Success of Essure Micro-Inserts in the Treatment of Hydrosalpinges Prior to In Vitro Fertilization (IVF) and Frozen Embryo Transfer (FET) Cycles and Pregnancy Outcomes

Abstract

Study Objective: To investigate pregnancy outcomes in women with hydrosalpinges treated with Essure micro-inserts prior to IVF and FET. Design: Prospective, single arm, clinical study. Setting: Private-practice. Patients: Six women (ages 34-41) with unilateral (N=1; prior LSO) or bilateral hydrosalpinges (N=5) diagnosed by HSG scheduled to undergo IVF or FET. Intervention: All Essure placements were performed by one physician in an office setting using local anesthetic (N=4) or in an out-patient surgery center with conscious sedation (N=2). Five patients had bilateral successful placement on first attempt. One patient had unilateral placement on first attempt and one month later underwent a successful second placement procedure. Tubal occlusion was confirmed by HSG in all patients. Measurements and Main Results: Three patients became pregnant on their first IVF treatment cycle; two delivered full-term without complications and one had a fetal demise at 8 weeks due to trisomy 13. Subsequently she conceived on a FET with twins and then had an uneventful fetal demise of one twin; the other was delivered at term without complications. One patient (age 40) underwent four IVF cycles; the first two cycles were unsuccessful, the third cycle resulted in a twin pregnancy that miscarried at 6 weeks and her last cycle resulted in a chemical pregnancy. The patient is now pursuing adoption. One patient (age 37 with prior LSO) discontinued treatment after an unsuccessful IVF cycle due to poor ovarian stimulation response. The sixth patient (age 34 with recurrent fibroids) had a single unsuccessful IVF cycle but has four frozen embryos available and is now pursuing a gestational carrier. Conclusion: Placement of the Essure micro-inserts in patients with hydrosalpinges provides a minimally invasive option for proximal tubal occlusion prior to IVF and FET and appears to result in excellent pregnancy rates and outcomes.