New approaches to female sterilization

This is a story about women who have decided not to have any more children. But men who squirm at the very thought of a vasectomy might want to read on.

Two new procedures — one on the market, one still experimental — could make female sterilization so simple and painless that vasectomy will fade into reproductive history.

The new approaches represent the first major advances in female sterilization since the 1960s, when the laparoscope allowed doctors to tie off the fallopian tubes through inch-long incisions instead of gaping holes in the abdomen.

The new methods require no incisions. Guided by a thin scope inserted through the vagina and cervix into the uterus, doctors can plug the fallopian tubes to permanently prevent the meeting of egg and sperm.

The main difference between the two methods is the material used to plug the tubes.

At Hartford Hospital in Hartford, Conn., Dr. August C. Olivar uses a stainless steel, corkscrew-like plug approved by the federal Food and Drug Administration in late 2002. Once he places the coil at the entrance to the fallopian tube, scar tissue grows around it, sealing the opening.

When a woman ovulates, the egg travels through the fallopian tube as usual but cannot enter the uterus, where it could be fertilized. The unfertilized eggs are safely reabsorbed into the body.

At New Britain General Hospital in New Britain, Conn., Dr. Anthony Luciano is testing a newer plastic plug that is smaller than half a grain of uncooked rice.

The plug is loaded at the end of a wand that is inserted into the uterus through the vagina. Once Luciano locates the opening to each fallopian tube, he releases the plug, then solders it in place using the same type of electrical cauterizing device used to control bleeding during surgery. Scar tissue grows to hold the plug in place.

“The egg stops in the tube; the sperm cannot get to the egg; the blockage is right there. If they don’t meet, you don’t get pregnant,” Luciano said.

Karen McAviney of Cheshire, Conn., is among 500 women across the United States who will test the plastic plug over the next five years.

She and her husband have three children ranging in age from 10 to 17. Both were happy with the size of their family and dissatisfied with the condoms they were using to keep it that way. Neither McAviney nor her husband was willing to undergo more traditional sterilization.

In traditional tubal ligation, doctors make one to three small incisions in the abdomen while the woman is under general anesthesia. Using a magnifying scope as a guide, the doctor ties a tight band around each tube, choking off the blood supply so part of the tube dies. While the woman can go home the same day, recovery can take up to a week.

With the plastic plug, McAviney went into the operating room at 8 a.m. on Feb. 25 and was home in bed by 10:30 a.m. the same day. The procedure was performed under local anesthesia (as is also the case with stainless-steel plugs), with light sedation to relax her. She was back at her job as a production scheduler for a manufacturing company in Watertown the next day.

“It was awesome,” said McAviney, 40. “With the three kids, I couldn’t afford to be out of work, and I need to be up to get them off to school. During the whole procedure, I did not feel anything.”

McAviney and the other women in the study will be followed for five years to determine if the procedure is safe and effective in preventing pregnancy. If it works, the plastic plug could be approved and on the market by 2009.

“I believe if this works well, it seems to me it would replace all sterilization, including male sterilization,” Luciano said.

Sterilization is the most commonly used form of contraception in the United States, with 27.7 percent of couples choosing female sterilization and 10.9 percent of couples using vasectomy. The birth-control pill is the second most widely used contraceptive method, with 26.9 percent of U.S. couples using it, according to the National Center for Health Statistics.

Doctors have been searching for a simpler alternative to the surgical method for many years, but experiments with silicon plugs and injecting toxins to block the tubes failed. Luciano and Olivar said the new devices are the most promising alternative they’ve seen.

Lawrence B. Finer, associate director for domestic research at the Alan Guttmacher Institute, an independent reproductive-health think tank, said every advance in contraception gives women more options for planning their childbearing.

“When you add a method to the mix, you’re increasing the probability that a particular woman is going to find a method that’s good for her,” Finer said.