Permanent Birth Control      Heather Beal M.D.          OB/GYN
Overview of Seminar• Permanent birth control options  – Vasectomy  – Laparoscopic tubal ligation  – Essure• Long term birt...
Seeking a Permanent    Birth Control Method              Families                         • 40% of US pregnancies         ...
What is Permanent Birth Control?• Permanent birth control provides protection against  pregnancy• There are currently thre...
Vasectomy - Overview• How it is performed: An incision is made in the  scrotum and the two vas deferens are tied in  two p...
Vasectomy - Benefits• 98.87% effective• Does not interfere with erection, ejaculation,  or hormone production• Quick and r...
Vasectomy - Risks•   Pain•   Bleeding•   Local irritation•   Bruising•   Infection•   Sperm granuloma•   Chronic pain
Vasectomy - Considerations• It may take three months or longer before it  can be relied upon  – An alternate form of birth...
Tubal Ligation - Overview• How it is performed: Surgery is performed  under general anesthesia. Two incisions are  made in...
Tubal Ligation - Benefits• 99.82% effective• Effective immediately• Does not affect libido• Does not affect normal monthly...
Tubal Ligation - Risks•   Pain•   Infection•   Bleeding•   Organ damage•   Pregnancy and risk of ectopic pregnancy•   Risk...
Tubal Ligation - Considerations•   Performed under general anesthesia•   Previous surgery•   Body habitus•   Temporary sid...
The Essure Procedure• Essure is permanent birth control without  hormones, cutting, or the risks of surgery• The Essure pr...
Essure - Overview• How it is performed: Soft, flexible micro-  inserts are placed in the fallopian tubes  through a hyster...
The Essure Micro-insert            •   Soft and flexible            •   Biocompatible            •   Hormone-free         ...
Essure - Overview• Average procedure time: 10 minutes• Recovery time: 1-2 days  – Cramping  – Spotting
Essure - Benefits• 99.80% effective• No hormones• Minimal recovery time• No cutting/surgery/anesthesia• No impact from pre...
Essure - Risks•   Mild cramping•   Nausea•   Dizziness•   Spotting•   Chance of tubal perforation, expulsion, or    unsucc...
Essure - Considerations• Patients must continue to use another form of  birth control for three months after the  procedur...
Essure
What to Expect• Before the procedure  – A relaxant may be offered to keep you calm and    comfortable• During the procedur...
Essure Procedure is Well Tolerated      with Local AnesthesiaProcedural discomfort similar to menstrual cramps  Pain Ranki...
Confirmation Test• 3 months later you will return for a test to  confirm that you tubes are blocked
Essure - Cost• Covered by most insurance providers• May be as low as an office co-pay• Verify your plan’s benefits prior t...
Essure is more effective thantemporary methods of birth control     Percentage of women that will become pregnant         ...
Comparing Effectiveness:        Five-Year Failure RatesEssure has the highest effectiveness of long-term birth control met...
Is Essure Right For You?An Essure Candidate Is a Woman Who Is:• Certain her family is complete  – Considering tubal ligati...
Is Essure Right For You?An Essure Candidate Does Not Want:• To wait for partner to have a vasectomy• Surgery that involves...
Is Permanent Birth Control Right             for You?• Yes, if:   – You know that your family is complete   – You no longe...
Long Term Birth Control Options• Intrauterine Device (IUD)  – Mirena  – Paragard
Mirena•   Placed within the uterine cavity•   In-office procedure•   Minimal cramping•   Does contain hormones•   Lessens ...
Paragard•   Placed within the uterine cavity•   In-office procedure•   Minimal cramping•   No hormones•   May increase men...
What Option Is Right For You?
© 2010 Conceptus Inc. All rights reserved. Conceptus and Essure are registered trademarks. CC-2343 11MAR10F   35
When Your Family Is Complete, Consider Essure®
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When Your Family Is Complete, Consider Essure®

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When you have completed your family and you want to prevent unplanned pregnancy, it can lead to big decisions – and big surgeries. Springfield Clinic now offers Essure®, a gentle, minimally invasive, in-office procedure that gets patients back to their normal lives faster and with less risk than ever before. Please join Dr. Heather Beal as she discusses this incredible new procedure that can get you back to your life—and free from birth control—in under an hour.

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  • Takeaways: Our target patients are women across all demographics (age, marital status, education, race) who have completed their families.About 40% of pregnancies in the US each year are unintended; in women 40 and older the percentage is slightly higher, about 51%. About a third of unintended pregnancies occur in women who have completed their families. Essure is the best PBC choice for these women. References: Mosher WD, Martinez GM, Chandra A, Abma JC, Willson SJ. Use of contraception and use of family planning services in the United States, 1982–2002. Advance data from vital and health statistics; no 350. Hyattsville, Maryland: National Center for Health Statistics. 2004. Chandra A, Martinez GM, Mosher WD, Abma JC, Jones J. Fertility, family planning, and reproductive health of U.S. women: Data from the 2002 National Survey of Family Growth. National Center for Health Statistics. Vital Health Stat . 23(25). 2005. Henshaw S. Unintended Pregnancy in the United States. Family Planning Perspectives. 1998;30(1):24–29 & 46. Rev history: Staff Training – CCXXX
  • Takeaways: (Pass around micro-insert in the vial) Soft, light and flexible Does not contain hormones or silicone; Does not contain or release hormones Made from materials used successfully for decades in medical procedures such as heart and other surgeries The tissue response has been found to be: Reliable – 100% of patients with correct placement had occlusion Localized to the micro-insert References: N/A Rev history: Staff Training – CCXXX; CC-0618 29APR09F
  • Takeaway : Studies show that on average patients that undergo Essure in the office setting with local anesthesia find the discomfort to be similar to menstrual cramps. Patients should be counseled to expect some cramping similar to menstrual cramps. In a small number of patients, cramping can get intense. It is impossible to predict how a woman will respond. Patients should be reassured that, if at any time, discomfort becomes unbearable, that the procedure can be stopped and rescheduled in the OR. Ask audience to share any personal stories . References: Levie M, Chudnoff S, Kaiser B, Levy B, Snyder D. Multicenter Trial of Hysteroscopic Sterilization in the Office Setting Under Local Anesthesia. Abstract presented at AAGL, 2007. Rev history:
  • Takeaway: Essure is more effective than temporary methods of birth control References: Kost K et al. Estimates of contraceptive failure from the 2002 National Survey of Family Growth. Contraception . 2008 Jan: 77(1):10-21 Rev history: 202 Course 0909
  • Takeaway: Essure has the highest effectiveness of long-term birth control methods References: Data on file. Conceptus Inc. Kost K et al. Estimates of Contraceptive Failure from the 2002 National Survey of Family Growth. Contraception . 2008. 77(1):10-21. Peterson HB et al. The risk of pregnancy after tubal sterilization: findings from the U.S. Collaborative Review of Sterilization. Am J Obstet Gynecol .1996;174(4):1161-8. Mirena Prescribing Information. Bayer HealthCare Pharmaceuticals. July 2008. JamiesonDJ et al. The risk of pregnancy after vasectomy. Obstet Gynecol . 2004;103(5 Pt 1):848-50. Rev history: Staff Training – CCXXX; 202 Course 0909
  • Takeaway: References: N/A Rev history: Staff Training – CCXXX, CC-0618 29APR09
  • Takeaway: References: N/A Rev history: Staff Training – CCXXX, CC-0618 29APR09
  • When Your Family Is Complete, Consider Essure®

    1. 1. Permanent Birth Control Heather Beal M.D. OB/GYN
    2. 2. Overview of Seminar• Permanent birth control options – Vasectomy – Laparoscopic tubal ligation – Essure• Long term birth control options – Mirena – Paraguard
    3. 3. Seeking a Permanent Birth Control Method Families • 40% of US pregnancies complete (>2M) are unintended – In women ≥40y the rate is 51%Unintendedpregnancies – About a third of unintended pregnancies occur in women who consider their families complete
    4. 4. What is Permanent Birth Control?• Permanent birth control provides protection against pregnancy• There are currently three permanent birth control options – Vasectomy – Tubal ligation – Essure• No method of permanent birth control is 100% effective and none protect against STDs
    5. 5. Vasectomy - Overview• How it is performed: An incision is made in the scrotum and the two vas deferens are tied in two places, then separated by burning, cutting, or blocking with clips or clamps• Procedure time: 20-30 minutes• Recovery time: 2-3 days – Swelling, bruising, pain
    6. 6. Vasectomy - Benefits• 98.87% effective• Does not interfere with erection, ejaculation, or hormone production• Quick and relatively simple procedure that can be done in a physician’s office• Performed on him
    7. 7. Vasectomy - Risks• Pain• Bleeding• Local irritation• Bruising• Infection• Sperm granuloma• Chronic pain
    8. 8. Vasectomy - Considerations• It may take three months or longer before it can be relied upon – An alternate form of birth control is necessary until a test is performed to confirm the absence of sperm.• Temporary side effects – Swelling, bruising, pain• How long are you willing to wait for him?
    9. 9. Tubal Ligation - Overview• How it is performed: Surgery is performed under general anesthesia. Two incisions are made in the abdomen to reach the fallopian tubes. The tubes are burned or clamped with clips or rings.• Average surgical time: 30-40 minutes• Recovery time: 4-6 days, cramping, abdominal bloating, bruising
    10. 10. Tubal Ligation - Benefits• 99.82% effective• Effective immediately• Does not affect libido• Does not affect normal monthly cycles (stopping hormonal contraceptive may)• Does not utilize hormones
    11. 11. Tubal Ligation - Risks• Pain• Infection• Bleeding• Organ damage• Pregnancy and risk of ectopic pregnancy• Risks of anesthesia
    12. 12. Tubal Ligation - Considerations• Performed under general anesthesia• Previous surgery• Body habitus• Temporary side effects – Difficulty with general anesthesia – Cramping, bloating, bruising• If pregnancy does occur, there is an increased risk of an ectopic pregnancy
    13. 13. The Essure Procedure• Essure is permanent birth control without hormones, cutting, or the risks of surgery• The Essure procedure works with your body to create a natural, permanent barrier against pregnancy• Essure has been trusted by women and physicians since 2002 with ~500,000 procedures performed.
    14. 14. Essure - Overview• How it is performed: Soft, flexible micro- inserts are placed in the fallopian tubes through a hysteroscope.
    15. 15. The Essure Micro-insert • Soft and flexible • Biocompatible • Hormone-free • Tube permanently blocked – Occlusion is reliable and localized
    16. 16. Essure - Overview• Average procedure time: 10 minutes• Recovery time: 1-2 days – Cramping – Spotting
    17. 17. Essure - Benefits• 99.80% effective• No hormones• Minimal recovery time• No cutting/surgery/anesthesia• No impact from previous surgery or body habitus• In-office procedure/simple co-pay• Peace of mind – confirmation test
    18. 18. Essure - Risks• Mild cramping• Nausea• Dizziness• Spotting• Chance of tubal perforation, expulsion, or unsuccessful placement
    19. 19. Essure - Considerations• Patients must continue to use another form of birth control for three months after the procedure, until the confirmation test verifies that the tubes are blocked.• Not all women will be able to have both micro-inserts placed.
    20. 20. Essure
    21. 21. What to Expect• Before the procedure – A relaxant may be offered to keep you calm and comfortable• During the procedure – A small scope is gently inserted into the vagina – The micro-inserts are inserted and released into each fallopian tube
    22. 22. Essure Procedure is Well Tolerated with Local AnesthesiaProcedural discomfort similar to menstrual cramps Pain Ranking N=253
    23. 23. Confirmation Test• 3 months later you will return for a test to confirm that you tubes are blocked
    24. 24. Essure - Cost• Covered by most insurance providers• May be as low as an office co-pay• Verify your plan’s benefits prior to the procedure and specify the location of your procedure
    25. 25. Essure is more effective thantemporary methods of birth control Percentage of women that will become pregnant in the first 12 months of typical use
    26. 26. Comparing Effectiveness: Five-Year Failure RatesEssure has the highest effectiveness of long-term birth control methods Five-Year Failure Rates per 1000 women
    27. 27. Is Essure Right For You?An Essure Candidate Is a Woman Who Is:• Certain her family is complete – Considering tubal ligation or vasectomy – Considering or has had endometrial ablation – Contraindicated for laparoscopic surgery – Dissatisfied with her current birth control method
    28. 28. Is Essure Right For You?An Essure Candidate Does Not Want:• To wait for partner to have a vasectomy• Surgery that involves incisions• To remember to take or use temporary birth control methods• A birth control that contains hormones
    29. 29. Is Permanent Birth Control Right for You?• Yes, if: – You know that your family is complete – You no longer want to take hormones – You worry about an unplanned pregnancy
    30. 30. Long Term Birth Control Options• Intrauterine Device (IUD) – Mirena – Paragard
    31. 31. Mirena• Placed within the uterine cavity• In-office procedure• Minimal cramping• Does contain hormones• Lessens menstrual bleeding• 5 years
    32. 32. Paragard• Placed within the uterine cavity• In-office procedure• Minimal cramping• No hormones• May increase menstrual flow• 10 years
    33. 33. What Option Is Right For You?
    34. 34. © 2010 Conceptus Inc. All rights reserved. Conceptus and Essure are registered trademarks. CC-2343 11MAR10F 35
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