Hysteroscopic Tubal Sterilization with Intrauterine Device In Situ in the Office Setting

Abstract

Study Objective: To evaluate the ability to place the Essure device with an IUD in place in the office setting using local anesthetic. Design: Feasability study. Setting: Office setting under local anesthesia without sedation. Patients: 6 patients in the private practice setting were recruited for evaluation if the Essure procedure could be performed without prior removal of an IUD in the office setting. Intervention: All patients received preoperative ibuprfen 800 mg for 24 hours prior to the procedure, were not fasting, received no sedation, and had a standardized lower uterine segment block utilizing 0.5% xylocaine with 1;200,00 epinephrine. The patients were within 1 week of their menses if they had a copper IUD and no cycle timing with progesterone containing IUD. Measurements and Main Results: All patients had the device placed bilaterally and no IUD's were removed in order to place the Essure implants. The IUD's were not removed until after HSG confirmation of tubal occlusion. No migration of strings was noted and all devices were easily removed without need for hysteroscopy. Conclusion: It appears that the removal of an intrauterine device is not necessary at the time of hysteroscopic placement of the Essure device.