Tissue Encapsulation of the Proximal Essure Micro-insert from the Uterinecavity Following Hysteroscopic Sterilization

Literature Review Article

Tissue Encapsulation of the Proximal Essure® Micro-insert from the Uterinecavity Following Hysteroscopic Sterilization. Kerin JF, Munday D, Ritossa M, Rosen D. J Min Invas Gynecol 2007;14:202-4  

Review
Jeffrey M. Goldberg, M.D., Cleveland, OH

In this retrospective observational study from three Australian centers, 22 women underwent hysteroscopic sterilization with the Essure® device with second-look diagnostic hysteroscopy 3 to 43 months later (mean 19.7 months). The length of the trailing coils within the cavity decreased from 5 to 1 mm. Only 1 of 6 patients evaluated within the first year had complete tissue encapsulation compared with 4 of 16 patients between 13 and 43 months. There was no evidence of endometrial inflammation. Two women who subsequently attempted IVF both conceived. They had almost complete tissue encapsulation on second-look hysteroscopy. In essentially a duplicate paper on these two patients published in Fertility Sterility 2007;87:1212.e1-4, it was noted that the second-look was performed at 28 and 41 months. 
 

Comments 
Steven R. Lindheim, M.D., San Diego, CA
Meike L. Uhler, M.D., Fertility Center of Illinois

Since hysteroscopic sterilization with Essure® is irreversible, IVF is the only option for subsequent fertility. There is a concern that the intrauterine portion of the device may act as an IUD to prevent embryo implantation. This small retrospective case series noted that while only a small segment remains in the uterine cavity, complete tissue encapsulation only occurs in a small minority of patients. The two patients who conceived with IVF had second-look hysteroscopy more than two years after Essure® placement and both had complete encapsulation. These papers provide no reassurance that IVF pregnancy rates are not compromised in the majority of women who do not have complete tissue encapsulation of the device. 

 

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

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