Radiographic aspects of office hysteroscopic tubal occlusion with siloxane intratubal devices (the Ovabloc method).

OBJECTIVE: To evaluate the importance of radiographs in women sterilized with hysteroscopically applied siloxane intratubal devices (ITDs). METHODS: A retrospective study of the frequency of abnormal radiographs in 500 women was carried out. The agreement in judging these radiographs and the expected reliability of the sterilization was measured. RESULTS: Abnormal radiographs were mostly documented in the first 100 sterilization procedures. Agreement in judging the radiographs is substantial. Different agreements on the expected reliability are due to the difference in experience with this sterilization method. CONCLUSIONS: Four types of abnormal radiographs can be categorized. Judgment of the radiographs can easily be learned. For the assessment of the reliability, training is necessary.

Office hysteroscopic tubal occlusion with siloxane intratubal devices (the Ovabloc method).

OBJECTIVES: To study the results of the Ovabloc method for female sterilization used in an outpatient setting. METHODS: A prospective longitudinal study at the Schieland Hospital of 411 patients who consented for the method for sterilization. For statistical analyses the x2 test is used for detection of differences between groups of patients. The life-table analysis is used for events during the follow-up period. RESULTS: Our results reflect those done under strict clinical conditions. The majority of the events took place in the first 36 months on Ovabloc. Unplanned pregnancies were mainly due to misdiagnosis in X-ray images and to incomplete procedures. CONCLUSIONS: The method failures are 3/1000 women in 12 months and 8/1000 women in 36 months. The follow-up should be extended to 12 months. The reversibility of the method remains questionable. The method should be offered to women with (relative) contraindications for laparoscopic sterilization such as severe obesity, extensive pelvic adhesions or anesthetic risks.

Impact of Ovabloc intratubal polymer on the morphology of the fallopian tube.

Treatment of the fallopian tubes by Ovabloc silicone intratubal polymer (ITP; Dow Corning silastic 382 Medical-Grade Elastomer) is used for permanent female contraception. Studies on animals show minor structural changes in the tubal epithelial lining caused by the ITP and suggest reversibility of tubal integrity after removal of the polymer. The aim of this study was to examine the impact of the ITP on the human tubal epithelial lining. From 13 patients treated with ITP, 23 fallopian tubes were studied by light microscopy and transmission electron microscopy. The examined 19 isthmical and 10 ampullary parts show marked structural changes. In the isthmical parts of the fallopian tubes, cellular and ciliary changes develop immediately after insertion of the silicone polymer. As for the ampullary parts, the cellular and ciliary changes are related to the ITP exposure time. The changes in the isthmus and ampulla are persistent for at least 15 months after removal of the ITP. It is not known whether the effects are reversible.