The Authors describe their experience with a new type of intratubal mechanical device to be inserted under hysteroscopic control. Up to present time, 1471 cycles without any other form of contraception have been observed. Although the promising results of this preliminary report in the field of hysteroscopic reversible tubal sterilization, the Authors underline that this new technique is still evolving and will be improved with further experience.
PIP: Techniques for hysteroscopic tubal sterilization may be divided into 3 categories: destruction of the interstitial of the bube by means of electrocoagulation or cryonecrosis; injection of sclerosing substances or silicone liquid; and mechanical devices which will occlude the interstitial section. Experience with a new type of intratubal mechanical device to be inserted under hysteroscopic control is described. The detailed and enlarged visualization possible with the aid of microhysteroscope, during an atraumatic outpatient examination, led to the invention of a device which is suitable for this method and for the anatomo-physiological conditions of the interstitial section of the tube. The device is made of surgical nylon (1 mm diameter) having an open loop at its distal end with an elastic memory so that it can be opened at varying widths and be fixed in the tube, and preventing its migration into the uterine cavity. A similarly adaptable proximal loop stops it from migrating into the peritoneum and facilitates its removal by means of a simple hook. The middle section of about 28-30 mm in length is supple so that it can be atraumatically inserted in the interstitial section. The 2 devices are placed in a supple inserting catheter (diameter 1.5 mm) and a nylon guide thread enables their progression to be followed under visual control. The microhysteroscopic technique is the same as that used for a diagnostic examination or for surgery. From march 1982 to February 1984, 166 patients who requested permanent sterilization were informed about and accepted this method. The average patient age was 33.5 years, with and average parity of 2.4. Patients less than 30 years of age or who had fewer than 2 living children were excluded. In 149 patients it was possible to effect a bilateral insertion during the 1st microhysteroscopy. In 7 patients it was necessary to make 2 attempts, either because of bleeding or unsatisfactory visualization. There was serious retroversion in 3 cases, atresic tubal orifices in 4, and in 1 case the pain felt by the patient was so violent that an hour's rest was necessary. In these 8 patients the device was not inserted. The discomfort felt during the procedure is equal to that experienced during a diagnostic microhysteroscopic examination. A microhysteroscopic examination performed 1 month after insertion showed 4 expulsions. Up to the present time, 1471 cycles without any other form of contraception have been observed. 1 intrauterine pregnancy occurred 6 months after insertion. The technique is still evolving and will be improved with experience and further study.