OBJECTIVE: To describe the use of Essure microinsert placement in patients with hydrosalpinges before IVF. DESIGN: Retrospective case-series. SETTING: An advanced endoscopic practice within a university-affiliated teaching hospital. PATIENT(S): Five women with unilateral or bilateral hydrosalpinges on transvaginal ultrasound, laparoscopy, or hysterosalpingogram who were planning further fertility therapy. In all patients, laparoscopy was felt to be relatively contraindicated because of previous extensive abdominopelvic surgery. INTERVENTION(S): Hysteroscopic placement of the Essure microinsert in four patients under general anesthesia. One patient underwent fluoroscopically guided placement. MAIN OUTCOME MEASURE(S): Placement rates and postoperative recovery, technical challenges in Essure placement, and results of subsequent treatment with IVF when available. RESULT(S): Successful bilateral Essure placement was confirmed in two of five patients. Unilateral placement was achieved in two of five. There were no postoperative complications. No pregnancies have occurred thus far. CONCLUSION(S): Hysteroscopic placement of the Essure microinsert is a minimally invasive option for proximal tubal occlusion. In patients requiring occlusion of hydrosalpinges before IVF and with contraindications to abdominal surgery, this technique may offer a safer alternative. Preoperative documentation of proximal tubal patency helps predict placement success. Further research into this unique clinical scenario is required.
OBJECTIVE: To describe the use of Essure microinsert placement in patients with hydrosalpinges before IVF. DESIGN: Retrospective case-series. SETTING: An advanced endoscopic practice within a university-affiliated teaching hospital. PATIENT(S): Five women with unilateral or bilateral hydrosalpinges on transvaginal ultrasound, laparoscopy, or hysterosalpingogram who were planning further fertility therapy. In all patients, laparoscopy was felt to be relatively contraindicated because of previous extensive abdominopelvic surgery. INTERVENTION(S): Hysteroscopic placement of the Essure microinsert in four patients under general anesthesia. One patient underwent fluoroscopically guided placement. MAIN OUTCOME MEASURE(S): Placement rates and postoperative recovery, technical challenges in Essure placement, and results of subsequent treatment with IVF when available. RESULT(S): Successful bilateral Essure placement was confirmed in two of five patients. Unilateral placement was achieved in two of five. There were no postoperative complications. No pregnancies have occurred thus far. CONCLUSION(S): Hysteroscopic placement of the Essure microinsert is a minimally invasive option for proximal tubal occlusion. In patients requiring occlusion of hydrosalpinges before IVF and with contraindications to abdominal surgery, this technique may offer a safer alternative. Preoperative documentation of proximal tubal patency helps predict placement success. Further research into this unique clinical scenario is required.
Authors: Kenan Omurtag; Natalia M Grindler; Kimberly A Roehl; Gordon Wright Bates; Angeline N Beltsos; Randall R Odem; Emily S Jungheim Journal: Fertil Steril Date: 2012-03-09 Impact factor: 7.329