A 2015 review found the effectiveness of<unk>  is unclear due to the low quality of evidence. With perfect use another review found evidence of a 99.8% effective based on 5 years of follow-up. The reported insertional failure rates are "failure to place 2 inserts in the first procedure (5%), initial tubal patency (3.5%), expulsion (2.2%), perforation (1.8%), or other unsatisfactory device location (0.6%)". Upon follow-up, occlusion was observed to have occurred in 96.5% of patients at 3 months with the remainder occluded by 6 months. A 2015 study published in the BMJ concluded that<unk>  was as efficacious as laparoscopic sterilization at preventing pregnancy, but with a "10-fold higher risk of undergoing re-operation" when compared to patients who underwent a laparoscopic sterilization procedure. Follow-up For the<unk>  method, three months after insertion a radiologist is supposed to perform a fluoroscopic procedure called a hysterosalpingogram, to confirm that the fallopian tubes are completely blocked and that the woman can rely on the<unk>  inserts for birth control. A contrast agent (dye) is injected through the cervix, and an x-ray technologist takes photos of the<unk>  coils to<unk>  no contrast leaks past the<unk> .
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