The Essure procedure is a new permanent birth control method for women that can be performed as an outpatient procedure in 10 minutes. It involves inserting flexible microinserts through the cervix and into the fallopian tubes, which cause a natural inflammatory reaction to permanently close off the tubes within 3 months. It provides effective sterilization without surgery or hormones and allows for rapid recovery. Potential risks include expulsion of the devices, perforation of the tubes, and failure rates are very low. The Essure coils can be seen on imaging such as ultrasound and X-rays to confirm proper placement.

1. ESSURE;
Female sterilization
in
10 minutes outpatient
procedure
BAKHSH HOSPITAL

2. • MEDICINE IS AN EVER
CHANGING SUBJECT
• WE HAVE TO…….

3. Trends in female sterilization

8. • 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.

9. • 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.

18. • 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

22. 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

23. •
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.

24. 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

25. 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 .

26. 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

27. complications
• Complications include device expulsion,
tubal perforation, and pregnancy.
• Unlike laparoscopic sterilization, it is not
immediately effective

28. 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

29. Radiographic, Sonographic, and MRI
Appearance of the Essure Device
o As this device became more widely
used, radiologists should be aware of
the device's appearance and be able to
assess device position

34. 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.

36. • 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):16-9
NEW CONCEPTS

37. 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

38. The role of Essure sterilization performed
simultaneously with endometrial ablation.
• Curr Opin Obstet Gynecol. 2008; 20(4):359-63

39. 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

40. THANK YOU