Objective: The aim of this research was to evaluate the experiences and outcomes of patients undergoing attempted Essure© sterilization, including successful and unsuccessful procedures, pregnancy, and need for additional procedures. Design: This was a retrospective longitudinal cohort study. Materials and Methods: Records of all patients who underwent attempted Essure sterilization from 2006 to 2014 by a single physician were reviewed for placement outcomes; follow-up imaging results; reliance rates; and long-term outcomes, including perforations, expulsions, and hysterectomy rates. Results: Records for 1024 patients intending to undergo Essure were identified. Of these, 1013 patients underwent attempted bilateral placement, with 1004 (99.1%) of these placements being successful. The intent-to-treat reliance rate was 94.4%, with 967 patients relying, with 1732 women-years of follow-up with an average of 1.7 years. Also, 778 (77.5%) patients had postprocedure hysterosalpingograms (HSGs), while an additional 170 (16.9%) had transvaginal ultrasound (TVUS) testing to confirm proper positioning and locations. Of these, 723 (92.9%) HSG-evaluated patients had satisfactory location and bilateral occlusion, and relied on their devices. Other findings were 9 (1.2%) perforations, 6 (0.8%) expulsions, 0 reports of allergic reactions or autoimmune symptoms, and 71 (6.9%) hysterectomies, while 46 (4.5%) were lost to follow-up and 11 (1.1%) were not relying. Zero pregnancies resulting from device failure were reported. Two luteal-phase pregnancies were diagnosed. One (0.1%) patient requested and underwent device removal because of pain. Conclusions: Within this cohort, there was a high rate of successful bilateral placement and reliance, while rates of pregnancy and malplaced devices were low. Long-term review revealed that only 1 patient requested Essure removal because of device-related pain. (J GYNECOL SURG 32:173)