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Women Opting for Permanent Birth Control

A nonsurgical method has been steadily growing in popularity since 2002. Find out why.

Patricia Anstett

McClatchy Tribune Newspapers

January 14, 2010

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Women who are looking for cheap, quick, noninvasive methods of permanent birth control, an option other than hospital-based tubal ligation, are turning to Essure.

The nonsurgical method has been around since 2002 and has grown steadily in use as more doctors are trained to perform it.

During the relatively quick procedure, often done in the doctor's office, a tiny coil is placed inside each fallopian tube, triggering a reaction that scars the tubes and prevents eggs from reaching the uterus, where they could be fertilized.

"Women are looking for something like this. They want a very simple procedure that is very effective, and they don't want to go to a hospital," says Dr. Charles Cash, an Oakwood Hospital and Medical Center obstetrician/gynecologist who has implanted Essure since early 2003.

Some 290,000 women worldwide have undergone the Essure procedure since 2002, according to the company. Last year, 88,000 procedures were done and this year, the company expects the number to grow to at least 105,000.

Essure - made by Conceptus Inc. of Mountain View, Calif. - and Adiana, a competing product that works in a similar way and is awaiting Food and Drug Administration approval, are nonhormonal and irreversible.

Through the '70s, tubal ligation and vasectomy were equally common among married and once-married men and women. But tubal ligation has become much more prevalent since the '80s, occurring 1 1/2 -2 times as often as vasectomy, according to the Centers for Disease Control.

Doctors say women are less reluctant than men to undergo a permanent procedure.

Karen Hill, 47, of Dearborn, Mich., had the Essure procedure in April 2008 in Cash's Dearborn office.

Hill works full-time in billing for a dental office, has two children, 22 and 18, and "didn't want any more surprises." She said she had no side effects. She's so pleased with the results that she's referred friends, including a friend whose husband, like hers, did not want a vasectomy.

"We both took one for the team," Hill said.

Dr. Roger Smith, a University of Michigan obstetrician-gynecologist, prefers intrauterine devices (IUDs) to Essure because he believes that "for most people an inter-uterine device is a better choice."

They're safer in the long-term, he says, and IUDs can be removed and are cheaper.

"The way I counsel people is by asking, 'Are you sure you want this done?' ... And if not an IUD, why not a vasectomy? Both are proven, easy, cheap and compared to Essure, they are a better choice for a couple."

Dr. Susan Hendrix, an obstetrician/gynecologist at the Detroit Medical Center, said she tries not to steer women to one or two choices. "I pretty much talk about everything," she says.

Hendrix, an unpaid consultant to Hologic Inc., manufacturer of Adiana, said she performs the Essure procedure in the hospital because she considers it a safer place to administer intravenous anesthesia and pain drugs, as are given for the procedure.

Insurance typically pays for the full cost when performed in the hospital, except co-pays and deductibles, she said.

She takes issue with publicity for Essure that attributes a rise in permanent birth control to the recession. "If anything, the recession causes baby booms," she said. "It doesn't cost much to have sex."


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FAQS ABOUT ESSURE

Q: How effective is it?

A: It works 99.8 percent of the time, according to company studies.

Q: What are the side effects?

A: The most common side effects, and the percentage of women experiencing them, are cramping (29.6 percent), pain (12.9 percent), nausea and vomiting (10.8 percent), dizziness and lightheadedness (8.8 percent) and bleeding and spotting (6.8 percent). Doctors say side effects almost always are short-term.

Q: Will insurance pay for it?

A: Most plans do. Co-pays may be as little as $35, though reimbursement varies for a second part of the procedure that involves an injection to see if the implant worked.

Q: Is it reversible?

A: No.

Q. Other issues?

A: Tell your doctor you have had the Essure implant if you are having a pelvic procedure or magnetic resonance imaging test (MRI). It can make an MRI of reproductive organs more difficult to read.