Dr. Erica Nelson likes to be able to offer her patients more options for birth control.
Until now, couples in Springfield wanting surgical sterilization had two alternatives: tubal ligation for women and vasectomy for men.
Both involve cutting or burning tissues. The procedures either prevent an egg from making its way down a woman's fallopian tubes to be fertilized or prevent a man's sperm from being released through the penis.
A few Springfield gynecologists this year have begun to offer the Essure procedure, in which a thin metal coil is inserted through the vagina, snaked up into the uterus and placed permanently inside each of a woman's two fallopian tubes.
The sterile medical device allows the body's own tissue to grow into and around it, blocking off the fallopian tube and rendering the woman sterile within a few months without hormones or incisions.
"It's very effective," said Nelson, an obstetrician and gynecologist at Springfield's Southern Illinois University School of Medicine. "This just gives women another really good, effective option. And the more options, the better."
Local doctors offering Essure include Nelson; Dr. Casey Younkin, another obstetrician-gynecologist at SIU; and Dr. Jane Arbuthnot, a gynecologist at Women's Healthcare, an affiliate of Memorial Medical Center.
The Essure device, manufactured by Californiania-based Conceptus Inc., received approval from the U.S. Food and Drug Administration in November 2002 and already has been used by about 40,000 women worldwide.
Springfield doctors began offering the procedure this year and have served a handful of patients so far.
But Conceptus officials believe the procedure eventually could replace tubals as the most common form of permanent contraception in the United States.
"We expect this to become the standard of care in three to five years," said Mark Sieczkarek, chief executive officer of Conceptus, a company that's publicly traded under the ticker symbol CPTS.
About 700,000 U.S. women undergo tubals each year, while about 400,000 men receive vasectomies annually.
The Essure procedure is more than 99 percent effective in preventing pregnancy after five years, according to Conceptus. That puts the device on par with tubal ligation and vasectomies in effectiveness.
Essure has the potential to save the health-care system money because it is less invasive and safer than a tubal and can be performed less expensively, Sieczarek said.
The 20-minute outpatient procedure can be done in a doctor's office under local anesthetic, although in Springfield, Essure procedures are taking place inside Memorial Medical Center, at least for now.
Nelson's patients are charged about $9,000 for a tubal and $14,000 for Essure; the charges include hospital and physician fees.
Tubals commonly are covered by health insurance, and most insurers are paying for Essure as well.
The procedure isn't allowed at St. John's Hospital because of the Catholic hospital's opposition to artificial birth control.
A doctor puts the Essure device in place with a 2-foot-long scope containing a catheter about the width of a strand of spaghetti. The doctor holds the scope at the vaginal opening and sees inside the uterus with a video camera at the tip.
The doctor deploys a catheter from inside the scope. That catheter contains the Essure coil for each fallopian tube. The coil is flexible and made out of nickel, titanium and stainless steel. When fully deployed, it's a few inches long.
"We push the coil through the scope until it feeds into the fallopian tube," Nelson said. "It's kind of what a plumber does with a drain wire. You just kind of push it into the drain. There should not be any resistance."
Risks of the procedure, though small, include bleeding and piercing the wall of the uterus, Nelson said.
In a tubal ligation, which takes about as long as the Essure procedure, a woman must be under general anesthesia. Through small incisions, doctors either cut, cauterized or clamp the fallopian tubes.
In a vasectomy, a small incision is made in the scrotum during the outpatient procedure. Then, the two tubes that carry sperm from the testicles to the penis are cut or blocked.
Nelson said Essure is a good option for any woman and particularly for a woman who may have had abdominal surgeries in the past. Internal scars left by those surgeries can make a tubal more difficult or impossible.
Essure also is a good option for obese women, she said, because excess belly fat can make a tubal difficult or risky for a doctor to perform.
Nelson so far has used general anesthetic during Essure procedures, but Arbuthnot said she uses local anesthetic for her patients.
Recovery time is quicker with the Essure procedure, Nelson and Arbuthnot said. And Arbuthnot said patients who receive local anesthesia don't have to deal with the "got-hit-by-a-truck kind of feeling" associated with general anesthesia.
Women who have undergone a tubal must rest for two or three days afterward, Arbuthnot said. But with Essure, she said, a woman "can have it done at lunch time and then can go out to dinner."
Nelson doubted Essure will replace tubals in popularity. Women often opt to have a tubal the same day or the day after delivering a baby, and a tubal is effective immediately.
Essure, on the other hand, can't be done right after delivery, and the woman must use other forms of contraception for three months after the procedure to allow for the tissue growth that blocks her fallopian tubes.
The FDA requires that the Essure procedure include a follow-up X-ray test at the end of three months to confirm the tubes are blocked.
As the procedure becomes more common, Sieczkarek said, the FDA might allow Essure without the follow-up X-ray, and the recommended three-month period for using alternative contraception might be shortened.
On the Net
www.essure.com
Dean Olsen can be reached at 788-1543 or dean.olsen@sj-r.com. / GRAPH SOURCE: Conceptus Incorporated
