Hysteroscopy and contraception

• The Essure sterilisation method has a high placement rate and effectiveness.
• A confirmation test 3 months after the procedure is indicated.
• Pregnancies after Essure sterilisation are related to non-compliance of the follow-up protocol and incorrect placements of micro-inserts.
• Essure can be used for pre-in vitro fertilisation (IVF) closure of hydrosalpinges.
• Global endometrium ablation techniques can be used in patients with micro-inserts in situ.

The Essure method is the only available hysteroscopic sterilisation method. A 4-cm device is placed in the fallopian tubes, which then induces an inflammatory reaction that causes occlusion. The method has a high successful placement rate and high effectiveness, and it can be performed in an office setting without anaesthesia. Three months after the procedure, a confirmation test has to be conducted to assure a correct position of the micro-inserts and tubal occlusion. This test can be performed by hysterosalpingography (HSG), plain X-ray or ultrasound. Pregnancies reported after Essure sterilisation are, in a majority, related to non-adherence to the follow-up protocol or misreading of the confirmation test. A majority of the pregnancies occurred after HSGs that were determined to have been misinterpreted, including missed expulsion or perforation of the micro-insert. Other complications such as ectopic pregnancy and allergic reaction to the micro-inserts seem to have been described to be of low incidence.