Microinsert Placement Research Articles

Outcomes in the Ultrasound Follow-up of the Essure Micro-Insert: Complications and Proper Placement

ObjectiveTo review the use of three-dimensional ultrasound follow-up of the Essure micro-insert placement at three months for the identification of misplaced coils and complications. MethodsWe conducted a retrospective cohort study of reproductive age women requesting permanent sterilization in a tertiary care ambulatory women's clinic. Women who underwent placement of the Essure micro-insert were assessed for appropriate positioning of the Essure micro-insert coil using threedimensional ultrasound as well as hysterosalpingography when indicated. ResultsA total of 610 women who had undergone the Essure procedure with ultrasound follow-up at three months were retrospectively reviewed and in 524 (86%) the location and shape were both normal. The remaining 86 (15%) required hysterosalpingography to confirm proper placement, 34 because of a non-diagnostic ultrasound and the remaining 52 for a complication noted on ultrasound, including perforation, proximal or distal migration of the device, or device expulsion. ConclusionUltrasound can be used at three months after Essure placement to identify normal placement as well as misplaced and perforated devices

Nickel Hypersensitivity Associated With an Intratubal Microinsert System

Although known nickel hypersensitivity is a contraindication to intratubal microinsert placement in the United States, this case demonstrates that nickel hypersensitivity to intratubal microinserts can occur. A young woman developed an allergic reaction after placement of intratubal microinserts. Nickel hypersensitivity was confirmed with skin patch testing. The microinserts were removed hysteroscopically, and the patient improved. If a patient experiences symptoms of an allergic reaction after hysteroscopic sterilization, referral to an allergy specialist is recommended. If nickel hypersensitivity is confirmed, the microinserts should be removed; this may be performed under hysteroscopic guidance.

Oral Analgesia vs Intravenous Conscious Sedation during Essure Micro-Insert Sterilization Procedure: Randomized, Double-Blind, Controlled Trial

Study Objective To compare the pain reported by patients during the Essure Micro-Insert sterilization procedure using either intravenous conscious sedation or oral analgesia. Design Randomized, double-blind, placebo-controlled trial (Canadian Task Force classification I). Setting Tertiary care ambulatory women’s clinic. Patients Eighty women of reproductive age women requesting permanent sterilization. Intervention Hysteroscopic placement of the Essure Micro-Insert permanent birth control system. Measurements and Main Results Patients undergoing placement of the Essure Micro-Insert system for permanent contraception were randomized to receive either intravenous conscious sedation, oral analgesia, or placebo. During the procedure, pain scores were recorded using a visual analog scale. Patients in the oral analgesia group reported slightly more pain during insertion of the hysteroscope and placement of the second micro-insert; the groups were otherwise equivalent. They were also equivalent when all visual analog scale scores were combined. Conclusion Oral analgesia is an effective method of pain control during placement of the Essure Micro-Insert permanent birth control system.

Use of essure micro-insert for treatment of hydrosalpinx prior to in vitro fertilization: a multicenter IDE/IRB off-label study

OBJECTIVE: To evaluate the proximal tubal occlusion rate following placement of Essure inserts in women with hydrosalpinx (HS) prior to undergoing in vitro fertilization (IVF), and to observe pregnancy and delivery rates post-IVF. DESIGN: Prospective, off-label, multicenter, sequential, non-randomized, IDE and IRB approved observational study of Essure proximal tubal occlusion in women with HS and subsequent pregnancy rates following IVF using a fresh or frozen embryo (FET) cycle(s) at two fertility centers. MATERIALS AND METHODS: Twenty women identified with a unilateral or bilateral HS were offered an off-label hysteroscopic placement of Essure micro-insert(s) rather than incisional surgery for proximal tubal occlusion. All patients had follow-up HSG done 3 months post Essure placement, then IVF cycle(s). Patient ages averaged 34.1 years. Day #3 serum FSH levels averaged 6.6 mIU. Average antral count was 17. Nine women had paracervical block anesthesia, and 11 women had I.V. sedation for their placements. RESULTS: Unilateral micro-inserts were placed in 8 women with a unilateral HS, and 12 women had bilateral placement. All microinserts were intentionally placed with a reduced number of coils visible in the uterus (average of 2.6). Follow-up HSG procedures have been completed in all patients, with 19 women demonstrating proximal tubal occlusion and one patient with only one of two tubes occluded at HSG. Average number of embryos placed was 1.7. Eight women became pregnant following fresh IVF cycles, and 3 pregnancies resulted from FET cycles. Five women have not yet begun IVF. CONCLUSION: A total of 19 post-Essure IVF cycles were completed with 11 clinical pregnancies. Four women have already delivered and there are 7 ongoing pregnancies. There were 6 cycles with negative pregnancy tests. No serious adverse events occurred in any patient. Successful tubal occlusion rate was 96.9%, clinical pregnancy rate was 63.2%, and ongoing/delivered pregnancy rate is 58%.

Unintended pregnancy after long-term Essure microinserts placement

A case of uterine perforation by an Essure microinserts placed in proximity to the tubal ostia mimicking proper microinsert placement and bilateral tubal occlusion on imaging techniques is presented. The presence of Essure microinserts did not interfere with implantation and pregnancy, and in this case, no adjacent intraabdominal tissue damage was caused by the misplaced device, which was finally removed almost 3 years after insertion.

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

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.

Essure® Tubal Sterilization Combined with Subsequent NovaSure® Endometrial Ablation: A Retrospective Analysis

Study Objective: To evaluate the safety and outcome of combining the Essure® tubal sterilization system followed by NovaSure® Endometrial Ablation prior to the 3-month Essure Confirmation Test(CoT) .Design: Retrospective cohort study of women who underwent Essure hysteroscopic sterilization followed by NovaSure EA between July 1, 2008 and April 15, 2009. All participants had menorrhagia and desired permanent sterilization. Demographic information, anesthesia type, bilateral placement rate, ablation treatment time, intra-operative and post-procedure complications, Essure confirmation results, and follow-up data were collected and reviewed.Setting: Private gynecologic practice in Indiana.Patients: 59 patients (ages 25-50) were identified who underwent Essure hysteroscopic sterilization followed by NovaSure EA in two in-office sessions separated by an average of 25 days.Intervention: All patients underwent Essure micro-insert placement followed by Novasure EA and had/are scheduled to have a(CoT).Measurements and Main Results: 25/59 patients completed the 3-month CoT. 24/25 patients underwent successful 3-month CoTs. At the 3-month CoT, 22 patients were noted to have bilateral occlusion, 2 patients had unilateral occlusion, and one patient could not tolerate the test. 34 patients are still in the 3-month waiting period prior to CoT. No adverse events have been reported in this cohort. Patients will be followed for the next 12 months for contraceptive and EA effectiveness.Conclusion: To date, in this retrospective medical chart review, Essure hysteroscopic sterilization followed by NovaSure EA, in women who desire permanent birth control and reduction of menorrhagia, appears to be safe and effective. In addition, the present data supports that a majority of 3-month CoTs can be obtained and evaluated post-NovaSure EA. Study Objective: To evaluate the safety and outcome of combining the Essure® tubal sterilization system followed by NovaSure® Endometrial Ablation prior to the 3-month Essure Confirmation Test(CoT) . Design: Retrospective cohort study of women who underwent Essure hysteroscopic sterilization followed by NovaSure EA between July 1, 2008 and April 15, 2009. All participants had menorrhagia and desired permanent sterilization. Demographic information, anesthesia type, bilateral placement rate, ablation treatment time, intra-operative and post-procedure complications, Essure confirmation results, and follow-up data were collected and reviewed. Setting: Private gynecologic practice in Indiana. Patients: 59 patients (ages 25-50) were identified who underwent Essure hysteroscopic sterilization followed by NovaSure EA in two in-office sessions separated by an average of 25 days. Intervention: All patients underwent Essure micro-insert placement followed by Novasure EA and had/are scheduled to have a(CoT). Measurements and Main Results: 25/59 patients completed the 3-month CoT. 24/25 patients underwent successful 3-month CoTs. At the 3-month CoT, 22 patients were noted to have bilateral occlusion, 2 patients had unilateral occlusion, and one patient could not tolerate the test. 34 patients are still in the 3-month waiting period prior to CoT. No adverse events have been reported in this cohort. Patients will be followed for the next 12 months for contraceptive and EA effectiveness. Conclusion: To date, in this retrospective medical chart review, Essure hysteroscopic sterilization followed by NovaSure EA, in women who desire permanent birth control and reduction of menorrhagia, appears to be safe and effective. In addition, the present data supports that a majority of 3-month CoTs can be obtained and evaluated post-NovaSure EA.

Intérêt de l’échographie 3D vaginale pour le contrôle du positionnement des dispositifs Essure®

To determine the interest and simplicity of 3D ultrasound for the 3-month check in place of the recommended routine radiologic in a general gynecology practice. Twenty-five patients had routine radiologic and transvaginal 3D ultrasound (Voluson 730 Expert) 3 months after placement of Essure micro-insert. Twenty-one 3D acquisitions were realized. In all cases, the micro-insert are easily visualized. Ideally, the echogenic micro-insert appears in the cornuale portion of the fallopian tube. The relationship between the micro insert and the uterine cavity is well documented. Easy-to-use, good reproducibility, absence of radiation, make the 3D ultrasound an interesting alternative for the 3-month check. The coronal view gives a directly exploitable document for the surgeon.

Spontaneous intrauterine pregnancy after unilateral placement of tubal occlusive microinsert

To present a case in which the use of a titanium/nickel microinsert in the management of unilateral hydrosalpinx contributed to a spontaneous intrauterine pregnancy. Case report. University hospital. A 37-year-old nulligravid female with dense pelvic adhesive disease and unilateral hydrosalpinx. Unilateral proximal occlusion of left fallopian tube with titanium/nickel microinsert. Pregnancy. Spontaneous intrauterine pregnancy after confirmation via hysterosalpingogram of left tubal occlusion and right tubal patency. Transcervical proximal tubal occlusion using titanium/nickel microinserts provides an alternative in the management of hydrosalpinx in the setting of tubal factor infertility. Additionally, in the setting of a unilateral hydrosalpinx, unilateral occlusion can contribute to spontaneous intrauterine pregnancy.

Predictive factors of Essure implant placement failure: prospective, multicenter study of 495 patients

To assess a new hysteroscopic method of tubal sterilization; specifically, to examine the factors associated with placement failure of Essure implants. Observational, multicenter, 6-month study. Seven gynecology clinics, including five public hospitals and two private clinics, in France. A total of 495 women who provided informed consent. All procedures were done by a vaginoscopic approach with a 5-mm operating hysteroscope. Data collected were age, parity, type of anesthesia, premedication, endometrial aspect, ostia visualization, duration of the procedure, pain during the procedure, and associated procedures. Unilateral and bilateral placement rates were assessed. Adverse events at 3 months (expulsion, migration, perforation) were also recorded. Mean parity was 2.45; 20 women were nulliparous. In 56.3% of cases (n = 277), none or local anesthesia was used for the placement procedure. Overall, 86% of the women (n = 423) had nonsteroidal anti-inflammatory drug (NSAID) premedication, and 8.1% (n = 40) had another intrauterine surgical procedure performed at the same time. In 24 cases, at least one of the tubal ostia could not be visualized well during hysteroscopy. The failure rate for Essure micro-insert placement was 6% at first attempt and 3.3% after two attempts. Success rate was not significantly associated with parity, mode of analgesia, NSAID premedication, or combination with another procedure. The only factor significantly associated with the failure rate was poor visualization of the tubal ostia.

Prospective Analysis of Pain Tolerance during Radiofrequency Endometrial Ablation Using Local Anesthesia and Mild Sedation in the Premenopausal Patient

Study Objective: To evaluate the safety and feasibility of endometrial ablation (EA) using NovaSure Endometrial Ablation System performed immediately after placement of Essure micro-inserts. Design: A retrospective chart analysis of 10 cases of hysteroscopic placement of Essure followed by the NovaSure EA. Demographic information, type of anesthesia, bilateral placement rate, ablation treatment time, intra-operative and post-procedure complications, and follow up information were collected and reviewed. Setting: A private gynecologic practice in the Southern United States. Patients: 10 women between the ages of 28e52 were identified for this study. Each had undergone Essure tubal sterilization followed by NovaSure EA in the same surgical session under IV sedation. All participants had benign uterine bleeding and desired permanent contraception. Intervention: Patients underwent bilateral Essure placement followed by NovaSure EA and were monitored with at least one post operative visit. Measurements and Main Results: Bilateral micro-insert placement was achieved in all of the patients. There were no complications at the time of or immediately following the combined procedures. Trailing coil lengths ranged between 3 and 5 coils. Ablation treatment time ranged from 47 seconds to 120 seconds. 100% of the patients have been relying on the Essure micro-inserts for contraception for 18e22 months with no reported pregnancies. Patients were instructed to use an alternative form of contraception for 6 months after the combined procedures. Micro-insert placement was confirmed by ultrasound at 3 months. All patients have been followed from 15 to 22 months post-procedure. Review of followeup visits include one patient that underwent TAH/ BSO one year post-ablation secondary to persistent bleeding and a large fibroid. Conclusion: This retrospective analysis demonstrates that performing NovaSure EA immediately following Essure micro-insert placement appears to be feasible, safe and effective. The optimal point in time for Essure micro-insert placement is prior to EA to ensure adequate visualization of the tubal ostia and successful bilateral micro-insert placement.

Essure® Transcervical Sterilization Combined with NovaSure ® Endometrial Ablation: A Perihysterectomy Safety Study

Study Objective: To evaluate the safety of Essure micro-insert placement followed by NovaSure endometrial ablation (NEA). This perihysterectomy study evaluated: 1) uterine and fallopian tube serosal temperatures during NEA with the micro-inserts and 2) degree, if any, of thermal fallopian tube injury associated with the micro-inserts.

Tubal perforation by Essure: three different clinical presentations

To assess the convenience and safety of Essure sterilization in an outpatient setting and the use of ultrasound as diagnostic tool for verification of proper placement for the 3-month follow-up. Prospective cohort study. Teaching hospital department of obstetrics and gynecology. Female patients with a request for permanent tubal sterilization. Essure sterilization. Bilateral tubal occlusion after Essure sterilization and complication rate. A total of 149 patients were scheduled for Essure sterilization. Microinsert placement was attempted in 143 patients. Bilateral placement of the device was successful in 95% (95% confidence interval [CI] 92%-99%). Seven attempts were unsuccessful. The complication rate was 2% (n = 3), and all involved a perforation. These three cases are discussed in detail. Vaginal ultrasound was conclusive in 91.7% (95% CI 87%-96%); two perforations were not recognized on the ultrasound. Essure sterilization is a safe and reliable sterilization method in an outpatient setting. Perforation of the device is the most frequent complication. Vaginal ultrasound is reliable for verification after an uncomplicated procedure. When the procedure is difficult (e.g., higher resistance, more pain then average, more time or more than two devices needed), a hysterosalpingogram should be performed.

Hysteroscopic tubal sterilization with Essure intratubal devices: A case-control prospective with inert local anesthesia or without anesthesia

Objective The contraceptive efficacy of hysteroscopic sterilization is well documented. The objective of this study was to compare procedure success, patient tolerance, and procedure time of Essure micro-insert hysteroscopic sterilization with or without anesthesia. Study design Between February 2002 and May 2005, one operator performed 140 sterilization procedures in this prospective study: the first 70 were performed using local anesthesia and the following 70 began without administration of anesthesia. Analysis was based on intention-to-treat. Results The groups were comparable in their demographic characteristics. Successful bilateral micro-insert placement in the first 70 cases, utilizing paracervical block, was 82.8% and did not differ significantly from the next 70 cases, without anesthesia (91.4%). A similar number of patients in each group received additional anesthesia. Report of procedure pain did not differ significantly between the groups: 87.1% reported moderate or less pain with the paracervical block, compared with 91.4% in the group without anesthesia. Duration of surgery was significantly shorter without anesthesia: 11.2 ± 6.3 min vs. 25.0 ± 8.0 min ( p < 0.001). Conclusions Administration of anesthesia does not appear to affect the procedure completion success rate or patient tolerance of this hysteroscopic sterilization procedure.

Utilization of the Essure ® micro-insert for the treatment of hydrosalpinx prior to in vitro fertilization

ObjectiveTo evaluate the success rate of proximal tubal occlusion with placement of Essure® micro-inserts in women with hydrosalpinx (HS) prior to undergoing in vitro fertilization (IVF), and to observe pregnancy rates post-IVF.DesignProspective, non-randomized, off-label, observational study of micro-insert tubal occlusion in women with HS and subsequent pregnancy rates following IVF using fresh or frozen embryos.Materials and methodsPlacement of Essure micro-inserts followed by a hysterosalpingogram (HSG) 3 months post-procedure, and IVF in 7 women ages 32–44 presenting with infertility and unilateral or bilateral HS as determined by laparoscopy or HSG.ResultsBilateral micro-insert placement was performed in 5 women, unilateral in 1 woman (with a unilateral HS), and 1 unsuccessful placement attempt. The devices were intentionally placed with an average of 2–3 trailing coils visible post-procedure. Follow-up HSG has been completed in 4 patients, with all demonstrating tubal occlusion. One woman elected to not have an HSG, and 1 patient is awaiting her HSG. IVF treatment was initiated in all patients an average of 3.5 months post-confirmation of tubal occlusion. Three women became pregnant on their first IVF cycle with term deliveries, one is currently 3 months pregnant from a frozen embryo cycle, one did not achieve pregnancy and one is awaiting her follow-up HSG prior to beginning IVF. There have been no complications from Essure placement or from the devices remaining in place during pregnancy.ConclusionsPreliminary results demonstrate an excellent pregnancy rate with IVF following Essure micro-insert placement for HS. ObjectiveTo evaluate the success rate of proximal tubal occlusion with placement of Essure® micro-inserts in women with hydrosalpinx (HS) prior to undergoing in vitro fertilization (IVF), and to observe pregnancy rates post-IVF. To evaluate the success rate of proximal tubal occlusion with placement of Essure® micro-inserts in women with hydrosalpinx (HS) prior to undergoing in vitro fertilization (IVF), and to observe pregnancy rates post-IVF. DesignProspective, non-randomized, off-label, observational study of micro-insert tubal occlusion in women with HS and subsequent pregnancy rates following IVF using fresh or frozen embryos. Prospective, non-randomized, off-label, observational study of micro-insert tubal occlusion in women with HS and subsequent pregnancy rates following IVF using fresh or frozen embryos. Materials and methodsPlacement of Essure micro-inserts followed by a hysterosalpingogram (HSG) 3 months post-procedure, and IVF in 7 women ages 32–44 presenting with infertility and unilateral or bilateral HS as determined by laparoscopy or HSG. Placement of Essure micro-inserts followed by a hysterosalpingogram (HSG) 3 months post-procedure, and IVF in 7 women ages 32–44 presenting with infertility and unilateral or bilateral HS as determined by laparoscopy or HSG. ResultsBilateral micro-insert placement was performed in 5 women, unilateral in 1 woman (with a unilateral HS), and 1 unsuccessful placement attempt. The devices were intentionally placed with an average of 2–3 trailing coils visible post-procedure. Follow-up HSG has been completed in 4 patients, with all demonstrating tubal occlusion. One woman elected to not have an HSG, and 1 patient is awaiting her HSG. IVF treatment was initiated in all patients an average of 3.5 months post-confirmation of tubal occlusion. Three women became pregnant on their first IVF cycle with term deliveries, one is currently 3 months pregnant from a frozen embryo cycle, one did not achieve pregnancy and one is awaiting her follow-up HSG prior to beginning IVF. There have been no complications from Essure placement or from the devices remaining in place during pregnancy. Bilateral micro-insert placement was performed in 5 women, unilateral in 1 woman (with a unilateral HS), and 1 unsuccessful placement attempt. The devices were intentionally placed with an average of 2–3 trailing coils visible post-procedure. Follow-up HSG has been completed in 4 patients, with all demonstrating tubal occlusion. One woman elected to not have an HSG, and 1 patient is awaiting her HSG. IVF treatment was initiated in all patients an average of 3.5 months post-confirmation of tubal occlusion. Three women became pregnant on their first IVF cycle with term deliveries, one is currently 3 months pregnant from a frozen embryo cycle, one did not achieve pregnancy and one is awaiting her follow-up HSG prior to beginning IVF. There have been no complications from Essure placement or from the devices remaining in place during pregnancy. ConclusionsPreliminary results demonstrate an excellent pregnancy rate with IVF following Essure micro-insert placement for HS. Preliminary results demonstrate an excellent pregnancy rate with IVF following Essure micro-insert placement for HS.

Pregnancy Outcome After Transcervical Hysteroscopic Sterilization

Hysteroscopic, transcervical sterilization involves placement of microinserts in tubal ostia. As with any contraceptive method, pregnancy can occur. This case reports the outcome when pregnancy occurred after microinsert placement. A multiparous woman presented at 16 weeks of gestation. Hysteroscopic sterilization was performed 2 years earlier, although a postprocedure hysterosalpingogram was not done to verify tubal occlusion. The patient had a normal-term pregnancy. Postpregnancy hysterosalpingogram revealed both microinserts were embedded in the uterine fundus and myometrium. This case demonstrates how pregnancy can occur after hysteroscopic microinsert placement and details how it might be avoided.

Pregnancy after Essure ® placement: report of two cases

To report two cases of pregnancy after placement of Essure micro-inserts. Case report. University-based Department of Obstetrics and Gynecology. Patient 1, a 38-year-old woman, presented with a positive pregnancy test 7 months after Essure hysteroscopic sterilization. Patient 2, a 35-year-old female, became pregnant approximately 1 year after undergoing the Essure procedure. Patient 1 received obstetric ultrasounds, a prophylactic cerclage, a cesarean section, and a tubal ligation. Patient 2 underwent a postprocedure hysterosalpingogram, an obstetric ultrasound, pregnancy termination, diagnostic pelvic ultrasound, and a hysterectomy. Documentation of normal progress of pregnancy after Essure placement. Patient 1 carried an uncomplicated pregnancy to term with an Essure micro-insert in place. Patient 2 became pregnant despite an hysterosalpingogram showing tubal occlusion and was ultimately found to have a micro-insert perforating the uterine wall. The presence of Essure micro-inserts in the fallopian tubes do not appear to interfere with implantation and pregnancy. Uterine perforation by an Essure micro-insert in proximity to the tubal ostia may mimic proper micro-insert placement and bilateral tubal occlusion on both hysterosalpingogram and saline infusion sonography.

Essure treatment of hydrosalpinges

To describe the use of Essure microinsert placement in patients with hydrosalpinges before IVF. Retrospective case-series. An advanced endoscopic practice within a university-affiliated teaching hospital. Five women with unilateral or bilateral hydrosalpinges on transvaginal ultrasound, laparoscopy, or hysterosalpingogram who were planning further fertility therapy. In all patients, laparoscopy was felt to be relatively contraindicated because of previous extensive abdominopelvic surgery. Hysteroscopic placement of the Essure microinsert in four patients under general anesthesia. One patient underwent fluoroscopically guided placement. Placement rates and postoperative recovery, technical challenges in Essure placement, and results of subsequent treatment with IVF when available. Successful bilateral Essure placement was confirmed in two of five patients. Unilateral placement was achieved in two of five. There were no postoperative complications. No pregnancies have occurred thus far. Hysteroscopic placement of the Essure microinsert is a minimally invasive option for proximal tubal occlusion. In patients requiring occlusion of hydrosalpinges before IVF and with contraindications to abdominal surgery, this technique may offer a safer alternative. Preoperative documentation of proximal tubal patency helps predict placement success. Further research into this unique clinical scenario is required.

Contrast infusion sonography to assess microinsert placement and tubal occlusion after Essure®

To develop a technique for contrast infusion sonography and assess the possible use in determining microinsert placement and tubal status after Essure sterilization. Techniques and instrumentation. Healthy women in an academic multispecialty group. Ten women desiring permanent sterilization who have recently undergone Essure hysteroscopic sterilization. Contrast infusion sonography, an adaptation of hysterosalpingo contrast sonography, performed at 3-23 weeks after Essure placement. To determine how readily tubal status and microinsert location could be assessed with this adaptation of hysterosalpingo contrast sonography. All microinserts were readily identified and tubal status was assessed by identification or absence of real-time contrast agent flow. This technique is very promising and could represent a convenient alternative to hysterosalpingogram (HSG) 3 months after Essure placement.

Stérilisation tubaire par voie hystéroscopique : faisabilité et évaluation à un an

Hysteroscopic flexible micro-insert (Essure) is an ambulatory improvement of fallopian tube sterilization, which is a deliberated suppression of fertility. The aim of this study was an evaluation of feasibility (learning curve) and the first year outcome of this method. This prospective study, carried out between February 2002 and March 2003, included patients who were matching with manufacturer recommendations. One surgeon only realized all the device placements. Fifty patients were included (one year follow-up). Mean age was 41 (+/-3.3), mean parity was 2.7 (+/-0.8). Mean time needed for device placement was 26 minutes (+/-6.5) and was reduced with increased experience. Six failures of placement (12%) were related, because of submucus leiomyomas, proximal tubal stenotic disease or too retroverted uterus. Only 5 patients (11,4%) described intensive pelvic pain during the placement. The only case of device expulsion benefited from a successful second placement. The one-year follow-up showed no significant difference of body weight increasing, duration or quantity of menstruation, neither significant pelvic pain nor vaginal bleeding. Tolerance was rated at least at "somewhat satisfied". There have been no pregnancies reported in 670 woman-months of effectiveness. Our results agree in any point with those of larger studies. We think that hysteroscopy micro-insert placement is not only reserved to specialized centers but also to any gynecologist who is used to performing hysteroscopy because of its feasibility.