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Abstract: In a review of the literature the history, present state of the art and possible future developments of hysteroscopic sterilization is given. In the Netherlands two systems are now available: Ovabloc® and Essure®. Although not yet as extensively evaluated as laparoscopic sterilization the pregnancy rate does not seem to be higher and the (major) complication rate appears to be significantly lower. According to this review hysteroscopic sterilization is an attractive alternative method of sterilization and is probably clearly indicated in cases of (relative) contra-indications to laparoscopy: obesity, intra-abdominal adhesions, haemorrhagic diathesis and cardiopulmonary disease. As long as X-rays are still advised in hysteroscopic sterilization techniques, this requirement remains the main disadvantage when compared with the laparoscopic approach, but otherwise one could indeed conclude: away with the laparoscope in sterilization! [Copyright &y& Elsevier]

The Essure method is the only available hysteroscopic sterilisation method. A 4-cm device is placed in the fallopian tubes, which then induces an inflammatory reaction that causes occlusion. The method has a high successful placement rate and high effectiveness, and it can be performed in an office setting without anaesthesia. Three months after the procedure, a confirmation test has to be conducted to assure a correct position of the micro-inserts and tubal occlusion. This test can be performed by hysterosalpingography (HSG), plain X-ray or ultrasound. Pregnancies reported after Essure sterilisation are, in a majority, related to non-adherence to the follow-up protocol or misreading of the confirmation test. A majority of the pregnancies occurred after HSGs that were determined to have been misinterpreted, including missed expulsion or perforation of the micro-insert. Other complications such as ectopic pregnancy and allergic reaction to the micro-inserts seem to have been described to be of low incidence., (Copyright © 2015 Elsevier Ltd. All rights reserved.)