Endoscopy for contraception.

PIP: Over the past 2 decades, endoscopic methods of tubal sterilization-- including laparoscopic, hysteroscopic, and transcervical techniques-- have been refined so as to be less aggressive. In developing countries, laparotomic, minilaparotomic, and chemical methods of tubal sterilization prevail. Hysteroscopic methods involving the injection of silicone plugs or inert devices and transcervical injections of adhesive and sclerosing substances remain largely experimental at this time. The failure rate of tubal sterilization has remained fairly constant at 0.5%, but there has been considerable progress in terms of safety and complications. The mortality rate has dropped from 4-110/100,000 cases in the early 1970s to 4-57/100,000 procedures. In the US, the mortality rate is 4.2 for surgical sterilization and 0.4 for chemical sterilization, while, in Bangladesh, these rates are 32.6 and 30.2, respectively. The greater safety of sterilization in developing countries is due, in part, to laparoscopy and the use of Falope rings or clips. Early complications requiring surgical intervention occur in 1.1% of laparotomic sterilization cases, 1.4% of minilaparotomies, and in 0.9-3.7% of laparoscopic sterilizations. The advent of microsurgical techniques has led to a drop in the ectopic pregnancy rate from 7-21% to 4-17%. In the US, 1.1% of women request sterilization reversal and 60% of such reversals result in an intrauterine pregnancy. Most successful are isthmo-isthmic and isthmo-ampullar anastomoses performed by skilled microsurgeons. The ultimate aim is to develop a noninvasive method of tubal sterilization that is fully reversible and can be performed in an outpatient setting.