When it comes to having children, the right number can vary widely. Some people want lots of children. For others, the right number is zero. If your family is the right size, whatever size that is, it may be time to think about permanent birth control. One option is called Essure.

What is Essure?
Essure is a procedure in which a doctor places tiny metal coils (called microinserts) into a woman's fallopian tubes. Scar tissue forms around the coils. This blocks the passage of eggs through the tubes to the uterus. Essure has been shown to be more than 99 percent effective at preventing pregnancy. This is a relatively new procedure, so studies are needed to check for long-term safety and effectiveness.

Essure is not the same as an IUD (which goes in the uterus, not the tubes), and it doesn't contain or release any hormones.

How is it done?
For the procedure, you will lie on your back with your feet in stirrups as you do for a pelvic exam. The doctor will use a speculum to widen the vagina and then insert a slim instrument called a hysteroscope through the cervix into the uterus. The hysteroscope has a tiny camera that lets the doctor see the inside of your uterus on a monitor.

The doctor uses the hysteroscope to guide the catheter with the micro-insert through the opening in the uterus into each of the fallopian tubes. Once in place, the coiled insert expands to fit inside the tube.

The procedure can be done in a doctor's office, and it only takes about 30 minutes. You may have some cramping during and after the procedure. You will be back to your normal activities in a day or two.

How long does it take for Essure to become effective?
It takes about three months for your body to form scar tissue around the microinserts. You must use another form of birth control during that time.

After three months your doctor will do a pelvic x-ray called a hysterosalpingogram (HSG) to be sure the tubes are blocked. Once HSG confirms this, you will not need backup contraception any longer.

Who should use it?
Essure may be a good method of permanent birth control for women who are sure they don't want to have more (or any) children. Talk to your doctor about this and other options.

Essure is not a good option if you:

• Cannot have microinserts placed in both fallopian tubes
• Are not willing to use backup birth control for three months
• Will not have the follow-up HSG
• Are allergic to nickel or the dye used for HSG
• Are not sure you want to become sterile

What are the risks?
Possible risks include:

• Failure to place a micro-insert in each tube on the first try; may require a second procedure
• Puncture of the uterus or fallopian tube during placement
• Tubal (ectopic) pregnancy, which can be dangerous and require treatment

Essure devices are fairly new, approved in the U.S. in 2002, so the long-term risks and effectiveness are not known.

What are the pros and cons of Essure?

Are there other choices for permanent birth control?
Tubal ligation is another option for women. It's also called "having your tubes tied." Tubal ligation is a surgical procedure in which a doctor cuts, clamps or scars the fallopian tubes. It requires small incisions in the abdomen, general anesthesia and a few days' recovery time. On the other hand, it has been done for many years so its safety and effectiveness are well established.

A couple may also want to consider vasectomy for the man. Vasectomy is a simple office procedure. It is more effective than female sterilization and also less risky and less expensive.

Related Articles Facts About Vasectomy The Birth Control Guide Male Birth Control Methods Tubal Ligation

External Sources Association of Reproductive Health Professionals. Non-hormonal contraceptive methods: tubal microinserts. . Accessed June 01, 2009 Ogburn T, Espey E. Transcervical sterilization: past, present, and future. Obstetrics and Gynecology Clinics of North America. 2007;34(1):57-72. . Accessed June 02, 2009 U.S. Food and Drug Administration. Medical devices: Essure System. . Accessed June 02, 2009

This article was reviewed and updated 08-01-2009.