ABSTRACT: A permanent contraceptive method that avoids abdominal incisions and general anesthetic should be safer than sterilization by laparoscopy or laparotomy. In theory, the transcervical route ought to be ideal for female sterilization. However, past attempts have not seen widespread success, and contemporary efforts demonstrate that challenges to the creation of an ideal transcervical sterilization technique continue to exist. After 6 years of use, clinical data and real-world experience indicate that the Essure permanent birth control system is a viable option. Efficacy of 99.74% has been demonstrated. Adverse effects and risks are low. Patient satisfaction is high. Successful placement is observed in worldwide marketing. It can be placed in the office setting, which offsets the relatively high cost of the device. Recent data suggest that patients and surgeons are choosing hysteroscopic sterilization over laparoscopic and postpartum sterilization. Adiana emerged in 2009 as a second hysteroscopic sterilization option. Challenges continue to exist for transcervical sterilization. Compliance with post-procedure confirmation imaging is not universal. Real-world contraception failures are seen in a setting of protocol non-compliance. However, extrapolation of the failure rates in real-world use seems to be comparable with other laparoscopic and abdominal sterilization methods.