Hysteroscopic sterilization

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Hysteroscopic sterilization is a technique offering permanent contraception. It was developed using the Essure® device[1] Hysteroscopic sterilisation using the Essure® device was approved in the US in 2002 and by NICE in the UK for NHS use in 2009. Initial studies suggested a 6 month failure rate of 3.3%[2]. Compared with laparoscopic sterilization it has a higher failure rate and longer term complication rate needing operation to correct but offers the advantages of a day office procedure[3][4]. From 2015 this caused some controversy and reports started to emerge of fluid accumulation in the uterine cavity and other rare complications associated with the Essure® device[5] [6]. In August 2017 the Essure® device was subjected to a one month moratorium in supply in Europe pending possible further regulatory action perhaps because a longer term monitoring of complication rates mandated by the FDA was due to have first results in September. It had already been withdrawn in Finland, Brazil and Canada[7]
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References

  1. Kerin JF, Carignan CS, Cher D. The safety and effectiveness of a new hysteroscopic method for permanent birth control: results of the first Essure pbc clinical study. The Australian & New Zealand journal of obstetrics & gynaecology. 2001 Nov; 41(4):364-370.(Print) (Link to article – subscription may be required.)
  2. Panel P, Grosdemouge I. Predictive factors of Essure implant placement failure: prospective, multicenter study of 495 patients. Fertility and sterility. 2010 Jan; 93(1):29-34.(Print-Electronic) (Link to article – subscription may be required.)
  3. Antoun L, Smith P, Gupta JK, Clark TJ. The feasibility, safety, and effectiveness of hysteroscopic sterilization compared with laparoscopic sterilization. American journal of obstetrics and gynecology. 2017 Jul.(Print-Electronic) (Link to article – subscription may be required.)
  4. Mao J, Pfeifer S, Schlegel P, Sedrakyan A. Safety and efficacy of hysteroscopic sterilization compared with laparoscopic sterilization: an observational cohort study. BMJ (Clinical research ed.). 2015 Oct; 351:h5162.(Electronic) (Link to article – subscription may be required.)
  5. Sills ES, Walsh DJ, Jones CA, Wood SH. Endometrial fluid associated with Essure implants placed before in vitro fertilization: Considerations for patient counseling and surgical management. Clinical and experimental reproductive medicine. 2015 Sep; 42(3):126-129.(Print-Electronic) (Link to article – subscription may be required.)
  6. Sills ES, Palermo GD. Surgical excision of Essure® devices with ESHRE Class IIb uterine malformation: sequential hysteroscopic-laparoscopic approach to the septate uterus. Facts, views & vision in ObGyn. 2016 Mar; 8(1):49-52.(Print)
  7. Essure, the alternative to tubal ligation for UK women, to be discontinued in September 2017 Leigh Day Solicitors accessed 29 August 2017

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