ESSURE;Female sterilization

in10 minutes outpatient procedure

BAKHSH HOSPITAL

• MEDICINE IS AN EVER CHANGING SUBJECT

• WE HAVE TO…….

Trends in female sterilization

• 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.

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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 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

• 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. 

USS

• 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

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

THANK YOU