The Effect of Menstrual Phase and Hormonal Contraception on Successful Bilateral Placement of the Essure Micro-Insert Tubal Coil

Abstract

Some investigators have suggested that insertion of the Essure microinsert tubal coil should be completed in the follicular phase to improve visualization of the tubal ostia and ensure successful placement. Others have proposed that hormonal endometrial suppression with drugs before the procedure also improves visualization. Timing the procedure according to the follicular phase of the menstrual cycle is impractical for many physicians due to scheduling problems and is difficult to accomplish in women who have irregular menstrual cycles. Moreover, suppressive hormonal therapy is contraindicated for some women and may be problematic for those who choose permanent sterilization to avoid the use of hormonal contraceptives. There are little or no data on the effects of cycle timing or endometrial suppression on improving successful Essure coil placement. This retrospective study investigated the effect of the menstrual cycle phase timing and preoperative endometrial suppression using hormonal contraceptives on the successful bilateral placement of the Essure microinsert coil. The study subjects were 84 patients of reproductive age who underwent the procedure at a Canadian ambulatory center. Data were obtained by a retrospective review of clinical charts (Canadian Task Force classification II-2). The primary study outcome measure was successful placement of the Essure micro-insert tubal coil (defined as bilateral visualization of the tubal ostia and cannulation with the coil on the first attempt). Visualization of the tubal ostia was achieved 81 of 84 patients (96%) and was followed by successful bilateral placement of the coil in 78 of 81 (96%). Among menstrual cycle phases, no difference was found in success rates for parameters of visualization, placement or visualization of proper coil placement (P = 0.959, P = 0.955, P = 0.307, respectively) or for these same parameters between women using hormonal versus nonhormonal methods of contraception (P = 0.557, P = 0.542, P = 0.506). These findings indicate that success rates for bilateral placement of the Essure micro-insert coil on first attempt are very high, and are not improved by menstrual phase timing or preoperative hormonal endometrial suppression.