• The Essure is a permanent birth control (female sterilization) by, an occlusion of the fallopian tubes with the use of trans- cervical bilateral insertion of blocking coils directly into the lumen of the tubes.
• The device itself is made from dual coils that expand into the tubal lumen when deployed. Its fibers stimulate occlusive tissue growth over a 3 month period.• Successful placement and tubal occlusion is confirmed by hysterosalpingography.
• The Essure microinsert is a hysteroscopically placed permanent contraceptive device made of an inner flexible metallic coil surrounded by an outer metallic coil. The ends of each coil have radiopaque markers.• Approved by FDA in 2002
ADVANTAGES• No incision• No hormones• No anaesthesia• outpatient• Effective The one-year and two-year failure rates established in the Essure clinical trials were both 0%.• Rapid recovery• High patient satisfaction
• Women were discharged 45 minutes after the procedure. Working women can resumed work in 24 hours or less after procedure.• This trans-cervical approach is much safer for women who would otherwise have a relative contraindication for laparoscopy like prior abdominal/pelvic surgery with adhesions or obesity.
Contraindications• Unsure about desire to end fertility,• Pregnancy or suspected pregnancy.• Delivery or termination of a pregnancy (< 6 weeks before placement).• Active or recent upper or lower pelvic infection or abnormal pap smear that has not been evaluated.• Known allergy to contrast media, or known hypersensitivity to nickel• Although not a contraindication, placement of Essure in immunosuppressive therapy is discouraged, because it is expected to negatively affect the tissue response to Essure
Patient Scheduling:• Procedure should be performed during the early proliferate phase of the menstrual cycle to: – Decrease potential for insertion during an undiagnosed (luteal phase) pregnancy. – Enhance visualization of the fallopian tube ostia.• In women with menstrual cycles shorter than 28 days, the day of ovulation must be carefully calculated to reduce the potential of a luteal phase pregnancy. Micro insert placement should NOT be performed during menstruation .
Patient Education:• Tthis product is intended only to prevent pregnancy. It does not protect against either HIV infection or other sexually transmitted diseases.• It is irreversible. Removal of the micro-inserts requires surgery.• Itshould not be considered 100% effective.• Successful placement of both micro-inserts will not be possible in all women.• Patients must use another method of birth control for at least 3 months after the procedure.• An HSG to be conducted 3 months post-op to evaluate micro- insert location and tubal occlusion.• Pain, bleeding
complications• Complications include device expulsion, tubal perforation, and pregnancy.• Unlike laparoscopic sterilization, it is not immediately effective
Complications of Essure(®) sterilisation: report on 4306 procedures performed in a single centre.• 2.7% complications• Non needed admission• 2% vasovagal syncope• 19 cases of expulsion “all discovered before 3 months”• BJOG. 2012; 119(7):795-9
Radiographic, Sonographic, and MRI Appearance of the Essure Deviceo As this device became more widely used, radiologists should be aware of the devices appearance and be able to assess device position
USS• On ultrasound, the outer coil shows up as two parallel interrupted echogenic lines that protrude into the endometrial cavity. The central coil may or may not be seen.
• The Essure system appears to be safe, permanent, irreversible, and a less invasive method of contraception compared with laparoscopic sterilization.Fertil Steril. 2010; 94(1):16-9NEW CONCEPTS
Essure treatment for hydrosalpinx before IVF• Essure microinserts is an effective method of nonincisional proximal tubal occlusion of hydrosalpinx.• Success rates achieved through subsequent IVF are typical of outcomes of good-prognosis in similarly aged patients without hydrosalpinx• J Minim Invasive Gynecol. 2011; 18(3):338-42
The role of Essure sterilization performed simultaneously with endometrial ablation.• Curr Opin Obstet Gynecol. 2008; 20(4):359-63
CONCLUSION• Women can be safely sterilized in 10 minutes by an easy effective outpatient procedure• It is coast effective & carries high degree of patient satisfaction