Birth Control Innovations Beyond the Pill
There are more options for women (and men) looking to ditch the once-daily dosing.
See also the history of tubal ligation.
“Done, done, done.”
That’s how Lauren describes her childbearing status. For her, four children—all under 11—is more than enough. “We decided a vasectomy was the way to go,” says the West Chester resident.
Lauren was fine with the publication of her last name—her husband, not so much. “He wondered if I should be the one to get something done, and I was like, ‘Seriously? Haven’t I done enough? It’s a 15-minute procedure, and you need a few days to recover. I was pregnant for nine months—four times!”
Thanks to the no-scalpel vasectomy, the procedure has become less invasive, eliminating the need for sedation and a trip to the hospital. Dr. Guy Bernstein, a urologist at Bryn Mawr’s Center for Urologic Care, was the first to perform the procedure in Pennsylvania. “In the 1980s, there were far more tubal ligations than vasectomies, which seemed crazy because vasectomies are surgically simpler. But men don’t like to expose their genitals to surgery,” he says.
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The Urology Center of Chester County’s Dr. Kenneth Fitzpatrick explains that the procedure severs the vas deferens through a puncture in the scrotum. “We pull out the vas deferens from one side, clip it, cut it and burn the end of it. We use local anesthetic, but you do feel tugging and some pressure, which I would call discomfort.”
The procedure takes 30 minutes, at the most. It often takes as little as 15. “Men joke that they wish there was a mirror on the ceiling so they could see what was happening,” says Fitzpatrick. “But if they saw it, they would pass out for sure.”
While complications are unlikely, risks include infection, bleeding from the incision site, the potential for a hematoma, and congestion in the ends of the vas deferens that remain connected to the scrotum. That last complication can result in chronic soreness—but it’s rare. Even more rare is recanalization, the healing and reuniting of the vas deferens.
Even so, pregnancies can happen after a vasectomy. Bernstein says they’re usually the doing of a patient who doesn’t abide by doctor’s orders. “The vasectomy is not immediately effective, because the live sperm have to clear out of the vas deferens,” he says. “That takes about 20 ejaculations. Until then, you’re armed and loaded.” To make sure the vasectomy has taken, Fitzpatrick and Bernstein have patients give semen samples about six weeks after the procedure. No sperm—alive or dead—means you’re “cleared for takeoff,” says Fitzpatrick.
Those fertile couples who choose to avoid surgery do so at their own peril. This past May, a study published in the New England Journal of Medicine showed that the Pill, birth-control patches and vaginal rings have a relatively high rate of failure. Over three years, rates were 4.8 percent for the Pill, 7.8 percent for the patch and 9.4 percent for vaginal rings. “Human error is a big cause of failed birth control,” says Dr. Thomas Dardarian, an OB/GYN with Main Line Women’s Health Care in Rosemont.
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Women have two options for permanent birth control. One is tubal ligation, the so-called tying of the fallopian tubes. While routine, it does require anesthesia, and there is risk of bleeding, injury to other organs and infection. But it’s effective right away. “So patients don’t have to use backup methods,” Dardarian says.
Still, tubal ligations are declining in number, and they’ve been found to have an 11.5-percent failure rate. The newer alternative is Essure, medically known as trans-cervical sterilization, in which two implants block the fallopian tubes.
“We do the procedure in the office, and there’s no sedation—just local anesthesia and sometimes a Valium, because some manipulation does take place,” says Dardarian. “The whole procedure takes, at the longest, 10 minutes.” There might be some mild cramping after the procedure, but nothing severe. Scar tissue takes three months to form, requiring another method of birth control for that waiting period. I think it is it the most effective, least invasive form of permanent birth control for women.”
Yet it’s not Dardarian’s first recommendation. “Most women say their husbands should get some skin in the game,” he says. “I think that sounds right.”
See page 4 for the history of tubal ligation.
Great moments in tubal ligation.
A doctor in Ohio is the first to ligate a woman’s tubes. Instead of sterilizing her by removing her ovaries, which was the norm, he ties strong ligatures around the fallopian tubes, giving birth to a well-known term.
A new tubal ligation procedure severs the ends of the fallopian tubes, instead of tying them. Known as the Pomeroy method, it remains the most widely used approach.
A doctor performs the first laparoscopic tubal ligation in Bern, Switzerland.
An English doctor introduces a titanium-silicone clip that eliminates cutting and suturing. Known as the Filshie clip, it was approved for use here in 1996.
About 700,000 tubal ligations are performed in the United States. Some 11 million American women have had tubal ligations.
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