Patent Publication Number: US-2011061659-A1

Title: Minimally invasive delivery devices and methods

Description:
FIELD 
     The present invention relates to the field of minimally invasive medical devices and procedures and, in particular, to devices and methods for transcervical gynecological procedures. 
     BACKGROUND 
     Female contraception and/or sterilization may be affected by transcervically introducing an object (e.g. a coil) into a fallopian tube to inhibit conception. Devices, systems and methods for such a contraceptive approach have been described in various patents and patent applications assigned to the present assignee. For example, PCT Patent Application No. 99/15116, U.S. Pat. No. 6,526,979 and U.S. Pat. No. 6,634,361, which are hereby incorporated herein in their entirety, describe devices that are transcervically inserted into an ostium of a fallopian tube and mechanically anchored within the fallopian tube. The devices described in these patents and patent application may promote a tissue in-growth around and within the inserted device, which may be referred to as an implant or an insert. One example of such devices is the device known as “Ensure” from Conceptus, Inc. of Mountain View, Calif. This tissue in-growth tends to provide long-term contraception and/or permanent sterilization without the need for surgical procedures. 
     U.S. Pat. No. 6,709,667 and U.S. Publication No. 2008/0041394, which are hereby incorporated herein in their entirety, and which are assigned to the present assignee, describe delivery systems and methods for these devices. The delivery system is typically formed of a handle, a delivery catheter system, and a guidewire onto which is held the contraceptive implant to be placed within the fallopian tube. The delivery catheter system contains the guidewire, a release catheter and the contraceptive implant and the guidewire within the release catheter. 
     The delivery catheter system is transcervically positioned into the uterus and the fallopian tubes via a hysteroscope. Example of hysteroscopes are described in U.S. published applications 2006/0293560 and 2005/0288551, both of which are incorporated herein by reference. The delivery catheter system and guidewire enter the hysteroscope through a working channel of the hysteroscope. A distention valve is typically positioned at the tip (proximal end) of the working channel. The distention valve seals the entrance of the working channel to prevent a distention fluid, such as saline, to flow out of the hysteroscope as a device, such as the delivery catheter system and guidewire of the intrafallopian contraceptive delivery device, is introduced into the working channel. The opening into the distention valve is designed to prevent the leakage of any fluid out of the hysteroscope and therefore has the smallest opening possible to allow a very tight fit between the device and the valve opening. To prevent damaging the tip of the guidewire or the contraceptive implant to be inserted into the fallopian tube, the guidewire and delivery catheter system are introduced into the distention valve through an introducer sheath. Some introducer sheaths are formed of a soft flexible material such as plastic or Teflon and have a slit to aid in grasping and in the removal of the introducer sheath after the delivery system has passed through the distention valve. These flexible introducer sheaths must therefore be inserted into the opening of the distention valve while on a stiff mandrel. Once the mandrel is placed within the distention valve and the channel to the desired depth the mandrel is removed, leaving the introducer sheath within the working channel and the distention valve. After placing the introducer sheath into the distention valve and removing the mandrel, the tip of the guidewire and the delivery catheter system may be inserted through the distention valve using the introducer sheath and into the working channel. The introducer sheath may then be removed or may be kept in place throughout the procedure. The distention valve may have a tight opening that places pressure on the delivery catheter and causes friction when withdrawing the delivery catheter. The distention valve prevents fluid leakage from the working channel. When the introducer sheath is inserted through the distention valve, fluid can spray out of the valve and onto the physician or physician&#39;s assistant. The amount of fluid spray-back can be significant depending on the fluid pressure during the procedure. In addition, friction between the introducer sheath and distention valve can be problematic. 
     Once a physician has positioned the delivery catheter system and the guidewire at a position within the fallopian tube where the contraceptive implant may be deposited, it may be awkward and difficult for the physician to maintain the position of the delivery system relative to the anatomy and may require the physician to use an assistant to aid in the proper stabilization of the system relative to the hysteroscope. In addition, some of the contraceptive implant devices in the above references require disengaging from a delivery catheter by using an axial torque. In practice this requires the delivery catheter to be fully rotated multiple times to disengage a contraceptive implant device from the delivery system in order to deposit the contraceptive implant device into a fallopian tube. This maneuver may be difficult and cumbersome to perform considering that the device must also remain axially aligned in the fallopian tube. 
     A stabilization device may be used to help with this awkwardness. One such stabilization device includes a handle that includes a contoured holster to couple the hysteroscope and the handle of the control device, creating a fixed distance between the hysteroscope and the control device. The stabilization device may also be coupled to an endoscope. Examples of such stabilization devices are described in U.S. published application 2006/0293560 and U.S. published application 2008/0041394, both of which are incorporated herein by reference. 
     Once the delivery catheter system is positioned at the proper position in the fallopian tube, the implant is exposed, and realigned if necessary, in the fallopian tube, expanded, and released from the delivery catheter system by rotating a thumbwheel on the handle. One problem with this thumbwheel is that the wheel sometimes sticks causing the doctor to look away from the hysteroscope. 
     SUMMARY OF THE DESCRIPTION 
     Various different embodiments are disclosed below and the following summary provides a brief description of only some of these embodiments. According to one aspect of the invention, certain embodiments described below relate to a medical device that provides a transcervical pathway and also stabilizes a device for a minimally invasive gynecological procedure. The device for the minimally invasive gynecological procedure may be an intrafallopian contraceptive delivery device. 
     One embodiment of the present invention relates to a system for delivering an implant to an ovarian pathway (e.g., a fallopian tube) of a female body that includes a delivery sheath having a first longitudinal opening and a second longitudinal opening wherein the first longitudinal opening is configured to receive a visualization system; and an implant delivery device having an implant sheath positionable within the second longitudinal opening and a delivery catheter (which may be a delivery wire) deliverable through the implant sheath, wherein the implant delivery device is lockable to the delivery sheath and wherein the delivery catheter is movable longitudinally and rotationally relative to the delivery sheath when the implant delivery device is locked to the delivery sheath. 
     Another embodiment of the present invention relates to a system for delivering an implant to an ovarian pathway of a female body including a delivery sheath having a first longitudinal opening and a second longitudinal opening; a visualization system deliverable through the first longitudinal opening; and an implant delivery device having a protective sheath and an implant sheath positionable within the second longitudinal opening and a delivery catheter deliverable through the protective sheath, wherein the delivery catheter and the implant sheath are more flexible than the protective sheath. 
     In a further embodiment, the present invention relates to an implant delivery system having a sheath having a first end and a second end; a first longitudinal opening in the sheath having a port at the first end of the sheath to receive an implant delivery system, the port having an interlocking element to lock the implant delivery system to the sheath wherein the implant delivery system is lockable to the sheath while still retaining the ability to move a deliverable implant longitudinally relative to the sheath when the sheath is stationary; and a second longitudinal opening in the sheath to receive an implant viewing system. 
     In yet another embodiment, the present invention relates to a system for delivering an implant to an ovarian pathway of a female body comprising: a guide; a protective sheath extending from the guide; a handle moveably (e.g. slideably) engaged with the guide; a release catheter having a proximal end and a distal end, the proximal end of the release catheter connected to the handle, the release catheter slideable through the protective sheath; and an implant releasably coupled with the distal end of the release catheter. The implant may comprise an expandable tubular member and a tissue in-growth agent, and the implant can be moved longitudinally, relative to the guide, by moving the handle along the guide. 
     In yet another embodiment, the present invention relates to a method of using a fallopian tube implant. This method may include: attaching the fallopian tube implant to a hysteroscope sheath; attaching a hysteroscope to the hysteroscope sheath; and moving a handle which is moveably coupled to a guide that is couple to the hysteroscope. As the handle is moved longitudinally, an implant, couple to a distal end of a release catheter, is also moved longitudinally. A proximal end of the release catheter is coupled to the handle. As the handle is moved rotationally, while the guide is locked to the hysteroscope, the implant is also moved rotationally without having to rotate the hysteroscope sheath; this can be useful in general and in particular for implant devices which have a remanufactured, built-in, bend or conformation (e.g., a 15° angular bend) as certain implant devices in the prior art. 
     In yet another embodiment, a system for delivering an implant to a fallopian tube includes a port, a handle coupled to the port and a control which is moveably coupled to the handle and which is configured, when the control is moved along on the handle, to move longitudinally the implant. The port is configured to be rotatably coupled to a working channel of a hysteroscope assembly. The implant is coupled to a release catheter which is coupled to the control, and the implant is moved, relative to the handle by the control. The implant may be moved longitudinally relative to the handle by moving the control along the handle, and the implant may be rotated, relative to a stationary hysteroscope assembly, by rotating the handle. The handle can be moved rotationally without releasing a valve on the working channel and the control (and hence the implant) can be moved without releasing a valve on the working channel. The port can include a ball configured to rotatably couple to a socket configured to receive the ball; the socket can be part of the working channel or an adapter designed to attach to the working channel. The ball and the socket each include a lumen designed to allow passage of the implant sheath and the release catheter. In one embodiment, the hysteroscope assembly is a hysteroscope sheath which is designed to receive a hysteroscope (through an imaging channel) and the port (through a working channel); in another embodiment the hysteroscope assembly is a hysteroscope with an integrated working channel. In one embodiment, a lumen of a protective sheath can be coupled to the lumen of the port and can provide protection to the implant sheath and release catheter which extend through a lumen of the protective sheath. 
     Various other devices and methods for using devices, including kits for use in treating patients, are also described below. Other features of the present invention will be apparent from the accompanying drawings and from the detailed description that follows. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The invention is described by way of example with reference to the accompanying drawings, wherein: 
         FIG. 1  is a schematic view illustrating the uterine and tubal anatomy for deployment of the contraceptive devices; 
         FIG. 1A  is a flow diagram of a method for delivering a contraceptive device in accordance with one embodiment of the invention; 
         FIG. 2  is a front perspective view of a delivery sheath in accordance with one embodiment of the invention; 
         FIG. 3  is a rear perspective view of the delivery sheath of  FIG. 2  in accordance with one embodiment of the invention; 
         FIG. 4  is a perspective view of the delivery sheath, guide, device delivery system and hysteroscope in accordance with one embodiment of the invention;  FIG. 4A  is a cross sectional view of the distal portion of the delivery sheath of  FIG. 4 ;  FIG. 4B  is a cross sectional view of the delivery system shown in  FIG. 4 ; 
         FIG. 5  is a side view of the guide and device delivery system in accordance with one embodiment of the invention; 
         FIG. 6  is a top view of the guide in accordance with one embodiment of the invention; 
         FIG. 7A  is a side sectional view of a handle of the device delivery system in accordance with one embodiment of the invention; 
         FIGS. 7B-7D  illustrate actuation of actuators on the handle of  FIG. 7A  in accordance with one embodiment of the invention; 
         FIG. 7E  is a side sectional view of a handle of the delivery device system in accordance with one embodiment of the invention; 
         FIGS. 7F-7H  illustrate actuation of actuators on the handle of  FIG. 7E  in accordance with one embodiment of the invention; 
         FIGS. 8A and 8B  are side views of a distal end of the device delivery system in accordance with one embodiment of the invention; 
         FIG. 9  is a side view of the implant in accordance with one embodiment of the invention; 
         FIG. 10  is a schematic view illustrating delivery of the implant to a fallopian tube with the delivery sheath in accordance with one embodiment of the invention; 
         FIGS. 11A and 11B  are schematics view illustrating lateral movement of the handle relative to the guide; 
         FIG. 11C  is a schematic view illustrating rotational movement of the handle relative to the guide; 
         FIG. 12  is a schematic view illustrating actuation of a first button on the handle to deliver the implant to the fallopian tube in accordance with one embodiment of the invention; 
         FIG. 13  is a schematic view illustrating actuation of a second button on the handle to deliver the implant to the fallopian tube in accordance with one embodiment of the invention; 
         FIGS. 14A and 14B  illustrate an alternative embodiment of the handle in accordance with one embodiment of the invention; 
         FIG. 15  is a perspective view of an alternative embodiment of the handle in accordance with one embodiment of the invention; 
         FIG. 16  is a perspective view of the handle of  FIG. 15  with the delivery sheath and hysteroscope in accordance with one embodiment of the invention; 
         FIG. 17  is a perspective view illustrating connection of the handle of  FIG. 15  with the delivery sheath in accordance with one embodiment of the invention; 
         FIG. 18  is a perspective view illustrating delivery of the delivery catheter through the delivery sheath in accordance with one embodiment of the invention; 
         FIGS. 19 and 19A  illustrate rotational movement of the delivery catheter with the handle in accordance with one embodiment of the invention; 
         FIG. 20  is a perspective view of another embodiment of a handle in accordance with one embodiment of the invention; 
         FIG. 21  is a perspective view of the handle of  FIG. 20  with the delivery sheath and hysteroscope in accordance with one embodiment of the invention; and 
         FIGS. 22 and 23  are perspective views illustrating a steerable handle in accordance with one embodiment of the invention. 
         FIG. 24A  shows a perspective view of another embodiment of a delivery device, shown in this view without a protective sheath; 
         FIG. 24B  shows a perspective view of the delivery device of  FIG. 24A  with a protective sheath attached to the delivery device; 
         FIG. 24C  shows an example of a conventional hysteroscope and hysteroscope sheath with a working channel which can receive the protective sheath and the delivery device; 
         FIG. 25A  shows a cross sectional view of the protective sheath and a distal portion of the delivery device; 
         FIG. 25B  shows a cross sectional view of the hysteroscope sheath; 
         FIG. 25C  shows a cross sectional view of the hysteroscope sheath with the delivery device and the protective sheath inserted into the working channel of the hysteroscope sheath; 
         FIG. 26  shows a cross sectional view of the delivery device; 
         FIG. 27  shows a view down the working channel of the hysteroscope sheath. 
     
    
    
     DETAILED DESCRIPTION 
     Embodiments of the present invention relate to self-aligning, easy locking and/or one-handed systems and methods for delivering a contraceptive device to an ovarian pathway of a patient. For example, the system may include a delivery sheath having a first longitudinal opening and a second longitudinal opening. A visualization system, such as a hysteroscope, is deliverable through the first longitudinal opening of the delivery sheath. The delivery sheath may also be referred to as a hysteroscope sheath. An implant delivery system is deliverable through the second longitudinal opening of the delivery sheath. In one embodiment, the implant delivery system includes a guide having a body, a rail extending proximally from the body, and a protective sheath extending distally from the body. The guide is locked to the delivery sheath at the second longitudinal opening of the delivery sheath, and the protective sheath extends through the second longitudinal opening of the delivery sheath. The implant delivery system may also include a handle, an implant sheath, a release catheter, and an implant releasably coupled with the release catheter. The release catheter may also be referred to as a deliver catheter. The implant sheath and release catheter each have a proximal end and a distal end, and the proximal ends of the implant sheath and the release catheter are connected to the handle. The implant sheath, the implant, and the release catheter are slideable through the protective sheath which is configured to be disposed within the delivery sheath. The handle of the implant delivery system is slideably engaged with the rail of the guide to position the implant in the ovarian pathway. Actuators on the handle of the implant delivery system can retract the implant sheath, expand the implant, and release the implant from the release catheter. 
     Referring now to  FIG. 1 , access to uterus U is gained through the cervix C. From within the uterus U, the fallopian tubes F are accessed via the tubal ostiums O. The fallopian tubes F generally include three segments between the ostium O and the fimbria FIM. Beginning adjacent the uterus U, the intramural segment INT of the fallopian tubes F are surrounded by the muscular uterine tissues. Beginning at the uterotubal junction UTJ, the fallopian tubes F extend beyond the uterine tissues and within the peritoneal cavity along an isthmic segment ISC, and then along an ampullary segment AMP. 
     Referring now to  FIG. 1A , an exemplary method  100  for delivering a contraceptive device to a fallopian tube is illustrated. It will be appreciated that the exemplary method  100  may include fewer or greater number of operations than those described below. In addition, the operations may occur in different orders than described or may occur simultaneously. 
     The method  100  begins at block  104  by identifying the anatomy and target location. The operator determines a preferred placement of the contraceptive device within the ostium, and also determines if any special circumstances are present for a particular device placement procedure. Anatomy and target location identification can be facilitated using a variety of known visualization modes, including hysteroscopy, sonography (ultrasound), fluoroscopy, and the like. 
     The method  100  continues at block  108  by positioning the device at the target location. A wide variety of techniques may be used to assist a healthcare professional in positioning the device in the correct location, including visualization techniques, providing high-contrast markers (such as radiopaque markers, echogenic markers, or the like), providing tactile indication of the placement position by including physical stops or “bumpers” (which may be adapted to engage reference tissues in such a tactile way as to send a signal to the healthcare professional), or the like. 
     The method  100  continues by deploying and/or expanding the device at the target location (block  112 ), and detaching the device from the deployment system (block  116 ). The method  100  may continue by confirming the position of the device at the target location (block  120 ). Confirmation may be provided by visualizing at least a portion of the device after detachment, often using the same visualization modality used during placement. In addition to optical visualization techniques, confirmation of delivery may be provided by including radiopaque markers for fluoroscopic placement confirmation, sonographic markers for ultrasound placement confirmation, or the like. 
     The method  100  may include anchoring and stabilizing the device at the target location (block  124 ) and verifying the efficacy (block  128 ) of the deployed device. Efficacy may be provided by incorporating a lumen/space filling design in the implant, such as polyester fibers to incite a tissue reaction (i.e., tissue in-growth fibers), that sufficiently alters the function and architecture of the fallopian tube so as to inhibit conception. This tissue reaction results in the incorporation of the contraceptive device into the tubal lumen tissues, so that the device is firmly embedded into the surrounding tissue structure. 
       FIGS. 2 and 3  illustrate a delivery sheath  200 . This delivery sheath may also be referred to as a hysteroscope sheath. The delivery sheath  200  is configured to deliver a contraceptive device to a fallopian tube through the cervix C and uterus U. The delivery sheath  200  includes an elongate body  204  that includes a first lumen  208  and a second lumen  212 . The elongate body  204  may optionally include a third lumen  216  (e.g. a fluid inlet lumen) and/or fourth lumen  220  (e.g., a fluid outlet lumen). 
     The elongate body  204  includes a proximal end  224  and a distal end  228 . As shown in  FIGS. 2 and 3 , the proximal end  224  of the elongate body  204  is larger than the distal end  228  of the elongate body  204 . The proximal end  224  extends out of the cervix and the patient such that an operator can deliver the contraceptive device through the sheath  200 , while the distal end  228  extends to or near the ostium O. 
     The length of the elongate body  204  is configured to provide a transcervical pathway. For example, the length of the elongate body may be about 29-30 cm. In one embodiment, the elongate body  204  includes a working length  204   a  that extends through the cervix C and uterus U to or near the ostium O, and a manipulating length  204   b  that extends away from the cervix C and out of the female patient. In one embodiment, the working length  204   a  may be about 19-20 cm. It will be appreciated that the length of the elongate body may be less than 29 cm or greater than 30 cm and the working length may be less than 19 cm or greater than 20 cm. 
     The first lumen  208  extends from the proximal end  224  to the distal end  228  of the elongate body. The first lumen  208  is configured to receive a visualization tool, such as, for example, a hysteroscope. The visualization tool may be secured to the sheath  200  through a locking mechanism, such as, for example, a groove and tab, at a proximal end of the first lumen  208 . Alternatively, the visualization tool is not secured to the sheath  200 . 
     The hysteroscope is positioned in the delivery sheath so that an operator can view the fallopian tube sufficiently to deliver the implant in the fallopian tube. In one embodiment, the distal end of the hysteroscope is aligned with the distal end of the sheath  200  (i.e., the distal end of the hysteroscope is flush with the distal end of the sheath  200 ). In another embodiment, the hysteroscope extends just beyond the distal end  228  of the elongate body  204 . For example, the hysteroscope may extend less than about 1 cm beyond the distal end  228  of the elongate body. 
     The second lumen  212  also extends from the proximal end  224  to the distal end  228  of the elongate body. The second lumen  212  is configured to receive a device delivery system. The device delivery system may be secured to the sheath  200  through a locking mechanism, such as, for example, a groove and tab at a proximal end of the second lumen  212 . As shown in  FIG. 3 , the second lumen  212  includes a tab  232  to interlock the delivery sheath with a corresponding groove in a device delivery system, described in further detail hereinafter. 
     The first lumen  208 , second lumen  212 , both the first lumen  208  and second lumen  212  or neither the first lumen  208  nor the second lumen  212  may include a distension valve to prevent fluid leakage through the sheath  200 . 
     The optional third lumen  216  and fourth lumen  220  are configured to be fluid lumens. For example, the third lumen  216  may be a fluid inlet and the fourth lumen  220  may be a fluid outlet, or vice versa. Alternatively, a single lumen (e.g., only third lumen  216 ) is provided. When a single lumen is provided, the single lumen may be both a fluid inlet and fluid outlet, or the single lumen may be a fluid inlet, while the second lumen  212 , for example, serves as the fluid outlet as well as a working channel. 
     In one embodiment, one or more tendons are connected to the distal end of the sheath  200  to allow the operator to deflect the sheath  200  (through controls at the proximal end which are couple to the tendons) to direct the distal end of the sheath  200  toward the ostium O. The sheath  200  and the hysteroscope  400  may, in one embodiment, have distal ends which are flexible. 
       FIG. 4  illustrates the sheath  200  with a hysteroscope  400  positioned in the first lumen  208  of the sheath  200  and a device delivery system  404  positioned in the second lumen  212  of the sheath  200 . The delivery system  404  includes a guide  408  and a delivery device  412 . As shown in  FIG. 4 , the proximal end of the delivery device  412  extends from the proximal end of the delivery sheath  200  and the distal end  412   b  of the delivery device extends from the distal end of the delivery sheath  200 . The distal end of the delivery device  412   b  includes the implant to be delivered to the ovarian pathway of the patient, and the proximal end  412  is configured to allow an operator to manipulate the delivery device to position and deliver the implant in the proper location in the ovarian pathway. This proper location is known in the art. The delivery sheath  200  allows for movement of the hysteroscope  400  or delivery device  412  independent of one another. The guide  408  is secured to the sheath  200 , and the delivery device  412  is moveably (e.g. slideably) coupled to the guide  408 . 
       FIG. 4A  shows an enlarged cross sectional view of the distal end of the delivery sheath  200  of  FIG. 4 . This enlarged view shows the hysteroscope  400 &#39;s distal end  400   a  extending through and slightly out of the lumen  208  of the delivery sheath  200 . This distal end  400   a  conveys an image through the hysteroscope  400  to the proximal end of the hysteroscope  400 . The distal end  412   b  of the delivery device  412  is shown extending through and slightly out of the lumen  212  of the delivery sheath  200 . The distal end  412   b  of the delivery device includes a protective sheath  520 , which surrounds and protects the implant sheath  800 , a release catheter  450 , and an implant (or other device)  460 . The implant  460  may be the contractive device  820  shown in  FIGS. 8A ,  8 B and  9 , and the release catheter  450  may be the same as release catheter  840  in  FIG. 8B ; this device  820  is designed to be deployed within a fallopian tube and, after deployment it expands or enlarges to resiliently engage the walls of the fallopian tube. This device  820  may include agents, such as polyester or Dacon fibers, which are designed to cause tissue-in-growth into the device. After time (e.g. several weeks), the tissue-in-growth into and around the device will effectively and functionally occlude the fallopian tube as is known in the art. The implant sheath may, in certain embodiments, be configured to cover and protect the implant  460  as it is being positioned with the fallopian tube but before it is deployed. In certain embodiments, the distal end of the implant  460  may be protected by the implant sheath  800  (as shown in  FIG. 4A ) while the implant  460  is being positioned in a fallopian tube; in other embodiments, the distal end of the implant  460  may be used as, in effect, a guidewire, and may include an atraumatic distal tip which extends beyond the implant sheath  800  (while the rest of the implant  460  remains covered by the implant sheath  800 ). The implant sheath  800  may radially restrain the implant  460  before the implant is deployed (e.g. released from the implant sheath), and after the implant sheath  800  releases the implant, the implant  460  can expand to resiliently engage the walls of the fallopian tube. The release catheter  450  (which is also referred to as a delivery catheter) is, in one embodiment, releasably coupled to the implant  460 ; the implant  460  may be coupled to the release catheter  450  by a variety of ways known in the art, including a friction fit or a screw connection. The release catheter  450  may serve to hold the implant  460  at a position while the implant sheath  800  is retracted or may serve to push the implant  460  out of the implant sheath (which may be stationary or may also move). In one embodiment, the release catheter  450  may be a delivery wire which is coupled to the implant  460  by a frictional fit between a distal portion of the delivery wire and a proximal portion of the implant  460 ; in one implementation of this embodiment, the distal portion of the delivery wire is coupled, by a frictional fit, to an inner coil of an implant device which also includes an outer tubular structure such as an outer coil. The release catheter  450  in one embodiment is coupled to a control near the proximal end of the delivery device  412 , and this control is configured to, when actuated, cause the release of the implant  460 . The implant sheath  800  in one embodiment is coupled to a control (which can be an additional control which is separate from the control for the release catheter) near the proximal end of the delivery  412 , and this control is configured to retract the implant sheath  800 , to thereby expose the implant  460 . 
       FIG. 4B  is a cross sectional view of one embodiment of the delivery system  404  of  FIG. 4 . The delivery device  412  is coupled to the rail  524  of the guide  408  by a tab  462  which rides in the rail  524  in order to allow longitudinal movement  468  of the delivery  412  (which acts as a handle) to in turn longitudinally move the release catheter  450  and the implant sheath  800 . The rail  524  may be a groove in the guide  408 , and the tab  462  is designed to slidably fit within the groove to allow the delivery device  412  to be moved longitudinally (in a proximal or distal direction) as shown by the arrow  468 . The tab  462  is coupled to a socket joint  464  which is designed to receive and hold a ball  466  near the distal end of delivery device  412 . The ball  466  has a lumen (not shown) to allow the implant sheath  800  and the release catheter  450  within the implant sheath  800  to pass through the ball and be connected with controls, such as buttons, on the delivery device  412  so that the implant sheath  800  can be retraced and the implant  460  can be released. The socket joint  464 , the interlock  516  and the guide  408  also include a lumen, which is in fluid communication with the lumen in the protective sheath  520 , and these lumens are configured to allow passage of the implant sheath  800  and the release catheter  450 . The ball  466  and the socket  464  are rotatably coupled so that the delivery device  412  can be rotated, as shown by arrow  469 , while it is coupled to the socket  464 . This allows the operator to rotate the implant  460 , coupled to the release catheter  450 , by rotating the delivery device  412 ; the operator can rotate the delivery device  412  (or move it longitudinally) without moving the delivery sheath and without moving the hysteroscope. The ability to rotate the implant  460  in this manner can be useful, particularly if the implant  460  has a preformed bend or shape which may require rotation of the implant in order to place in the implant in a proper position within a fallopian tube. 
       FIG. 5  illustrates the guide  408  and delivery device  412  in further detail.  FIG. 6  illustrates the guide  408  in further detail, and  FIGS. 7-9  illustrate one embodiment of the delivery device  412  in further detail. As described above, the guide  408  is secured to the sheath  200 , which allows an operator to manipulate the delivery device  412  with one hand. The guide  408  also helps protect the delivery device  412  from damage. 
     The delivery device  412  is coupled to the guide  408 , such that the handle of the delivery device can slide longitudinally relative to the delivery sheath  200 . In one embodiment, the delivery device  412  is preloaded in the guide  408 . In another embodiment, the delivery device  412  is loaded through the guide  408  by an operator. 
     Referring to  FIG. 5  in combination with  FIG. 6 , the guide  408  includes a body  512 , an interlock  516 , a protective sheath  520  (which may be made of rigid metal), a rail  524  and a stopper  528 . 
     The interlock  516  has a diameter that is smaller than the body  512  and is configured to be inserted into the second lumen  212  of the sheath  200 . The shape and size of the interlock  516  is complementary to the shape and size of the second lumen  212  of the sheath. The interlock  516  may also include a groove  530 . The groove  530  is configured to engage with the tab  232  in the second lumen  212  to lock the guide  408  to the sheath  200 . 
     The protective sheath  520  is, in one embodiment, hard and is configured to protect the outer sheath (also referred to as the implant sheath) of the delivery device  412  from damage. The sheath  520  is configured to be inserted into the second lumen  212  at the proximal end and may extend to the distal end  228  of the sheath  200 . In one embodiment, the distal end of the protective sheath  520  is aligned with the distal end  228  of the sheath  200  (i.e., the distal end of the protective sheath  520  is flush with the distal end  288  of the delivery sheath  200 ). Alternatively, a portion of the protective sheath  520  may extend beyond the distal end  228  of the sheath  200 . The protective sheath  520  may be made of a metal which is both protective and bendable. 
     An exemplary length of the sheath  520  is about 29-30 cm. It will be appreciated that the length of the sheath  520  may be less than 29 cm or greater than 30 cm. In one embodiment, the sheath  520  includes a distension valve to prevent fluid leakage through the sheath  520 . 
     An exemplary material for the sheath  520  is stainless steel. It will be appreciated that the sheath  520  can be formed from other materials, such as, for example, other metals, hard plastics or composites. 
     The rail  524  is configured to allow the handle of the delivery device  412  to slide along the rail  524 . Thus, the rail  524  is a slider assembly. The shape of the rail  524  can be generally complementary to the shape of at least a portion of the handle of the delivery device  412 . For example, if the handle is curved, the rail  524  may be also be curved, the diameter of the curve of the rail  524  being slightly larger than the diameter of the handle. 
     The rail  524  extends distally away from the body  512 . The stopper  528  is provided at a distal end of the rail  524  to limit movement of the handle relative to the body  512 . In one embodiment, the length of the rail  524  is any value or range of values between about 1 and 10 cm in length to allow for about 1-10 cm of corresponding movement of the handle. Thus, the rail  524  both allows longitudinal movement of the delivery device  412  (and hence the implant) without requiring longitudinal movement of the hysteroscope but also limits the longitudinal movement of the delivery device  412 . 
     The rail  524 , in one embodiment, is sufficiently deep to allow for movement of the handle without the handle coming off the rail  524 , but sufficiently shallow to allow for removal of the handle from the rail  524 . The rail  524  may have openings (not shown) to allow an operator to more easily remove the handle from the rail  524 . In addition, the rail  524  may have a track (not shown) to improve movement along the rail  524 . 
     The guide may allow, in certain embodiments, for rotational movement of the rail relative to the delivery sheath  200 . For example, the body of the guide may include a ball and socket joint (not shown) which is designed to receive a ball attached to the handle of the delivery device  412 . 
     The handle of the delivery device  412  positions the implant at a correct location in the fallopian tube by sliding the handle of the delivery device  412  on the rail  524  which in turn moves the release catheter  450 . The handle and/or rail  524  may optionally allow for rotational movement of the implant relative to the sheath, as described herein. The handle can include at least one control for deploying the implant. In the example shown in  FIG. 7A , the handle  540  includes two controls, actuator  548  and actuator  552 . 
     Actuation of the first actuator  548  expands the contraceptive device and, actuation of the second actuation  552  releases the contraceptive device from the delivery device  412 . In one embodiment, first actuator  548  and second actuator  552  are both push buttons; alternatively, one or the other of the first actuator  548  or second actuator  552  is a push button. Other exemplary actuators that can be used for one or both of the actuators  548 ,  552  include a toggle switch, a trigger, a tab slider, a thumb wheel and the like. In one embodiment, the handle  540  includes an auxiliary actuator, such as a thumb wheel, if one or both of the first actuators  548 ,  552  fail. 
     As shown in  FIG. 7A , the handle  540  includes a housing  700 . The first actuator  548  extends into the housing  700  and is connected to a first rack  704  that is connected to a first gate  708 . Similarly, the second actuator  552  extends into the housing  700  and is connected to a second rack  712  that is connected to a second gate  716 . An energy storing device  720 , such as a spring or piston, is connected to an implant sheath  800  and abuts the first gate  708 . A first channel  724  is provided between the first gate  708  and the second gate  716  and a second channel  728  is provided between the second gate  716  and a stopper  732 . A release catheter catch  734  is also provided adjacent the second gate  716 , which is connected to the release catheter  450 . 
     As shown in  FIG. 7B , the first actuator  548  is actuated in a downward motion (arrow  736 ), which pushes the first rack  704  to the left (arrow  740 ), pushing down gate  708  (arrow  744 ). By pushing down gate  708 , the energy storing device  720  moves to the right (arrow  748 ) sliding within the first channel  724  until the energy storing device  720  abuts the second gate  716  and release catheter catch  734 , as shown in  FIG. 7C . When the energy storing device  720  slides toward the second gate  716 , the energy storing device  720  withdraws the outer sheath (not shown) of the catheter  544 . As shown in  FIG. 7C , the second actuator  552  is actuated in a downward motion (arrow  752 ), which pushes the second rack  712  to the left (arrow  756 ), pushing up gate  716  (arrow  760 ). By pushing up gate  716 , the energy storing device  720  along with the release catheter catch  734  moves to the right (arrow  764 ), sliding within the second channel  728  until the energy storing device  720  abuts the stopper  732 , as shown in  FIG. 7D . When the energy storing device  720  slides toward the stopper  732 , the energy storing device  720  further withdraws the implant sheath (not shown) along with the release catheter  450  (not shown). 
       FIG. 7E  illustrates an alternative handle configuration. In  FIG. 7E , the housing  700  includes a motor  768 , a threaded shaft  772 , a first sled  774 , a second sled  778 , a first rack  782  and a second rack  786 . The motor  768  is coupled with the threaded shaft  772  so that the motor  768  rotates the threaded shaft  772  when it is powered on. The first sled  774  and second sled  778  are connected to the threaded shaft  768  at a first position and second position, respectively. The first sled  774  is coupled with the outer sheath of the delivery device  412  and the second sled  778  is coupled with the release catheter of the delivery device  412 . The first rack  782  couples the first actuator  548  with the motor  768  and the second rack  786  couples the second actuator  552  with the motor  768 . 
     As shown in  FIG. 7F , the first actuator  548  is actuated in a downward motion (arrow  790 ), deflecting the first rack  482 , which powers the motor  768 , thereby rotating the threaded shaft  772 . Rotation of the threaded shaft  772  moves the first sled  774  toward the second sled  778 , which remains stationary. The movement of the first sled  774  retracts the outer sheath of the catheter. When the first sled  774  contacts the second sled  778  ( FIG. 7G ), power to the motor  768  is discontinued. As shown in  FIG. 7H , when the second actuator  552  is actuated in a downward motion (arrow  794 ), the second rack  786  is deflected, powering the motor  768  to again rotate the threaded shaft  772 . Rotation of the threaded shaft  772  causes movement of the second sled  778  toward a proximal end of the housing  700  to retract the release catheter and outer sheath. 
       FIGS. 8A ,  8 B and  9  illustrate the distal end of the delivery device  412  and the implant. As shown in  FIG. 8A , the delivery system  412  includes an implant sheath  800  and a marker  802  disposed on the implant sheath  800 . The marker  802  may be one or more of the various types of conventional markers such as an optically visible marker (e.g. a marker which is colored to distinguish from its surroundings) which is visible during a hysteroscopy by visible light and a camera or a radiopaque marker or an ultrasound marker (which is visible in an ultrasound image) or other known markers which allow the user of the delivery device  412  to guide and place the distal end of the system at a proper deployment position. 
     In  FIG. 8A , a distal portion  804  of the contraceptive device  820  is shown. The distal portion  804  includes a tip  808  and an attachment mechanism  812 . The attachment mechanism  812  may be a solder bond. In certain embodiments, the distal portion  804  (such as the portion from the tip  808  to the attachment mechanism  812 ) may have a preformed bend of about 15° relative to the rest of the implant. 
       FIG. 8B  shows the delivery device  412  after the implant sheath  800  has been retracted (or alternatively, the contraceptive device has been pushed relative to the implant sheath  800 ) such that the contraceptive device  820  is fully viewable. 
     The contraceptive device  820  includes, in this embodiment, an outer coil  824  which is attached at attachment mechanism  812  to an inner coil  828  shown in  FIG. 9 . The inner coil  828  may extend from the tip  808  in a proximal direction toward an end piece  832  which is attached to the outer coil  824 . The outer coil  824  is thus coupled to the inner coil  828  at attachment  812  and coupled to the end piece  832  as shown in  FIG. 9 . The end piece  832  may, in one embodiment, be coupled by a frictional fit to a release catheter or delivery wire such as the release catheter  450  shown in  FIG. 4A . In an alternative embodiment the end piece can be attached to, on one hand, to the inner coil (at a proximal portion of the inner coil) and on the other hand be releasably attached to the release catheter (and in this ease the outer coil is not attached to the release catheter). 
     The contraceptive device  820  shown in  FIGS. 8A-8B  and  9  may also include a tissue in-growth agent  836 . The tissue in-growth agent may be a polyester fiber or other types of agents designed to cause tissue in-growth to functionally occlude the fallopian tube. Functional occlusion of the fallopian tube is described, for example, in U.S. Pat. No. 6,526,979 which is incorporated herein by reference. 
     Referring back to  FIG. 88 , the end piece  832  is adjacent to and abuts a release catheter  840 . The release catheter  840  may include a pin or other interface designed to mate with a receptor or other interface on the end piece  832  to thereby couple the contraceptive device  820  to the release catheter  840 . In one exemplary embodiment, the two interface elements on the release catheter  840  and the end piece  832  are coupled through an interference fit. The contraceptive device and the release catheter can be released by retracting the release catheter. In another exemplary embodiment, the two interface elements on the release catheter  840  and the end piece  832  may resemble a screw and a nut which more securely secures the contraceptive device and release catheter to each other. The contraceptive device and release catheter can be released by unscrewing the contraceptive device from the release catheter after the contraceptive device has been implanted. 
     The contraceptive device  820  shown in  FIGS. 8A-8B  and  9  resembles the Essure device from Conceptus, Inc. of Mountain View, Calif., in that there is an outer coil which may be formed from a superelastic or resilient member and an inner coil which is coupled to the outer coil. The outer coil is designed to radially expand to engage the walls of a portion of the fallopian tube to thereby engage those walls and hold the device within the fallopian tube. 
     It will be appreciated that other contraceptive devices and/or delivery device configurations may be used. For example, the contraceptive devices described in copending U.S. application Ser. No. 10/866,493, filed Jun. 10, 2004, entitled Medical Devices and Methods of Making and Using Such Medical Devices, the entirety of which is hereby incorporated by reference, may be used as an alternative to the contraceptive device  820  described above. Other exemplary contraceptive devices include spider-like, stent-like, coil-like, or other implantable contraceptive devices. 
       FIG. 10  illustrates placement of the contraceptive device  820  in the ovarian pathway with the delivery sheath  200 . As shown in  FIG. 10 , the device  820  may extend proximally beyond ostium O into uterus U by a distance of, for example, about 0.2 to 1.2 cm. The device  820  may also extend distally beyond the intramural section INT and/or uterotubal junction by a distance of, for example, at least about 0.6 cm. It will be appreciated that the values provided above are exemplary and that the values may vary. In addition, it will be appreciated that there may be no proximal extension, no distal extension or neither proximal nor distal extension of the contraceptive device  820 . 
     Referring to  FIGS. 11A-13 , delivery of the implant with the device delivery system  404  is illustrated in further detail. Referring to  FIGS. 11A and 11B , the handle  540  of the delivery system  412  is slideable along the rail  524  of the guide  408 . Sliding the handle  540  toward the sheath  200  pushes the contraceptive device  820  distally ( FIG. 11A ), while sliding the handle  540  away from the sheath  200  causes the contraceptive device  820  to move proximally ( FIG. 11B ). Thus, sliding the handle  540  along the rail  524  allows an operator to accurately position the contraceptive device at the target location and this can be done without moving the current position of the sheath  200  (which moving may disrupt the physician). As described above, the rail  524  may have a length between about 1 cm and 11 cm; thus, the operator can position the contraceptive device within about 1 cm-11 cm from the initial delivery position. It will be appreciated that the value may less than 1 cm or greater than 11 cm. 
     As shown in  FIG. 11C , the contraceptive device  820  is, optionally, rotatable. The ability to rotate the implant, without rotating the sheath  200 , is particularly useful for those embodiments in which the implant has a preformed bend (or other non-linear conformation), such as a 15° bend (shown in  FIG. 11C ). As shown in  FIG. 11C , the guide  408  includes a ball and socket  1100  that allows the rail  524  and handle  540  to rotate relative to the sheath  200 . Rotational movement of the handle  540  results in rotational movement of the distal end of the delivery system  412 , as shown in  FIG. 11C . The rotational movement can be used to position the contraceptive device in the fallopian tube or to separate the contraceptive device from the release catheter. It will be appreciated that although the ball and socket is shown as being a part of the guide  408 , the ball and socket could alternatively be part of the handle, allowing rotational movement of the handle  540 . In addition, it will be appreciated that although a ball and socket joint is described as allowing for rotational movement of the handle  540 , it will be appreciated that alternative joints or devices may be located at the handle  540  or guide  408  to allow for rotational movement. 
       FIG. 12  shows actuation of the first actuator  548 , which results in exposure of the contraceptive device  820  via retraction of the implant sheath. It will be appreciated that, alternatively, actuation of the first actuator may result in exposure of the contraceptive device  820  by pushing the release catheter (e.g. release catheter  450 ) and, hence, the contraceptive device, distally from the delivery catheter. 
     As shown in  FIG. 13 , actuation of the second actuator  552  results in expansion of the implant when the release catheter releases the implant. Actuation of the second actuator  552  may also retract the guidewire  1300  to release the contraceptive device  800  from the guide wire  1300 . 
     It will be appreciated that in embodiments in which the contraceptive device is a self-expanding contraceptive device, actuation of the first actuator will result in both exposure and expansion of the contraceptive device  800  when the delivery catheter is retracted. In such an embodiment, actuation of the second actuator may simply result in release of the contraceptive device  800  from the release catheter. In alternative embodiments, the contraceptive device may be balloon-expandable; thus, actuation of the second actuator would expand and release the contraceptive device by expanding the balloon in such an embodiment. 
     In one embodiment, the delivery device includes an indicator (not shown). The indicator may indicate that the catheter has been retracted and then that the implant has been delivered. The indicator may be visual or audible. 
       FIGS. 14A and 14B  illustrate an alternative delivery device configuration. The delivery device  1400  includes a handle  1404  having a first handle portion  1406  and a second handle portion  1408 . A first actuator  1412  and a second actuator  1416  are provided on the handle  1400 . Although the first and second actuators  1412 ,  1416  are shown on the second handle portion  1408 , it will be appreciated that the actuators  1412 ,  1416  can alternatively be placed on the first handle portion  1406 , or the first actuator  1412  can be placed on the first handle portion  1406  and the second actuator  1416  placed on the second handle portion  1408 . A delivery catheter  1420  is also shown extending from the handle  1404 . 
     As shown in  FIG. 14B , actuation of the first actuator  1412  causes separation of the first handle portion  1406  and the second handle portion  1408 . The second handle portion  1408  moves distally relative to the first handle portion  1406  resulting in retraction of the delivery catheter to expose a contraceptive device, as described above. Actuation of the second actuator  1416  causes expansion of the contraceptive device and release of the contraceptive device from the release catheter, as described above. 
       FIG. 15  illustrates an alternative delivery system  1500  for delivering a contraceptive device at a fallopian tube of a patient. The delivery system  1500  includes an interlocking element  1502 , a main body  1504 , a secondary body  1508 , a first actuator  1512  and a second actuator  1516 . The delivery system  1500  may also include a knob  1520 . The interlocking element  1502  is similar to the interlocking element of the guide  408 , and is configured to be inserted into the second lumen  212  of the sheath  200 , and includes a groove  1524  that engages with the tab in the second lumen  212  of the sheath  200  to lock the delivery system  1500  to the sheath  200 , as shown in  FIG. 16 .  FIG. 17  illustrates connection of the delivery system  1500  to the sheath  200  in further detail. Actuation of the actuators  1512  and  1516  operate in a manner similar to the actuators of the delivery device  412  to deliver the contraceptive device in the fallopian tube, as shown in  FIG. 18 . 
       FIGS. 19 and 19A  illustrate an alternative embodiment of the sheath  200  that includes a rotational element  1900  that allows for rotation of the delivery system  1500  and thus the contraceptive device. 
       FIG. 20  illustrates an alternative delivery system  2000  for delivering a contraceptive device at a fallopian tube of a patient. The delivery system  2000  includes an interlocking element  2002 , a main body  2004 , a secondary body  2008  and an actuator  2012 . The actuator  2012  has a clamshell design that includes a releasable lock  2016  and a clamshell  2020  that is moveable in an opening  2024  in the secondary body  2008 .  FIG. 21  illustrates connection of the delivery system  2000  to the sheath  200 . The delivery system  2000  is connected to the sheath  200  as described above with reference to  FIGS. 15-17 . 
       FIGS. 22 and 23  illustrate a flexibility extension  2200  that may be provided between the sheath and a delivery system, such as the delivery system shown in  FIG. 15 . The flexibility extension  2200  allows the delivery system to be positioned away from the proximal end of the sheath. It will be appreciated that the flexibility extension  2200  can be used with any of the other delivery systems described herein. 
       FIGS. 24A ,  24 B,  25 A,  25 B,  25 C,  26  and  27  show another embodiment of a delivery device according to the present invention. In this embodiment, rather than having a handle which moves on a rail on a guide, the handle has a control (e.g. a longitudinal placement control) which moves on the handle to position, longitudinally (in a proximal/distal direction), the implant without requiring movement of the handle longitudinally and without requiring movement of the hysteroscope. In one implementation, the control may be a ring, coupled through a slot in the handle to the release catheter or delivery wire, and this ring is moved along the exterior of the handle to in turn move the implant longitudinally; moreover, the entire handle may be rotated to rotate the implant for proper delivery, and the handle may be swiveled to a side of the working channel. 
     The delivery device  412 A shown in the perspective view of  FIG. 24A  includes a handle having a slot  2405  and an interlocking end piece  2401 . The interlocking end piece  2401  is designed to be attached to a coupler or adapter on a hysteroscope sheath, such as the coupler  2441  shown in  FIGS. 258 and 25C ; the interlocking end piece  2401  may be removably attached to the coupler or adapter through an interaction between structures on the end piece (e.g. a groove, a ridge, etc.) and corresponding structures on the coupler or adapter (e.g. a ridge, a groove, etc.). The slot  2405  is designed to allow longitudinal movement of the longitudinal placement control  2407  along the length of the handle; moving the control distally moves the implant distally relative to the handle and moving the control proximally moves the implant proximally relative to the handle. In other implementations, other types of controls may be used such as a rotating wheel or a button coupled to a spring or electric motor designed to move the implant longitudinally. The delivery device  412 A may optionally include a ball joint  2403 ; in the embodiment shown in  FIG. 24A  and  FIG. 24B , the ball joint connects the end piece  2401  with the rest of the delivery device  412 A and allows the handle of the delivery device to be rotated and swiveled (see  FIG. 27 ) relative to the working channel and the hysteroscope sheath. 
     The delivery device  412 A is shown in  FIG. 24B  with a protective sheath  520 A attached to the distal portion of the interlocking end piece  2401 . This protective sheath  520 A may be similar to protective sheath  520  described above; for example, it may be relatively hard (e.g. a metal) and may protect the release catheter and the implant from harm when the deliver device  412 A is inserted into a working channel of a hysteroscope sheath and it may be less flexible than the release catheter and any implant sheath which protects and surrounds at least a portion of the implant. 
       FIG. 24C  shows an example of a conventional hysteroscope sheath  2425  which may be used with one or more embodiments of the delivery devices described herein. The hysteroscope sheath  2425  may have a plurality of channels just as the delivery sheath  200  can have a plurality of channels. For example, the hysteroscope sheath  2425  may have a visualization channel (which includes a hysteroscope lumen  2437 ) configured to receive a hysteroscope, such as hysteroscope  2427 , and a working channel  2429 , configured to receive any one of the delivery devices described herein such as the delivery device  412 A, and other channels such as fluid inlet and fluid outlet channels. The working channel  2429  includes a lumen  2431  configured to receive any one of the delivery devices described herein. The hysteroscope sheath shown in  FIG. 24C  is a rigid sheath and may be used with a rigid hysteroscope; in other embodiments, a flexible hysteroscope and/or a flexible hysteroscope sheath may be used with a delivery device described herein. 
     The delivery device  412 A includes an interlocking end piece  2401  which is configured to be attached removably to a hysteroscope sheath through cooperating structures on the end piece and on a portion of a couple of the hysteroscope sheath or an adapter fitted on or coupled to the hysteroscope sheath.  FIG. 25A  shows a cross sectional view of a distal portion of the delivery device  412  A. This view shows that the interlocking end piece  2401  includes two ridges  2401 A and  2401 B, and these ridges may be separate (to fixedly lock the end piece to the coupler) or may run along the entire perimeter of the end piece as a continuous ridge (to allow rotation of the end piece within the couple or adapter  2441 ). The end piece has lumen through it and extending into the protective sheath, and the release catheter and the implant sheath (if any) and the implant are configured to be disposed in that lumen such that the implant can be initially within the protective sheath (see  FIG. 26 ) and then move distally out of the protective sheath to be delivered. 
     If the ridges  2401 A and  2401 B are separate they may be used to fit into and lock the end piece into the coupler  2441  to prevent the end piece from rotating within the coupler  2441 . On the other hand, if the ridges run the entire perimeter of the end piece, thereby forming a continuous ridge, then a corresponding continuous groove which mates with that ridge will allow the end piece to rotate within the coupler  2441 . In those implementations in which the end piece is non-rotatably fixed within the coupler  2441 , rotation of the handle relative to the hysteroscope sheath may be provided by the optional ball joint  2403  shown in  FIG. 24A . 
       FIG. 25B  shows a cross sectional view of the hysteroscope sheath  2425  which includes two lumens, which are the working lumen  2431  and the hysteroscope lumen  2437 . The working lumen  2431  ends at a distal end  2534  of the lumen of the working channel. The working channel  2429  includes a coupler  2441  or adapter  2441  which is used to attach the delivery device  412 A to the working channel. The coupler  2441  includes the socket  2439  which is designed to receive the end piece  2401 , and this socket includes two grooves  2401 C and  2401 D. In one embodiment, these grooves may be separate and distinct and be designed to mate with separate and distinct ridges  2401 A and  2401 B, respectively, in order to fixably lock the end piece relative to the coupler, thereby preventing rotation (but rotation can still be allowed with the optional ball joint  2403 ). In other implementations, the groove may be continuous around the inner perimeter of the socket  2439  thereby allowing the ridges  2401 A and  2401 B to move within that groove and to allow rotational movement of the end piece  2401  relative to the coupler  2441 . The coupler  2441  may be permanently secured to the hysteroscope sheath  2425  or may be removeably coupled to the working channel  2429  of the hysteroscope sheath  2425 . The coupler or adapter may fit into the working channel or fit on the outside of the working channel (as shown in  FIG. 25B  which shows a fit on the outside). The coupler or adapter may be secured by glue, a clamp, tongue and groove interface, etc. In certain embodiments, the adapter or coupler may be built into the hysteroscope sheath. While  FIG. 25B  shows that the working channel lumen and the hysteroscope lumen are separate channels, in other embodiments, the channels may be merged into one channel or lumen along at least a portion of the hysteroscope sheath  2425 . In alternative embodiments, the delivery device  412 A may be used with other types of hysteroscope sheaths, such as the hysteroscope sheaths shown in  FIGS. 2 and 3 . 
       FIG. 25C  shows a cross-sectional view of the distal portion of a delivery device  412 A shown inserted into the working channel of the hysteroscope sheath  2425 . In particular, the protective sheath  520 A has been inserted into the lumen  2431  of the working channel. Even though the protective sheath may be hard (e.g., formed of a metal) it can still bend in order to place the sheath into the lumen  2431  of the working channel.  FIG. 25C  also shows that end piece  2401  has been secured into the coupler  2441  by having the ridges on the end piece mate with corresponding grooves, or a single groove in the coupler  2441 . The release catheter  450  and the implant  460  are not shown in the view of  FIG. 25C  in order to simplify that view, but it will be understood that they are present in the typical embodiment of the present invention. 
       FIG. 26  shows a cross sectional view of the delivery device  412 A. The protective sheath  520 A is shown protecting the implant  460  within the protective sheath, and the implant  460  is coupled to the release catheter or delivery wire  450  in order to allow longitudinal placement of the implant  460  through longitudinal manipulation of the longitudinal placement control  2407  which may be a ring with a post  2407 A extending through the slot  2405  and coupled to a distal end of the release catheter  450 . Distal movement of the control  2407  moves the implant  460  distally relative to the delivery device  412 A while proximal movement of the control  2407  retracts the implant  460  back into the protective sheath  520 A. In a typical delivery sequence, the implant  460  is retracted proximally so that it is protected while the protected sheath  520 A is inserted into the lumen  2431  of the working channel of the hysteroscope sheath  2425 . After the delivery device  412 A has been properly positioned relative to the coupler  2441  as shown in  FIG. 25C , the implant can be extended out distally out past the protective sheath  520 A and positioned properly relative to the fallopian tube to deploy the implant  460  at the conventional and known positions for deploying such implants within a fallopian tube. It will be understood that actuators, such as the first and second actuators may be included on the delivery device  412 A to allow retraction of the implant sheath as described above and to allow release of the release catheter  450  from the implant  460  after the implant  460  has been deployed in the proper location of a fallopian tube. For example, a first actuator can include a stretched spring which stores a force which is used, when the stretched spring is allowed to relax, to retract the implant sheath; one end of the stretched spring can be coupled to a proximal portion of a handle of the delivery device  412 A and the other end of the stretched spring can be coupled to the implant sheath and to a button or other user control. When the user presses the button (or activates the other user control) the button (or other user control) can release a stop on the spring to allow the spring to relax and thereby pull back the implant sheath. The button (or other user control) can itself form a stop by fitting through an opening in the handle and in doing so, prevent the spring from relaxing; when the button is depressed, it can be released from the opening and then allow the spring to relax. The release of the implant  460  from the release catheter  450  can occur concurrently with the retraction of the implant sheath or separately. In one implementation which uses a concurrent release, a single actuator can pull back the sheath and release the implant  460  from the release catheter (and there would be no second actuator in this implementation). This implementation can use, for example, a necked down (reduced diameter) sheath along a portion of the sheath to grasp and pull back the release catheter  450  from the implant  460  to thereby release the implant  460  from the release catheter  450 . In another implementation which uses a separate release, a second actuator can be activated to cause release of the implant  460  from the release catheter  450 , and this second actuator can also use a stretched spring which stores a force which is used, when the spring is allowed to relax, to pull the release catheter  450  from the implant  460 . 
       FIG. 27  shows how, in at least certain embodiments, the delivery device  412 A may be rotated and swiveled relative to the working channel  2429  of the hysteroscope. The view of  FIG. 27  is looking down the lumen  2431  of the working channel  2429 . Arrow  2701  represents pure rotational movement around the central axis of the lumen  2431 . This pure rotational movement may occur by rotating the handle of the delivery device  412 A without swiveling from left to right or up and down the handle relative to the working channel. This rotational capability may be provide by a rotational coupling between the end piece  2401  and the adapter  2441 . In other embodiments, this rotational movement may be provided by the optional ball joint  2403 . In addition, in those embodiments which use an optional ball joint  2403 , the handle may be swiveled relative to the working channel by moving either left to right or up and down or other directions or combinations of swiveling and rotation. Arrows  2707  and  2703  show a left or right swivel, respectively, while arrows  2705  and  2709  show an up and down swivel, respectively. It will be understood that these swivels may occur at any angle rather than at zero, 90 degrees, 180 degrees, and 270 degrees as shown in  FIG. 27 . In addition, the handle may be swiveled at any angle while at the same time being able to rotate the handle as shown by rotational movement  2701 , particularly in to those embodiments which employ a ball joint  2403 . 
     The foregoing description with attached drawings is only illustrative of possible embodiments of the described method and should only be construed as such. Other persons of ordinary skill in the art will realize that many other specific embodiments are possible that fall within the scope and spirit of the present idea. The scope of the invention is indicated by the following claims rather than by the foregoing description. Any and all modifications which come within the meaning and range of equivalency of the following claims are to be considered within their scope.