoned. 2001;33(4):161-65.

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