When the words ‘permanent birth control’ are what comes out of the doctor’s mouth, it brings to mind mainly 3 things. First, the fact that it’s permanent. So prophylactics like the pill, condoms, and spermicides are no longer needed. Second, it’s going to do the job properly, so it will definitely stop an egg from becoming fertilized. And third? Well, that it’s safe, tested, and proven to work.
Unfortunately, that’s not always the case.
What if I said that not all permanent birth control stays permanent? What if I said that sometimes, tubes can reconnect themselves, coils can fall out, and things can go horribly wrong? Well, that’s the truth in a nutshell, and today we’re going to explore the many ways that birth control can fail couples and women who depend on these methods to avoid pregnancy.
Now, a fail does not always mean that someone got pregnant. If it endangered lives, or there was human error involved, it counts as a fail. We’re also going to discuss what the main 3 kinds of permanent birth control options are, some of the drama behind the more controversial method of the 3, and what women are doing to take a stand for their own reproductive health.
One of the key things to understand how these methods can fail, is to understand what these methods are and how they work exactly. What is a Vasectomy, or a Tubal Ligation? What is Essure? We have the answers to those questions as well.
15 What Is Essure?
The Essure permanent birth control system is a prescription only, non hormonal form of permanent birth control for women sold by Bayer. Insertion is intended to be nonreversible and is an alternative to female sterilization procedures such as tubal ligations.
The system is made up of two flexible coils made up of stainless steel, nickel titanium, and polyethylene fibers that doctors insert into the fallopian tubes. About 750,000 women have used this method to prevent pregnancy.
Bayer markets this product as the only “FDA-approved permanent form of birth control with a procedure that can be performed in an office setting without general anesthesia.” According to the company’s five-year long study data, it is nearly 100 percent effective at preventing pregnancy.
While the manufacturer claims Essure is safe and effective, thousands of women disagree. They claim the metal coils caused them injury, neurological damage, and severe pain. In some cases, women died from complications.
14 Essure Coils Can Fall Out
In the same way that an IUD can move around after being placed, the same thing can happen with the Essure. Most coils will not move once placed, but some can move, and usually it happens because the doctor does not insert the coil far enough, or because the doctor inserts the coil too far in the fallopian tube.
If it’s not inserted far enough, contractions can cause the coils to expel into the uterine cavity, where they can stay or be expelled later on during a menstrual cycle. Just as likely, though, is the coils being inserted too far into the tube, where the contractions can cause the coil to be expelled into the end of the tube, the pelvis, or the abdominal cavity.
Essure coil expulsion is not common, but it happens. It usually happens within the first few days to weeks after the initial insertion. However, once the doctor confirms the coils are in the right place at the time of the HSG confirmation test, there is little to no chance of delayed migration occurring.
13 Allergies To Essure Coil
Unfortunately, migration of the device isn’t the only negative thing that can happen when Essure is implanted. However, many women are reporting to be allergic to the nickel in the coils…months or years after they were initially implanted.
Originally, women who were getting Essure were advised to get tested for the nickel allergy before getting the Essure, but the manufacturer asked the FDA to remove that requirement a few years ago. And now, women with the problem are reporting the same symptoms, and describing the same nightmare scenarios.
While this is not a fail just because it causes pregnancy. It’s a fail because it causes severe health issues for the women who have it inserted. Women are reporting extreme bloating, skin rashes, and headaches from the allergy to the coils.
With so many women having the same issues, you would think that the manufacturer would step in, but so far they have only commented on this issue through an interview they gave to ABC. During the interview they said, “Although we do not comment on individual adverse events, we do take all adverse events seriously, and they are reported to the US FDA as required.”
12 Essure Can Cause Pain
For some women, the pain and bleeding this form of birth control caused them made living a daily hell. Most women made sure they did everything the way they were supposed to, and the pain just got worse and worse. And the Essure still failed to protect someof them.
One woman reported having paid thousands of dollars for a failed procedure that left her with a stabbing pain in her right ovary and a dull ache in her back.
And that pain isn’t even the worst it can get. In an Adverse Event Report filed with the FDA on September 19, 2013, a woman came to the emergency room with severe abdominal pain. She’d had the Essure coils implanted earlier that year. During the pelvic exam, the doctor found that the patient’s cervix, fallopian tubes, and uterus were all necrotic.
The patient eventually went into renal failure and passed away, after testing positive for a type of strep infection called streptococcal toxic shock syndrome. Doctors had said that the cause of death was not directly related to the Essure or the procedure, and they did not comment whether her death was indirectly caused by it either.
11 Essure May Mean More Operations
To correct the damage of a failed or migrated Essure, some women turn to surgery to remove the coils, because they just can’t take the pain of having the Essure in anymore. Or the women want to try and preserve their reproductive organs from further damage.
After getting Essure many women report having adverse side effects, or are often advised to have a hysterectomy or have their fallopian tubes removed, some even have to have a tubal ligation, which is what many of them wanted in the first place.
It is possible to remove an Essure coil without getting a hysterectomy or fallopian tube removal. Although some doctors are wary about doing performing these procedures after an Essure removal. But some doctors are quite skilled at removing the coils intact, without breakage or fragmentation. And for many women, removal is the answer they’re looking for when it comes to relief of their symptoms.
10 What Women Are Doing About It?
When it comes to the controversy surrounding Essure, women are angry, and rightfully so. Many women claim they were pushed into this method of birth control with promises of few side effects, and instead got horrible side effects. Those women aren’t going to take it anymore, they’re done with Essure and the empty promises.
Instead, they’re getting lawyers and they’re taking the company that makes Essure, Bayer, to court. They’re fighting back against a product that has done more harm than good, and that’s admirable.
Women are also protesting, and even some politicians are getting involved and trying to get Essure yanked off the market, for good. Many believe that, despite claims of the product’s safety, that it does far too much harm than it does good. Because of this, they’re fighting back by any means necessary, and using their voices to try and make a difference.
9 Legal Action Against Essure
One of the main steps women have been taking is to take Bayer, the maker of Essure, to court. A judge just ruled on August 10, 2016, that a handful of lawsuits against Bayer are valid and can continue. The ruling pertains to just 11 cases that are representing 14 women out of hundreds of cases in California alone.
It may make it so that future lawsuits against Bayer can continue across the country. Previously, lawsuits against Bayer have been blocked after the company argued that ‘federal preemption law’ meant that Bayer could not be held responsible for any injuries related to Essure.
Thousands of women have spoken out about injuries they believe were caused by Essure. They are now forcing the world, and Bayer, to pay attention. Many want Essure banned, saying that the benefits do not outweigh the risk, and even some politicians are getting in on this.
Representative Mike Fitzpatrick is leading the ban on Essure with his bill, the ‘E-free Act’, which would require the FDA to withdraw its approval for Essure.
8 Protests Against Essure
There have been numerous protests, by dozens of women, who are targeting Essure and demanding it be removed from the market. Some doctors even agree with the protests, such as Julio Novoa, who says that, “It works too well sometimes. It causes a chronic inflammatory response in the fallopian tubes, which causes pain. Pain in intercourse and irregular bleeding.”
Novoa has been opposed to the device after serious side effects were reported during the clinical trials.
Protests have been held in many places, at Gynecological conferences, and even at the Bayer headquarters in Berkeley, CA. The protests have had many medical professionals who support the cause of removing Essure from the market, for a multitude of reasons.
There are also groups that have gotten attention for their sheer volume of members and the protesting they do against Essure, such as the group Essure Problems, which has over 16,200 members.
7 What Exactly Is A Vasectomy?
A vasectomy is a form of permanent birth control that involves surgically blocking or cutting the vas deferens (the tube that transport the sperm from the testicles to the penis.) When men have this procedure, their sperm can no longer reach the semen, and as a result any semen that is ejaculated during sex contains no sperm.
Normally this procedure is quite effective and a permanent means of preventing pregnancy. It’s estimated that only one out of every 2,000 men who get a vasectomy will impregnate a woman.
Most vasectomies take about 30 minutes to perform, and the procedure is minimally invasive with very minor pain. There are 2 kinds of vasectomies, a conventional vasectomy and a no-scalpel vasectomy. In most cases the patient is awake for the procedure.
It is highly recommended that men use an additional method of birth control for the first few months after a vasectomy to prevent pregnancy. After two clear semen tests, it’s usually safe to have intercourse without having to use a backup method.
6 Not Using Back-Up Protection After Vasectomy
This one is more common sense than an actual fail, but it still counts nonetheless. When a man has a vasectomy, he is told that he needs to use a backup method for at least 6 months, give or take, to give the last remaining sperm that can be in the tubes time to absorbed or be ejaculated.
Men must use another method of birth control until they have a semen sample tested and it shows a zero sperm count. Otherwise the man can still get a woman pregnant. How some couples forget this advice is mind boggling, and inevitably this situation ends up with the couple expecting another kiddo they weren't prepared for.
In this instance the birth control didn’t fail, but the actual person did, because they didn’t heed the doctor’s advice on the matter. That said, to some, it’s still rather unexpected when the person is literally expecting to be safe, and suddenly, they’ve gotten someone pregnant. And this can happen many years later with many zero sperm count tests, because…
5 The Vas Deferens Can Reconnect Post-Op
Sometimes, the vas deferens reconnects sometime after the surgery, in a process known as spontaneous recanalization. While this is incredibly rare, it does happen on occasion. It’s usually referred to as a ‘technical failure’, although that term is generally used for all failures during a vasectomy. Late recanalization is where the vasectomy spontaneously reverses itself later on, after the all-clear has been given.
There are two ways that recanalization can happen. The first way is when sperm granulomas leak post-op and the man’s immune system attacks it causing an inflammatory reaction. The body traps the sperm in pockets scar tissue, and inflammatory cells that result. The sperm granulomas turn into firm balls of tissue in about 60% of patients.
The second way that recanalization can occur is due to micro-recanalization through scar tissue, which can happen in cases where there is a lot of scar tissue after the vasectomy, and sperm wriggles through new and very small channels in the scar tissue.
4 What Is A Tubal Ligation?
A tubal ligation, is also known as having your tubes tied or a tubal sterilization. This type of permanent birth control is for women. During the procedure, the fallopian tubes are cut or blocked to prevent pregnancy. A tubal disrupts the movement of the egg to the uterus for fertilization, and blocks sperm from traveling up the fallopian tubes.
It can be done any time, including after childbirth or in combination with other abdominal surgeries. It’s possible to reverse, but reversal requires major surgery and is not always effective.
This is one of the most commonly used surgical sterilization methods for women. It ends the need for contraception, and may even decrease the risk of ovarian cancer. A tubal ligation is not appropriate for everyone, though, and the doctor can help make sure the patient fully understands the benefits and risks of this procedure. The doctor may also discuss other permanent sterilization options.
3 When The Tubal Ligation Results In Incomplete Occlusion
When a tubal ligation is performed, the patient expects that the procedure will go as planned, same as a patient would with a vasectomy. That’s not always the case. Every so often, the tube will not be completely closed off during the procedure, leaving the woman still able to get pregnant. This happens when a tubal ligation is done improperly, because the tube should have been properly cut and occluded before the doctor left the surgery.
Sometimes there are equipment problems that lead to a failed tubal ligation. Tubal procedures that try and cause less damage to the fallopian tubes usually lead to higher instances of failed procedures. There is less of a chance of pregnancy when maximum damage has been done to the the tubes or where a large portion of the tube has been removed.
As bad as that sounds, this is honestly a case where the more harm that is done to the tube, the more likely it is that this procedure will be successful in preventing pregnancy, when it comes to a tubal ligation.
2 The Formation Of A Fistula Or Recanalization
Sometimes after the procedure when the tube is initially closed, it reopens or holes form in the scar tissue and allows an egg to slip through. An abnormal opening called a tuboperitoneal fistula can develop between the abdominal space due to incomplete healing of the ligated end of the fallopian tube.
Recanalization, like when it happens in vasectomies, is when the end of the fallopian tube regenerates and forms slit like spaces and pouches, or the ends of the tubes actually meet and re-establish the patency of the tube.
This form of failure is rare, just as it is in vasectomies, but it happens on occasion and leaves women unknowingly unprotected. Surgical procedures that prevent approximation of the resected ends of the fallopian tubes should result in lower failure rates.
When it comes to permanent birth control failures, we don’t often think of vasectomy or tied tubes, but we do hear a lot about the failure of this next method.
1 Consider the Options
With any large decision, it’s always recommended that women do research to determine that what they are getting done is what is best for them. Sometimes, a permanent method just isn’t worth it, or isn’t going to cover the spectrum of things that the patient wants, and that’s ok.
There are a plethora of other birth control options that women can choose from, from hormonal pills, to IUDs (which also have risks), all the way to condoms, spermicidal gels or foams, and diaphragms.
Talking to the doctor and coming up with a plan of action that works best is what most would recommend. Sometimes they have new birth control methods or ideas that can give the patient an extra option that they didn’t have before.
Sometimes, doctors can discuss other surgical options, such as a hysterectomy, if there are other problems that the patient is dealing with. But either way, it’s up to the patient to figure out what works best for them and their lifestyle.