Unintended pregnancies after Essure sterilization in the Netherlands

ObjectiveTo analyze the data of cases of unintended pregnancies after Essure sterilization.DesignRetrospective case series analysis.SettingNational multicenter.Patient(s)Ten cases of unintended pregnancies after Essure sterilization in the Netherlands were reported from August 2002 through May 2008.Intervention(s)Data on the hysteroscopic Essure sterilization procedures and postprocedure confirmation tests of the reported cases were reviewed and analyzed by two authors. The causes of the unintended pregnancies were determined in agreement with the physicians who performed the sterilizations.Main Outcome Measure(s)Most pregnancies occurred in patients with only one device placement and bilateral occlusion on hysterosalpingography (HSG). Other cases included misinterpretation of HSG, undetected abnormal device position by ultrasound, one undetected preprocedure pregnancy, and two patient failures to follow up with the physician advice.Conclusion(s)The risk of pregnancy after hysteroscopic sterilization may be reduced by strictly following the follow-up protocol, performing a urinary pregnancy test on the day of the procedure, and instructing the patient to return for the follow-up visit. A procedure with only a single device placement in a patient without a history of tubectomy of the heterolateral tube should be considered unsuccessful.