Elizabeth Lazarus MD, Presenter: Nothing to Disclose

Susan Casper, Abstract Co-Author: Nothing to Disclose

Ana P. Lourenco MD, Abstract Co-Author: Nothing to Disclose

Rebecca Allen MD, Abstract Co-Author: Nothing to Disclose

To determine the success rate of appropriate placement and satisfactory tubal occlusion post Essure micro-insert placement evaluated by hysterosalpingraphy (HSG) in a general population.

IRB approval was obtained. We retrospectively evaluated electronic medical records of a women's hospital in an academic medical center to identify all patients presenting for HSG post Essure micro-insert placement for desired sterility between 1/1/08 and 3/1/10. We recorded patient demographic information and the HSG results. The images of all abnormal cases were reviewed. The HSG results were reviewed to assess for appropriate placement of the micro-insert, for the presence of successful occlusion as determined by the manufacturer, and for any additional abnormalities found on HSG.

190 HSG examinations were performed in 187 patients with a mean age 36 years (range 20 to 50). Thirteen examinations (7%) demonstrated either inappropriate device placement or lack of satisfactory tubal occlusion. Ten examinations (5%) demonstrated either unilateral or bilateral unsatisfactory tubal occlusion. Of these 10 cases, 4 (40%) were due to inappropriate placement of the micro-insert. The remaining 6 (60%) demonstrated appropriate placement. Three (2%) additional examinations demonstrated inappropriate placement of the micro-insert. Bilateral tubal occlusion was documented in all 3, which may be false positive due to tubal spasm. One examination (0.5%) was inconclusive due to inability to distend the endometrial cavity. Of the 10 patients without bilateral tubal occlusion, 3 underwent repeat examinations and average of 4.7 months later. Two of these patients underwent a second placement procedure. All demonstrated satisfactory occlusion on repeat examination. Incidental endometrial abnormalities were found on 44 examinations (23%). These included 28 filling defects, 10 diffuse irregularity, 3 cavity enlargement, 1 IUD, 1 non-distensible, and 1 muellerian abnormality.  

HSG following Essure micro-insert placement is necessary as up to 7% of examinations demonstrated abnormalities requiring an alternative form of contraception.

Hysterosalpingography is essential post Essure as 5% will not demonstrate satisfactory tubal occlusion, despite appropriate placement of the micro-inserts in 60% of these.

Lazarus, E, Casper, S, Lourenco, A, Allen, R, Hysterosalpingography for Determination of Appropriate Placement and Tubal Occlusion Post Microinsert Placement for Contraception.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9008948.html