Duration of Endometrial Preparation and Hysteroscopic Sterilization Placement Success

Abstract

Objective: Previous research has demonstrated the value of endometrial preparation before hysteroscopic procedures. Duration of endometrial preparation prior to hysteroscopic sterilization has not yet been evaluated. The aim of our study is to evaluate the relationship between hormonal endometrial preparation duration and the placement success rate with Essure hysteroscopic sterilization. Study Design: An institutional review board (IRB) approved retrospective cohort study of all women who underwent hysteroscopic sterilization from August 2003 to April 2010 in an urban academic center in Chicago, Illinois was performed. Exclusion criteria included insufficient or incomplete data. Variables including Essure placement success, type and duration of endometrial preparation, demographic factors and hysterosalpingogram (HSG) occlusion rates were compared using chi-square and co-relational analyses. Results: Overall, the Essure placement success rate was 91.5% (226/247). Race, parity, body mass index (BMI), previous surgical history and type of hormonal endometrial preparation did not significantly affect the placement success rate. Women with endometrial preparation (n=216) were significantly more likely to experience successful placement compared to those with no preparation (n=31; p<.005). When comparing Essure placement success rates in patients with 30 days or less (n=49) compared to those that underwent more than 30 days of preparation (n=167), there was no significant effect of duration of hormonal endometrial preparation on placement success rate (p=0.518). Conclusion: This study supports the use of hormonal endometrial preparation prior to hysteroscopic sterilization and suggests that the duration of hormonal treatment does not affect the rate of successful Essure placement. Therefore, scheduling patients for Essure procedures within 30 days of initiating endometrial preparation is unlikely to deleteriously affect Essure placement success, but may instead lower costs and improve patient compliance. Further prospective studies are needed to validate these findings.