Conceptus, Inc. has designed a new form of permanent birth control called Essure. It is an alternative to tubal ligation or vasectomy. Essure is a soft flexible micro-insert. Currently used in Australia, Essure has been approved by the FDA as long as a few minor adjustments be made. These adjustments have not been released to the public. The product is in the third stages of testing and will be available soon.

Essure is inserted into the woman via catheter to the fallopian tubes. It is guided visually by a hysteroscopy. The inserter device, the catheter, flattens the coiled spring so that the device can pass through the cervix and uterine cavity into the entrance of the fallopian tubes. About 5-10mm of the device remains within the uterine cavity but as the inserted device is withdrawn, the coiled spring uncoils and lodged firmly into the fallopian tube. This is then repeated on the other side. This coiled micro-fiber triggers scar tissue growth, eventually permanently blocking sperm from reaching the egg, creating a biological blockage. This procedure will be able to be performed in gynecolologists' offices and with only local anesthetics. The actual procedure takes only 20 minutes to perform and women can usually walk out within 45 after that. A 3-month check-up x-ray is required to make sure the scar tissue has at least begun to grow.

On the pro side, Essure's number one selling point is that no incision has to be made in the abdomen. It is typically done with only local anesthesia and the entire time in the doctor's office is just over an hour. Women are said to have returned to daily life activities in as little as one day after the procedure. There has been no known life threatening complications from the procedure. It is not reversible, comparable to the IUD in which you have to get a new one every 5 years. As for now, it is said that insurance companies will pay for this procedure.

On the con side, Essure is not reversible. And so, in case of tragedy, death, or change of mind, doctor's tell their patients they must be 100% sure they want to go through with this procedure. There is a 3-month waiting period before the blockage is complete, which even though is only just over 99% accurate. There hasn't been any long term, more than 5 years, studies performed, so this is a new technology. We are only now seeing the long-term effects of birth control pills, a contraceptive that has been widely used for over 30 years. There is also the possibility of misplacing, as in putting it in the wrong place, as well as misplacing, in term of losing, the small micro-fiber, as well as expulsion of the inserts. There is a very low rate of tubal and/or uterine perforation, which is tearing of the tubes or uterine cavity. There is a small risk of fainting, overabsorbtion of saline, vaginal bleeding, ongoing pain/discomfort, and menstrual changes. And about 10% of women can't have the inserts due to anatomical differences.

As a group, our questions about this new technology are, I'm sure, similar to those of the general public. We wonder how much it would cost if it were not covered by insurance. We want to know how and on whom did they test Essure. We are interested to know what a woman's menstrual cycle is like after having this procedure, whether it is normal or not, and how exactly, biologically, does it work for the eggs being expelled if the fallopian tubes are blocked. Finally, our big question relates to eugenics and population control. We are concerned about how this reproductive technology, along with others currently used, will be used in Third World countries as a form of sterilization. We think about if this will be used on women and them not even know about it, especially since it is not an intensive surgery.

In conclusion, thinking about reproductive technologies and what they mean as far as progress in our country, you must stop and think about whether or not this is truly a good surgery? Since currently an estimated 700,000 American women undergo tubal ligation each year, this could be just the answer to an alternative permanent surgery. Or, could it be another technology to add to the list of good intentions, but bad outcomes?

Suggested Readings:
"Essure a Permanent Birth Control." www.essure.com

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