Abstract:
The present invention relates to medical devices and methods for treating and occluding a female patient&#39;s fallopian tubes to provide birth control or sterilization, where such birth control/sterilization can be short term, long term, or permanent.

Description:
RELATED APPLICATIONS 
       [0001]    The present disclosure is a non-provisional application of U.S. provisional application 62/021,334 filed Jul. 7, 2014 and U.S. provisional application 62/053,676 filed Sep. 22, 2014. Each of which is incorporated by reference herein. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates to medical devices and methods for treating and occluding a female patient&#39;s fallopian tubes to provide birth control or sterilization, where such birth control/sterilization can be short term, long term, or permanent. 
       BACKGROUND 
       [0003]    Female sterilization typically involves occluding a patient&#39;s fallopian tubes, with various procedures using laparoscopic or minimally invasive trans-cervical approaches. One procedure involves placing flexible coil-like devices into the fallopian tubes which are made of polyester fibers and metal wires. Tissue in-growth into the implanted devices can block the fallopian tubes. However, such implants are worrisome due to potential unknown long term effects. Further, the metallic implanted devices may raise concerns about other future medical procedures, such as use of MRI. 
       SUMMARY OF THE INVENTION 
       [0004]    The tubal occlusion procedure described herein is a minimally invasive procedure in which a device can be introduced into the patient&#39;s uterine cavity trans-cervically. Variations of the procedure does not leave an implant in the patient&#39;s body to minimize the risk of infection and other potential complications. 
         [0005]    The present disclosure includes systems, devices, and methods for preforming a desired treatment in a tube, lumen, or body passageway, such as a fallopian tube. The features and aspects of the various illustrated devices and methods can be combined as needed. 
         [0006]    In one example, a device or system according to the present disclosure includes an elongated flexible catheter configured for trans-cervical access to a site in the fallopian tube; a first electrode and a second electrode spaced apart at a working end of the flexible catheter; and a tissue cutting mechanism carried by the working end and located between the first electrode and second electrode. 
         [0007]    In one variation, the system includes first and second electrodes that extend axially over at least 1 cm of the working end. 
         [0008]    In an additional variation, the system can include a cutting mechanism having at least a first sharp cutting edge carried by a moveable outer sleeve, where the first electrode is positioned on the moveable outer sleeve. 
         [0009]    In another variation, the cutting mechanism is intermediate the proximal and distal regions of the electrodes. Variations of the cutting mechanism can include cutting mechanisms having an inner member disposed in a passageway of the moveable outer sleeve. 
         [0010]    The devices and systems can further include a negative pressure source communicating with a flow pathway in the catheter with an open termination in the working end. In additional variations, the system can further comprise an RF source and a controller operatively coupled to the first and second electrode. 
         [0011]    In certain variations, the first and second electrodes comprise opposite polarity electrodes when transmitting energy from the RF source. 
         [0012]    The system can include any additional safeguard measures, including a controller that terminates energy delivery to the electrodes in response to at least one of time, impedance, capacitance, and temperature. 
         [0013]    In another variation, the disclosure includes a catheter system for occluding a fallopian tube. In one such example the catheter includes an elongated catheter having a working end carrying a thermal ablation portion configured to ablate tissue in a fallopian tube lumen; and a tissue cutting mechanism carried by the working end configured to cut tissue in the fallopian tube lumen. 
         [0014]    The catheter system can further include a negative pressure source communicating with a flow pathway in the catheter having an open termination in the working end. 
         [0015]    The devices described herein can include thermal ablation structures that provides at least one of a heating treatment or a cryogenic treatment. Alternatively, or in addition, the thermal ablation mechanisms can perform thermal ablation using at least one of RF energy, light energy, microwave energy, resistive heating, inductive heating or ultrasound. 
         [0016]    In an additional variation, the thermal ablation portion comprises a first portion and a second portion spaced apart on either side of the tissue cutting mechanism, where the first portion is moveable relative to the second portion. 
         [0017]    The catheter system can also include a tissue cutting mechanism that includes at least one of a sharp blade edge, an abrasive element and a sharp puncturing element. 
         [0018]    Variations of the systems and devices can include one or more expandable balloons. 
         [0019]    Additionally, the systems can include a biodegradable implant configured for deployment in the fallopian tube lumen. Such an implant can be barbed, porous, and/or include one or more bioactive substances. 
         [0020]    In an additional variation, the present disclosure includes one or more methods for occluding a fallopian tube or any other tubular structure in the body. For example, such a method can include advancing a probe trans-cervically to a site in the fallopian tube; applying energy from the probe to ablate fallopian tube tissue at the site; actuating a cutting mechanism of the probe to cause bleeding within the site wherein the bleeding facilitates adhesion of walls of the fallopian tube to provide permanent occlusion. In one variation, the method can include advancing the probe over a guidewire. 
         [0021]    The method can include energy applications such as RF energy, light energy, microwave energy, resistive heating, inductive heating or ultrasound. The actuating step can include actuating at least one of a sharp blade edge, an abrasive element and a sharp puncturing element. 
         [0022]    In another variation, the method can include a method for female sterilization comprising: ablating the endothelial and/or endometrial cells in an elongated segment of the lumen of a fallopian tube; and treating an intermediate portion of said lumen segment to cause Asherman&#39;s syndrome in said intermediate portion to thereby occlude the lumen. 
         [0023]    In one aspect of the method of the invention, a physician uses RF energy to ablate a thin layer of tissue in a segment of a fallopian tube which can be performed very rapidly, for example in 10 to 60 seconds. A second step involves inducing a wound healing response (for example by cutting or otherwise damaging the tissue within the segment). These acts can be accomplished very quickly. The wound healing response causes an adhesion of the walls in the segment allowing for closure of the fallopian tube. In certain cases, the closure can be permanent. 
         [0024]    In another method under the present disclosure, an elongated segment of a fallopian tube is damaged by cutting, abrading, puncturing or the like to cause a wound healing response which again can cause an adhesion of the fallopian tube walls. In this method, the damage at least partially de-nudes the tube walls of endothelial cells, and the length of the damaged segment is sufficient such that an adhesion occludes the segment before new endothelial cells migrate inwardly from the ends of the damaged segment. 
         [0025]    The details of one or more embodiments of the invention are set forth in the accompanying drawings and the description below. Other features, objects, and advantages of the invention will be apparent from the description and drawings, and from the claims. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0026]      FIG. 1  is a representation of a uterus and the use of an endoscope to introduce a working end of a treatment probe into a fallopian tube. 
           [0027]      FIG. 2A  is a schematic sectional representation of a step of a method of positioning an RF applicator portion of the probe working end in the fallopian tube. 
           [0028]      FIG. 2B  is another schematic representation of a subsequent step of moving apart proximal and distal body portions of the RF applicator portion of the probe working end, followed by the step of activating RF energy delivery to ablate surface tissue. 
           [0029]      FIG. 2C  is a representation of another step of applying suction to draw a tissue segment into a gap between the proximal and distal body portions of the working end to thereby cut surface tissue. 
           [0030]      FIG. 2D  is a representation of another step of moving together the proximal and distal body portions of the working end to cut tissue captured in the gap shown in  FIG. 2C . 
           [0031]      FIG. 2E  is another representation showing withdrawal of the working end and the accumulation of blood following the cutting step which initiates a wound healing response to scar across and occlude the lumen. 
           [0032]      FIG. 2F  is another representation after a week or more time has passed showing the adhesion or scar tissue occluding the lumen and the re-growth of endometrial tissue in the lumen up to the adhesion. 
           [0033]      FIG. 3  is schematic representation of another variation of working end for treating tissue in a manner similar to the embodiment and method in  FIGS. 2A-2F . 
           [0034]      FIG. 4A  is an illustration of another variation of a catheter and working end comprising abrading wires;  FIG. 4A  shows use of abrasive wires to damage and abrade the surface layers of an elongate segment of a fallopian tube lumen. 
           [0035]      FIG. 4B  shows a subsequent step in the method wherein the abrading wire assembly is retracted and blood from the damaged tissue is disposed within the lumen of the fallopian tube. 
           [0036]      FIG. 4C  shows the fallopian tube after the passage of time wherein an adhesion is formed to occlude the lumen of the fallopian tube and endothelial cells have migrated into the lumen from both ends of the treated sement. 
           [0037]      FIG. 5  is a representation of another variation of a catheter and working end including an abrading balloon that is adapted for abrading the surface layers of the lumen of a fallopian tube. 
           [0038]      FIG. 6  is a representation of a catheter working end that carries a deployable barbed implant that is adapted for puncturing and damaging the walls of the lumen of a fallopian tube. 
           [0039]      FIG. 7  is a representation of a catheter working end that has deployed an implant that is adapted to promote an adhesion across the lumen of a fallopian tube. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0040]    A method for female sterilization is described below wherein a female&#39;s fallopian tubes are occluded in a minimally invasive procedure. Referring to  FIG. 1 , a schematic representation of a uterus  100  is shown, including a uterine cavity  102  lined with endometrial tissue  104 . The fallopian tubes  105  extend from the uterine cavity  102  at the tubal ostia  110 . In  FIG. 1 , it can be seen that an endoscope  115  with a working channel  118  is introduced trans-cervically into the uterine cavity  102 . The distal end of the endoscope can be positioned near the tubal ostium  110 . The working end  120  of treatment probe  125  is introduced through the working channel  118  and into a fallopian tube  105 . 
         [0041]    Referring now to  FIGS. 2A-2B , it can be seen that the working end  120  of probe  125  includes an RF (radiofrequency) applicator which in one variation is spaced apart bi-polar RF electrodes  140 A and  140 B. The RF applicator is configured to ablate a thin tissue layer within a segment of the lumen of the fallopian tube  105  and optionally a segment in the tubal ostium. The tissue targeted for ablation is the endometrial or endothelial layer. The RF electrode arrangement can consist of a singular opposing polarity electrodes (as shown for convenience) or there can be a plurality of electrodes of each polarity which in any event are configured to provide a selected ablation depth. The axial spacing between bi-polar electrodes  140 A- 140 B and the width of the exposed surface of the electrodes can be adapted to control the ablation depth, which is further dependent on the power level selected and other RF operating parameters. Tissue impedance can be used to terminate power which can be also be used to assist in achieving the selected depth of tissue ablation. An RF generator/controller  150  is electrically connected to the electrodes  140 A- 140 B to provide bi-polar RF energy to the electrode arrangement. As will be described below, both the length of the targeted ablation and the depth of the ablation are controlled in the method corresponding to the invention. 
         [0042]    In one variation of a method referring to  FIGS. 1-2C , the system (including controller  150  and working end  120 ) is actuated to deliver RF energy through the RF electrodes  140 A and  140 B to ablate a selected tissue depth that may range from approximately 0.5 mm to 2.5 mm. 
         [0043]    As can be seen in FIGS.  1  and  2 A- 2 B, probe  125  comprises a catheter or elongate flexible shaft  155  that extends to the distal working end  120 . The diameter of the catheter  155  and working end can be any suitable diameter and may range from 1 mm to 5 mm. 
         [0044]    One variation of working end  120  has proximal body portion  160 A carrying electrode  140 A and distal body portion  160 B carrying electrode  140 B.  FIGS. 2A-2B  illustrate that the proximal and distal body portions  160 A,  160 B may be axially moveable relative to one another to expose blade edge or edges  165 . The central wire member  170  is coupled to the distal body portion  160 B and extends to the probe handle  172  ( FIG. 1 ) to allow the physician to manipulate the distal end component. An annular space in the catheter  155  around the central wire member  170  comprises a suction lumen  175  and is coupled to negative pressure source  180 . In variations of the device, as shown in  FIGS. 2A and 2B , the cutting surface or blade edges  165  are positioned proximally of the distal end of the device to prevent inadvertent damage to tissue when advanced to the target site. Furthermore, the diameter of the cutting surfaces can be less than a diameter of the electrode  140 A or  140 B (or less than a diameter of the catheter shaft  155 ) to limit damage to tissue that is drawn into the cutting section (as illustrated in  FIG. 2C ). 
         [0045]    The entire probe may have an interior guidewire lumen (not shown) to allow the probe to be introduced over a guidewire. 
         [0046]    Referring again to  FIGS. 2A-2B , each electrode  140 A and  140 B (or plurality of electrodes) can have an axial length ranging from about 1 mm to 20 mm. The distance D of the gap  200  between the proximal body portion  160 A and distal body portion  160 B when moved apart indicated in  FIG. 2B  also is controlled and can have a dimension ranging from about 5 mm to 20 mm. 
         [0047]      FIGS. 2B  further shows a subsequent step of the method wherein the system is activated for a predetermined time interval and RF energy creates an ablation zone  190  around the walls of the lumen thus providing a pre-selected length and depth of ablation. The controller can automatically terminate energy delivery base on time, impedance, capacitance, temperature sensing or any combination thereof. 
         [0048]      FIGS. 2C  shows the next step of the method wherein the controller activates the negative pressure source  180  to thus draw tissue into the gap  200  between the blade ends  165  of the proximal and distal body portions  160 A,  160 B. Next,  FIG. 2D  illustrates the physician actuating the central wire member  170  to thus move the proximal and distal body portions  160 A,  160 B together wherein the blade edges  165  approximate to cut tissue suctioned into the gap. The step of cutting tissue may be performed one or more times. The depth of tissue that is cut is controlled by the radial dimension R between the annular blade edge  165  and the diameter of the wire member  170 . 
         [0049]      FIG. 2E  illustrates the treated fallopian tube  105  after withdrawal of the working end  120  form the treatment site. It can be seen that the cut or excised tissue causes blood  204  to ooze from the walls from a depth greater than the ablation zone  190 . It is this bleeding step that is important to initiate the wound healing response which will result in scarring and an adhesion across the lumen. 
         [0050]      FIG. 2F  illustrates the adhesion or occlusion after a period of time, for example at least on week.  FIG. 2F  shows the scar/adhesion tissue  204  across the lumen as fully developed, and the re-growth of endometrial tissue has migrated up the scar or adhesion  204  but such endometrial proliferation was slower than the formation of the adhesion  204  across the lumen. The ablated tissue  190 ′ is shown in the process of being resorbed which may take from 2 weeks to one month or more. 
         [0051]    In one aspect of the method, the adhesion or scar tissue is intentionally created to occlude the fallopian tubes which may be alternatively described as Asherman&#39;s syndrome. Such adhesions are internal scars which are made up of strand like fibrous tissues forming abnormal bridges/bonds between two parts of the body after trauma, through complex processes involving the injured tissues. Asherman&#39;s syndrome describes the condition in which scar formation causes the walls of your womb to adhere to one another, which can be triggered by uterine inflammation due to trauma to the endometrium. Scar formation begins immediately after such uterine trauma and it had been reported that scar formation maybe complete in about 7 days. 
         [0052]    Hormones likely have a role to play in the development of Asherman&#39;s syndrome. Estrogen is the hormone that causes the endometrium (uterine lining) to grow and low levels may predispose to the development of scar tissue in the uterus. This is true around the time of pregnancy and breast-feeding when the predominant hormone is progesterone. The high levels of progesterone and the low levels of estrogen create an environment where it is more likely to develop. In the treatment of Asherman&#39;s syndrome, estrogen is often used to help the endometrium grow and it is prescribed in order to thicken the uterine lining quickly. In the method of the invention, hormone modulation also may be used to control the speed at which endometrial cells re-grow over the ablation zone  190  to insure that scarring and adhesion is complete before the endometrial cells interfere with the occlusion site. 
         [0053]    In general, a method for female sterilization corresponding to the invention comprise transcervically inserting a working end of a treatment probe into a fallopian tube, actuating the probe to cause a wound healing response in a targeted adhesion segment of a fallopian tube resulting in adhesion of walls of the tube. At the same time, the probe is actuated to ablate surface tissues in first and second ablation segments on either side of the adhesion segment. The method provides an adhesion segment having a length of at least 1 mm or at least 5 mm. The method further provides that each ablation segment (on both sides of the adhesion segment) has a length of at least 1 mm or at least 5 mm. 
         [0054]    In another aspect of the invention, each ablation segment has a length along the lumen that provides for a time interval for endometrial cells to migrate over such an ablation segment, and such interval is at least 2 days and preferably one week. 
         [0055]    In another aspect of the method, adhesion segment is treated to provide a wound healing response therein that includes at least one of bleeding, inflammation, macrophage formation, fibroblast proliferation, vascularization, fibrin matrix formation, and scar tissue organization. The treatment of this segment can be provided by at least one of cutting, puncturing, incising or resecting tissue. 
         [0056]    In another aspect of the method, the step of ablating surface tissue is provided by at least one of a thermal treatment or cryogenic treatment. Such a thermal treatment can be provided by RF energy, laser or light energy, microwave energy, inductive heating, ultrasound heating, resistive heating. A cryogenic treatment can be provided by a cryogenic fluid flow to the probe working end  120 . Clearly any modality of creating the desired tissue effect can be employed in the methods and devices described herein. 
         [0057]    As described in one variation above, the adhesion segment can be treated by at least one of a thermal treatment or cryogenic treatment prior to the step of cutting tissue. The cutting step can be performed by a blade edge of any type or performed by a needle-like element to puncture tissue through the depth of the ablated layer. The cut tissue can be captured and removed or not captured. 
         [0058]    In another aspect of the method, endometrial cell migration can be modulated by a hormone treatment, for example by oral medication of by introducing drugs or drug-carrying implantable media into the treatment site. 
         [0059]    In general, a method for female sterilization comprises ablating the endothelial and/or endometrial cells in an elongated segment of the lumen of a fallopian tube and treating an intermediate portion of said lumen segment to cause Asherman&#39;s syndrome in said intermediate portion to thereby occlude the fallopian tube lumen. The step of treating the intermediate portion again includes causing bleeding therein to precipitate the wound healing response as described above. 
         [0060]      FIG. 3  illustrates another variation of working end  220  that does not have components that move axially apart and together. The working end  220  of  FIG. 3  still is adapted to occlude a fallopian tube as described above using the pervious embodiment. In  FIG. 3 , the working and has a plurality of proximal electrodes  240 A and has a plurality of distal electrodes  240 B. Intermediate the electrodes is a blade element  250  that can be pushed outwardly from slot  255  to cut tissue. The blade can be actuated outwardly by push-pull member  270  in the catheter shaft  155 . After the RF energy is used to ablate tissue  190 , the blade then can be extended outwardly to cut tissue to cause the bleeding step. The working can be move axially or rotationally to assist in the cutting step. In this variation, working end can have suction ports  244  for suctioning tissue against the electrodes. The multiplicity of electrodes can allow multiplexing while changing the polarity of electrodes or groups of electrodes to achieve the desired ablation depth. In this variation and the previous variation, the working end or a portion carrying an electrode can be translated or rotated during RF energy delivery. Following the cutting step of  FIG. 3  described above, the bleeding will induce the wound healing response and scarring as depicted previously in  FIGS. 2E and 2F . 
         [0061]    It should be appreciated that any kind of blade edge or needle can be used in the embodiment of  FIG. 3  to cause the bleeding step to precipitate the scarring process. 
         [0062]    Obviously, the steps described above are performed in both fallopian tubes to provide sterilization. 
         [0063]    In another method, as shown in  FIGS. 4A-7 , an elongated segment of a fallopian tube can be damaged to cause a wound healing response which again causes an adhesion across the lumen of the fallopian tube without requiring of ablating the of the cells lining the fallopian tube as described above. In this method, the damage is provided over an elongated longitudinal segment of the fallopian tube lumen, and the adhesion can form and permanently occlude the lumen before new endothelial cells can migrate inwardly from the ends of the damaged segment, which cells are adapted to maintain the patency of the lumen. 
         [0064]      FIG. 4A  illustrates a catheter of probe shaft  415  and working end  420  that is adapted damage a longitudinal segment of a fallopian tube  105  to cause an adhesion therein which results naturally from the wound healing response as described previously. In  FIG. 4A , it can be seen that the catheter shaft  415  carries a balloon  422  that can be expanded by a fluid from a syringe (not shown). The balloon  422  can have any suitable length as required. For example, such lengths can include a range between about 5 mm to 20 mm or more. The balloons may be shaped to fit in a fallopian tube  105  or partly in the ostium  424 . In this embodiment, the balloon  422  is used to stabilize the working end  420  in relation to the fallopian tube. Thereafter, an abrading element  425  is exposed at the distal end  428  of the probe and it can be rotated and/or moved axially to damage the walls of the fallopian tube  105 . In the variation of  FIG. 4A , the abrading element  425  can be extended from a bore in the shaft  415  or a sleeve can be withdrawn proximally to expose the element  425 . The variation of  FIG. 4A  includes an abrading wire  440  that can be expanded radially outward from a central wire  442  by axial translation of one wire relative to the other. The outward abrading wire  440  then will better conform to and engage the walls of the fallopian tube  105 . In one variation, the abrading wire  440  is provided with an abrasive surface which can be deposited on the wire. The wires can be stainless steel, NiTi or any other suitable material. The assembly of wires  440  and  442  then can be fully or partially rotated or moved from the probe handle (not shown) either manually or by a motor at any suitable rpm to abrade the lining of the fallopian tube. In one variation, also shown in  FIG. 4A , the catheter can include a negative pressure source  450  communicating with a passageway in the catheter having an open termination  455  distal to the balloon  422  which can be used to suction the lumen walls against the abrading assembly. The abrading wires can have an exposed longitudinal length ranging from about 10 mm to 25 mm or more. 
         [0065]      FIG. 4B  shows a subsequent step in the method wherein the abrading element  425  is withdrawn and blood  456  from the damaged tissue accumulates within the lumen of the fallopian tube  105 .  FIG. 4C  shows the fallopian tube after the passage of time with an adhesion  458  formed to occlude the lumen of the fallopian tube and endothelial cells have migrated into the lumen from both ends of the treated sement. 
         [0066]    In general, a method for female sterilization corresponding to the invention comprises transcervically introducing a working end of a treatment probe into a fallopian tube, and actuating the working end to damage a longitudinal segment of the fallopian tube sufficient to cause a wound healing response that thereafter caused adhesion of at least a portion of the segment to permanently close the fallopian tube. 
         [0067]    In another variation shown in  FIG. 5 , the catheter has a working end  460  that again is adapted to abrade tissue and comprises a rotatable expandable balloon  462 . The balloon  462  can have an abrasive surface or one or more lines of an abrasive material that can be expanded radially outward. The working end  460  again carries an expandable positioning balloon  422  as in the previous embodiment that is proximal to the rotatable abrading balloon. In another variation (not shown) a second distal balloon can be carried by the working end  460  that is distal to the abrading balloon  462  to thus stabilize both the proximal and distal regions of the fallopian tube  105  on either side of the segment targeted for treatment and damage. In another variation (not shown), the catheter can have proximal and distal stabilizing balloons, and a rotatable non-balloon abrading element intermediate the two stabilizing balloons. The rotatable abrading element can a wire assembly as shown in  FIG. 4 , an balloon that pushes wires or blades outwardly, an articulating member or simply a straight wire with a curved repose (non-tensioned) shape that can be rotated to abrade tissue. The negative pressure source  450  described above can be used to suction tissue against the abrading or cutting element between such proximal and distal stabilizing balloons. In the variation of  FIG. 5 , it can be understood that the damaged tissue will result in a wound healing response and adhesion as shown in  FIGS. 4B-4C . 
         [0068]    In another aspect of the invention, the method includes applying negative pressure from source  450  to the treatment site to cause bleeding in the site (cf.  FIG. 4B ). Such bleeding contributes to the wound healing response that in turn causes the formation of an adhesion in the treatment site. 
         [0069]    In another variation of the invention shown in  FIG. 6 , the catheter has shaft  515  and working end  520  that carries a deployable barbed implant  525  that is configured to cause barbs  528  to puncture the walls of the fallopian tube  105  to thus induce a wound healing response. The implant  525  can be carried in a bore in the catheter shaft  515  and can be pushed outwardly to thus cause the resilient barbs  528  to project radially outward. The assembly then can be actuated to move the implant  525  proximally to cause the barbs  528  to penetrate the walls of the fallopian tube  105 . In this variation, the stabilizing balloon  422  again can be used as in the previous embodiments of  FIGS. 4A-5  to engage the walls of the fallopian tube  105  prior to the step of moving the implant  525  to cause the barbs  528  to penetrate tissue. The length of the implant can be from about 5 mm to 20 mm or more. The negative pressure source  450  can be used to cause bleeding as described above from the sites where the barbs  528  penetrate tissue. The number of barbs can range from 2 to 100 or more. 
         [0070]    The implant of  FIG. 6  can be formed of any biodegradable or bioresorbable polymer known in that art or it can be a metal implant made of a suitable material such as NiTi. Alternatively, the implant  525  can be a combination of a polymer and a metal. The material can be porous or microporous to allow rapid ingrowth of fibrotic material. 
         [0071]    In another aspect of the invention shown in  FIG. 7 , a catheter with shaft  555  can deploy a porous, microporous or nanoporous implant  560  following an abrading step (typically using a different catheter) as described previously. Such an implant  560  can carry a pharmacological agent adapted to accelerate fibrosis in the treated segment. In another aspect, end portions of such an implant  560  can carry pharmacological agents to inhibit or degrade the migration of endothelial or endometrial cells, and the central portion of the implant  560  can optionally carry drugs to promote fibrosis. Any suitable polymers can be used that are infused with pharmacological agents. Alternatively, strands of material such as in electrospun filaments can be used to form the implant  560 . 
         [0072]    While the above  FIGS. 4A-6  have shown various catheter working end adapted to damage tissue, it should be appreciated that any mechanical structure having abrasive features, cutting features, penetrating features and/or puncturing features that can cut, incise, resect, abrade, damage, puncture or de-nude the surface or in the fallopian tube wall fall within the scope of the invention. 
         [0073]    A number of embodiments of the invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention.