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Hysteroscopic Sterilisation ESSURE TM

Hysteroscopic Sterilisation ESSURE TM. Sarah Wallage Gynae / SRH Consultant Aberdeen 2013. What is Essure ?. Vaginoscopy, 20 mins on table. Permanent IVF for subsequent pregnancy No effect on periods can have subsequent endometrial ablation

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Hysteroscopic Sterilisation ESSURE TM

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  1. Hysteroscopic Sterilisation ESSURE TM Sarah Wallage Gynae / SRH Consultant Aberdeen 2013

  2. What is Essure ?

  3. Vaginoscopy, 20 mins on table

  4. Permanent IVF for subsequent pregnancy • No effect on periods can have subsequent endometrial ablation • Hysteroscopy not laparoscopy • Not require GA • Takes 3 months to work • Confirmation test X ray / USS 15% need hysterosalpingogram ( HSG)

  5. Who can have EssureTM • Not suitable after previous tubal surgery previous endometrial ablation nickel allergy ??? immunesuppressed 6/12 + HSG • Can offer if not suitable for lap sterilisation eg BMI >30 previous midline scar/ abdominoplasty not fit for GA

  6. Essure TM • 86-96% bilateral placement – endometrium/ tubal spasm distortion • <2 % perforation/ migration - need removal • <2% expulsion • 1:1000 pregnancy rate after OK confirmation test ( 5yr data) • Outpatient procedure if LA • Back to normal within a day • Must use contraception until confirmation test

  7. Aberdeen experience • Funding- £200 + HSG > lap steri hosp cost • No unplanned overnight stay • Clinic / Theatre ?? hysteroscope + kit 2 nurses 1 operator recovery – similar to IUD • Cycle stage- need thin endometrium provera prep

  8. Information- staff training / clerking proforma • Preclinic pt info / GP awareness • Demand? No increase in steri referrals 2012 • Success - only 37/48 placed- ostia not clear/ tubal block • Follow up - USS X ray often difficult to interpret almost all need HSG logistics/ staff / acceptability

  9. Summary • Another option if reversible methods are unacceptable • Similar to vasectomy – no GA, recovery time and delay till effective • Suitable for many women ineligible for lap steri • Possible in specialised clinic setting • Significant Failure rate for placing devices • Confirmation test – most need HSG

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