Transcervical hysteroscopic permanent sterilization is currently Federal Drug Administration (FDA) approved. The hysteroscopic approach obviates the need for general anesthesia and surgical incision. The device is a dynamically expanding micro-insert that, when placed in the proximal portion of the fallopian tube, generates a benign tissue response that results in anchoring of the device and subsequent occlusion of the tube. The current trial of 745 women seeking birth control from Australia, Europe, and the United States were evaluated for successful micro-insert placement at three months. Comfort, safety, and return to normal activity were evaluated. All patients were followed for five years and returned for annual gynecologic status. Procedure time was 18 minutes, 92% returned to work in one day. There were no reported pregnancies among these patients in 27,526 months. The transcervical approach for sterilization represents ease of application, low morbidity, and convenience to the patient.