Female Sterilisation

The fallopian tubes are a conduit or pipe, connecting the uterus with the ovary.  Sperm can swim up into the tubes through the uterus after intercourse, and the egg is picked up by the flowery like projections on the end of the tube (called the fimbriae).

Anything which permanently interrupts the fallopian tubes will lead to the inability of the patient to conceive.

A filshie clip, made of titanium and plastic is a relatively modern way of occluding the tube.

PHOTO OF FILSHIE CLIP 

If this is done consciously, the result is surgical sterilisation.  In the past, tubes have been cut and tied.  This originally required a formal cut in the lower abdomen and the removal of about 2cm of the tube.  Although this is still occasionally done, most commonly now the tubes are interrupted using “clips” called Filshie Clips – with the use of a laparoscope and the clip applicators, tubes are permanently occluded.  The clips are inert and allergies to the clips are very, very rare.  The failure rate is approximately 3 per 1000 operations performed.  Several years ago, there was a worldwide spike in the failure rate because it was not realised that the applicators needed to be calibrated to check that the amount of tension in the clip applicator was sufficient to occlude the tube.  This problem has now been rectified and I am again happy to offer patients this choice.

Advantages of Tubal Occlusion

Tubal occlusion is more reliable and permanent as a method of contraception than some other methods.

The woman doesn’t have to remember to take the contraceptive pill every day

The woman suffers no hormonal side effects, as may occur with the oral contraceptive Pill or other hormonal treatments.

Tubal occlusion does not upset the menstrual bleeding pattern (although bleeding may be heavier than periods whilst on the contraceptive pill)

There are no chemicals or devices to put in or take out at the time of sexual intercourse

There are no ongoing costs, as there are with other methods of contraception.

Reversible Birth Control

Intrauterine Contraceptive Device (IUCD)

Copper IUCD’s –can cause periods to become heavier. Rarely used now

The Mirena device – decidedly better for the woman with endometriosis or adenomyosis (it takes around 4-6 months to settle in and may even stop the periods completely). The mirena is a medicated device that releases a small amount of progesterone hormone every day.

Hormonal Birth Control

Oral Contraceptive Pill – combining oestrogen and progesterone.  Progesterone only when breastfeeding

Depo Provera (I rarely use this in my practice). This is an injectable form of progesterone. Initially five injections 6 weeks apart, then every three weeks.

Subdermal Contraceptive Devices for example the Norplant or Implanon ( I rarely use these either)

Barrier Method – condoms, diaphragms or cervical caps