For couples who want a permanent form of birth control but don’t want to go under the knife for a tubal ligation or vasectomy, there’s positive news about a decade-old nonsurgical procedure called hysteroscopic sterilization. How it works: Doctors place tiny metal coils or silicone inserts into the fallopian tubes via the cervix. In three months, scar tissue forms around the implants and closes the fallopian tubes just as a tubal ligation would, but without the risk of general anesthesia. The 30-minute procedure is usually done in a doctor’s office (don’t worry—there’ll be pain relievers and local anesthetics) for the price of an office copay. A recent analysis of Essure-brand metal coils in Reviews in Obstetrics & Gynecology found that no women who used them got pregnant over nine years of follow-up—making the product even more effective than tubal ligations, which have a 1 percent failure rate. Women using Adiana-brand silicone inserts had a slightly higher pregnancy rate: about 2 percent during a five-year period.

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