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Summary

Hysteroscopic sterilization is a method to prevent pregnancy permanently. It involves closure of the fallopian tubes (narrow tubes that carry the egg from the ovaries to the womb) by placing microinserts in them. A hysteroscope is used to see and place the device correctly inside the tubes. Once placed, the microinsert causes tissues to grow inside and around the tubes, thus blocking the fallopian tubes, preventing fertilisation and hence pregnancy. Your doctor may perform this procedure if you no longer wish to have a baby. However, under certain conditions like pelvic infections, pregnancy or delivery, hysteroscopic sterilization is contraindicated.

Before the procedure, you will have a counselling session with your doctor where the doctor will tell you about the consequences of the procedure on your health. You will need to fast before the operation. To ensure that you are not pregnant at the time of the procedure, your provider may prescribe contraceptive pills for three weeks before the procedure. You will also have to undergo a pregnancy test on the day of the surgery. The procedure will be done under local anaesthesia. The device will take three months to block the tubes. Until then, you must continue taking the contraceptive pills to avoid a pregnancy. The surgeon will schedule an appointment three months after the procedure to check for blockage of your fallopian tubes. 

  1. What is hysteroscopic sterilization?
  2. Why is hysteroscopic sterilization recommended?
  3. Who can and cannot get hysteroscopic sterilization?
  4. What preparations are needed before hysteroscopic sterilization?
  5. How is hysteroscopic sterilization done?
  6. How to care for yourself after hysteroscopic sterilization?
  7. What are the possible complications/risks of hysteroscopic sterilization?
  8. When to follow up with your doctor after hysteroscopic sterilization?

Hysteroscopic sterilization is a non-surgical (no incisions required) method to prevent pregnancy permanently.

In this procedure, a device is used to implant microinserts inside each fallopian tube through the vagina. Fallopian tubes are a pair of muscular tubes that carry the egg, the female reproductive cell, from the ovaries to the uterus or womb. The healthcare provider will first insert a hysteroscope, a thin, long tube with a light and camera at one end, through your vagina, to visualise and place the device correctly inside your fallopian tubes. Once the device is implanted, tissue will grow inside and around your fallopian tubes within about three months. This will close the tubes, keeping the egg from coming in contact with the sperm (male reproductive cell), and hence preventing pregnancy.

The procedure will not stop your periods or protect you from sexually transmitted infections (e.g., AIDS). Your surgeon will perform this operation immediately after your periods end to avoid the placement of the device in case of an undiagnosed pregnancy.

This surgery is recommended to women who no longer wish to become pregnant.

Your surgeon may not perform a hysteroscopic sterilization if you:

  • Are uncertain about your decision to not get pregnant in the future 
  • Are allergic to contrast dye (used during the imaging scan)
  • Had a delivery or termination of pregnancy in the past six weeks 
  • Have an infection of the reproductive organs (pelvic infection)
  • Are pregnant or suspect that you are pregnant 
  • Have abnormalities of the uterus or fallopian tube that cause difficulty in visualising through a hysteroscope

Before this procedure, you will need the following preparations:

  • The healthcare provider will perform a physical examination.
  • You will have a counselling session wherein the doctor will explain the consequences of this procedure on your health.
  • You will be asked to share with your doctor a list of all the medicines that you take, including prescribed or non-prescribed medications and herbal supplements.
  • If you take any blood thinners (aspirin), you will be asked to stop them a few days prior to the procedure.
  • Notify your doctor if have an allergy to any medicine or tools used during surgery such as iodine, tape, or latex or if you have a bleeding disorder. 
  • You may need to fast before this procedure. 
  • You will be asked to stop smoking to avoid the risk of complications after the procedure.
  • To prevent a pregnancy at the time of this procedure, you will have to take contraceptive pills three weeks before the procedure. 
  • Your pregnancy test will be performed on the day of the procedure, for which, you will be asked to carry an early morning urine sample in a sterile container. 
  • You will have to sign an approval form to grant permission for this procedure. 
  • Make sure to ask a friend or family member to give you a ride home after you are discharged from the hospital.

Once you reach the hospital, a nurse will provide you with a hospital gown. Your doctor will tell you to empty your bladder. Then, you will be asked to lie on an operating table with your legs supported in stirrups (to allow access to your vagina).

The following steps will be performed during the surgery:

  • An anesthesiologist will inject local anaesthesia to you to numb the operated area. He/she may also give you a sedative to keep you relaxed during the surgery. 
  • Once the anaesthesia takes effect, your healthcare provider will insert a speculum and widen your vagina to allow access to your cervix (the mouth of the uterus [womb]) 
  • He/she will gently place in a hysteroscope inside your uterus through your vagina.
  • Next, the surgeon may insert a saline solution into your uterus through the hysteroscope to enhance the visibility of your uterus and fallopian tubes. 
  • After ensuring that the opening of one of your fallopian tubes is in line with the head of the device, the surgeon will release the microinserts from the hysteroscope inside your fallopian tube. 
  • Once the microinserts are implanted, the surgeon will check their location and remove the hysteroscope. 
  • The procedure is then repeated at the other fallopian tube.

Once the hysteroscope is placed, inserting the device in the fallopian tubes takes only 10 minutes. After this procedure, you will rest in the recovery area. You will be given medications to reduce post-operative pain and discomfort. A nurse will monitor your health during your stay in the recovery room. Your doctor may perform an ultrasound scan to check if the microinserts are placed in properly. You will be sent home in about an hour.

After hysteroscopic sterilization, the following care is needed at home:

  • Medications: 
    • You will need mild pain medications like ibuprofen for a few days.
    • Continue taking contraceptive pills for up to three months.
  • Activities: 
    • You may be able to resume your routine within one to two days.
    • You will be allowed to drive once the effect of anaesthesia has worn off.
    • Avoid having sex or douching (inserting a liquid inside the vagina) for at least two weeks.

When to see the doctor?

Notify (call or visit) your healthcare provider immediately if you experience the following:

  • Heavy vaginal bleeding (mild bleeding is normal for one to two days after the procedure) 
  • Prolonged bleeding 
  • Vomiting 
  • Severe abdominal pain 
  • Fever 
  • Chills
  • Device falls out 
  • Cramping

This surgery is known to carry the following risks:

  • Ectopic pregnancy (pregnancy that occurs in a place other than the uterus) 
  • Infection 
  • Tear in the uterus 
  • Bleeding 
  • Allergic reaction to the metal coil in the microinserts 
  • Pelvic pain
  • Displacement (slipping) of the device 
  • Improper placement or movement of the device 
  • Chronic (long-term) pain 
  • Tear in the fallopian tube

Your doctor will schedule a follow-up appointment after three months during which, he/she will conduct imaging scans like an X-ray or ultrasound to check for the closure of your fallopian tubes. 

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Saint Luke's Hospital [Internet]. Kansas City. US; Understanding transcervical hysteroscopic sterilisation
  2. McMartin K. Hysteroscopic tubal sterilization: an evidence-based analysis. Ont Health Technol Assess Ser. 2013 Oct;13(21):1–35. PMID: 24228084.
  3. Baill IC, Cullins VE, Pati S. Counseling issues in tubal sterilization. Am Fam Physician. 2003 Mar 15;67(6):1287–1294. PMID: 12674457.
  4. Beth Israel Lahey Health: Winchester Hospital [Internet]. Winchester. Maryland. US; Hysteroscopic Sterilization
  5. Johns Hopkins Medicine [Internet]. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System; Hysteroscopy
  6. UAB medicine [Internet]. Alabama. US; Hysteroscopic Sterilization
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