SA researchers make a breakthrough in sterilisation
KERRY O'BRIEN: After a two-year trial in Adelaide, medical researchers are hailing a new procedure that could revolutionise attempts to control the world's population growth
For decades, women wanting to stop having children have had to undergo significant surgery to permanently close their fallopian tubes.
But the operation isn't foolproof, in part because the body's reproductive system is determined not to be stopped.
Now, in a remarkably simple and quick procedure, usually under local anaesthetic, tiny coils are placed into the fallopian tubes to stop fertilisation.
After the two years of trials with 130 women, not a single pregnancy, no apparent side effects.
Mike Sexton reports.
MIKE SEXTON: Tracy Korsten and Paul Nicholson have two sons, a daughter and no plans for any more kids, so at age 37, Tracy decided she wanted to be sterilised.
TRACY KORSTEN: I certainly didn't want to go for tubal ligation because I'm aware that that can sometimes go wrong, the clips can come off.
Also, it's surgery and I didn't really want to have to go through surgery if I could avoid it.
I wanted to make sure that I was sterilised.
MIKE SEXTON: Tracy's one of a growing number of Australian women opting for a bold new procedure which could eventually have an impact on global population growth rates.
JOHN KERIN, UNIVERSITY OF ADELAIDE: Without being too modest, I think it's potentially one of the biggest advances in the last 30 or 40 years.
MIKE SEXTON: And it's all down to this tiny metal coil.
JOHN KERIN: It's so soft.
If I pick this up and show you, it's very soft, as you can see there.
MIKE SEXTON: The device is placed into the patient's fallopian tubes during a few minutes of local surgery.
It's wound tight when inserted and then springs open to block the fallopian tube.
Once in place, it adapts to the body's form and, in turn, the body absorbs the device as a permanent block to sperm finding its way to an egg.
JOHN KERIN: When you compare current technology for sterilisation, it requires a general anaesthetic, cuts, surgical incisions, it takes half an hour longer recovery time and much more expensive hospital equipment.
So this procedure is all the opposite to that.
The patient's awake, no cuts, it's quick, the recovery time is very quick, and the patient's in control because she can see you actually doing the procedure.
MIKE SEXTON: For 43-year-old Christine Heywood, the procedure meant she didn't have to take any time off from her busy young family.
CHRISTINE HEYWOOD: I had no pain.
I came home and ironed and my husband came home and sat on the lounge and fell asleep.
But I went out for lunch and then I came home and did some ironing, and then I went walking the next morning.
MIKE SEXTON: The coil is the invention of biomedical engineer Don Gurskis, who works for the Californian company Conceptus.
He's spent years trying to figure out how to outsmart the human body.
DON GURSKIS, BIOMEDICAL ENGINEER: Because the tube is a fighter, it's there for human reproduction.
It will do anything it can to stay functional.If it means having to spit out whatever's in there, it will spasm and do that.
That's one of the difficult things -- that we had to get something that was dynamic, that would move with the tube rather than be an obstruction that was a solid plug and that the tube could move.
MIKE SEXTON: In a joint venture, the coil is being tested at Adelaide's Ashford Hospital.
More than 100 patients have had the procedure, and in two years not only hasn't there been a single pregnancy, but also no complications nor side-effects detected.
JOHN KERIN: Good morning, everyone in the audience there.
I'm Professor John Kerin.
MIKE SEXTON: So now Professor Kerin has taken the plunge and shown the system off to the rest of the world.
JOHN KERIN: I've got to be careful to get it right spot on, feed it in, as you can see here, just gently.
MIKE SEXTON: This month an entire procedure was beamed live via satellite link-up to the largest gynaecological conference in the world, meeting in Las Vegas.
JOHN KERIN: I'm just taking out the tip of the introduction wire there and the device is now free in the fallopian tube.
You can see if I go up close, the outer coil expanded and you can see the inner coil and the back end there.
So that's one tube done.
We got a standing ovation.
I could hear through the earphones as I was talking to them they were very impressed and, from feedback the next day, it was the main talk of the whole conference.
MIKE SEXTON: Professor Kerin and his team believe the worldwide interest in this device is in part because of its implications for global population.The World Health Organisation has been monitoring the trials closely and believes the system could be adapted for developing countries.
JOHN KERIN: I think that's the important thing about it, it's portable.You don't have to take patients to a sophisticated hospital.You could take this technology, as you say, in the back of a four-wheel drive into villages, into peripheral health centres and offer it there.
MIKE SEXTON: Next year a training centre will be established in Adelaide and then clinics set up in cities across Australia, North America and Europe and, if the clinical trials continue the way they started, sterilisation could be changed forever.
DON GURSKIS: This is a permanent implant and the long-lasting effects are profound with regards to human population.
So it is pretty exciting.
New methods for transcervical cannulation of the fallopian tube.
1. (Lead Australian Investigator For Essure)
Technological advances have led to major improvements in the design and application of Fallopian tube cannulation devices using the transcervical approach. Presently such cannulation systems are being used to overcome infertility disorders. These transcervical access systems are now able to displace debris that may block the tube, break down intraluminal adhesions or place egg, sperm or embryos in the tube to facilitate conception. Conversely, these same or modified devices could be used to place sclerosing agents or occlusive devices within the Fallopian tubes using similar transcervical access technology. Transcervical delivery systems incorporating a very fine endoscopic fiber have also been developed to visibly assess the inside lumen of the Fallopian tube using a transcervical approach. Such a system could be used to accurately identify specific sites in the tube for placement of such devices. The potential for placing permanent or temporary devices in the tube and the option of reversible sterilization may become a possibility in the future. One of the biggest obstacles against a wide distribution of these devices, particularly in third world countries, will be cost and the relative technical complexity in using them. These factors will need to be addressed more carefully in assessing the overall strategy of population control. The pressure on governments and international agencies to place more resources into population control may facilitate the accelerated development, application and cost containment of these new devices and delivery systems.
Georgina Fry's public comment on Erin Brockovitch's website for us... (One of Kerins clinical trial participants)
-written by Amanda Dykeman