Original articleContrast Infusion Sonography in the Post-Essure Setting
Section snippets
Materials and Methods
Seventeen healthy women desiring permanent sterilization were included in the study from January 2006 through December 2006. Both informed consent and institutional review board approval were obtained. All patients were multiparous, aged 31 to 45 years, and between 1 and 12 weeks post-bilateral Essure microinsert placement. All patients agreed to undergo evaluation within 4 weeks after Essure placement in order to demonstrate patency: 14 presented within 4 weeks, and 3 presented between 8 and 9
Results
A total of 19 paired studies were performed on 17 patients, with 38 fallopian tubes assessed. All microinserts were in satisfactory location on office ultrasound, a finding that was confirmed in all cases on HSG. Localizing the microinserts was more difficult in several patients with an acutely retroverted uterus; however, ultimately all were well seen. Obesity did not impair visualization due to the highly echogenic nature of the microinserts.
Fourteen studies were performed within 4 weeks of
Discussion
Essure is performed in multiple countries, and various methods are used for the 3-month confirmation test. Because proper location of the inserts has been shown to correlate highly with tubal occlusion [6, 7], in Europe a transvaginal ultrasound is considered sufficient for localizing the microinserts. In Australia and New Zealand, a flat-plate x-ray is taken to confirm device presence, position, and symmetry. In the United States, current labeling requires an HSG for both confirmation of
Conclusion
This pilot study suggests that CIS may be a safe, accurate, and convenient ultrasound-based alternative to HSG as a 3-month confirmation test after Essure. The majority of patients felt strongly that a confirmatory test performed by their gynecologist, in the familiar office setting, was preferable to one performed by an unfamiliar physician in an unfamiliar setting. The convenience and comfort of an in-office test may also increase the compliance with any required confirmation test. A high
References (10)
- et al.
Microinsert nonincisional hysteroscopic sterilization
Obstet Gynecol.
(2003) Contrast infusion sonography to assess microinsert placement and tubal occlusion after Essure
Fertil Steril.
(2006)- et al.
Ultrasound: an effective method for localization of the echogenic Essure sterilization micro-insert: correlation with radiologic evaluations
J Minim Invasive Gynecol.
(2005) Follow-up of successful bilateral placement of Essure microinserts with ultrasound
Fertil Steril.
(2005)- et al.
Advantages and disadvantages of hysterosonosalpingography in the assessment of the reproductive status of uterine cavity and fallopian tubes
Eur J Radiol.
(2005)
Cited by (21)
Twelve-year retrospective review of unintended pregnancies after Essure sterilization in the Netherlands
2016, Fertility and SterilityCitation Excerpt :Some studies suggest tubal occlusion already occurs within those 3 months. For example, a study by Sia et al. (24) showed tubal occlusion after 1 month in 86%–100% of cases (24); Connor et al. (25) found an occlusion rate of 82% after 1 month; and Valle et al. (11) confirmed tubal occlusion in all cases before performing hysterectomy, including in those who were scheduled within 4 weeks after placement. Two patients did not use additional contraceptives, and both patients showed expulsion of one device on additional imaging, explaining the cause of the pregnancy.
Contrast ultrasonography for tubal patency
2014, Journal of Minimally Invasive GynecologyCitation Excerpt :Sensitivity ranges from 75% to 96%, and specificity from 67% to 100% [10,11]. HyCoSy is also accurate when compared with HSG in determining tubal occlusion after hysteroscopic sterilization, with 88% of patients stating they would prefer to undergo the tubal occlusion test in their gynecologist's office [12]. Because HyCoSy also includes evaluation of the uterine cavity using saline solution, sonohysterogram accuracy in evaluating the uterine cavity is >90% when compared with hysteroscopy [2,11].
Multimodality imaging of the Essure tubal occlusion device
2012, Clinical RadiologyCitation Excerpt :In Europe and Australia the HSG is not required and is often replaced with a radiograph of the pelvis or ultrasound.13–18 Contrast-enhanced ultrasound has been proposed as an additional means to confirm tubal occlusion.19,20 However, ultrasound contrast agents are not FDA approved for this use in the United States.
The Imaging of Contraception
2011, Gynecologic ImagingCan hysterosalpingo-contrast sonography replace hysterosalpingography in confirming tubal blockage after hysteroscopic sterilization and in the evaluation of the uterus and tubes in infertile patients?
2011, American Journal of Obstetrics and GynecologyCitation Excerpt :Our data show excellent concordance of HyCoSy with HSG in confirming tubal blockage, but HyCoSy is more convenient for the patients and often less uncomfortable. In a similar study to ours, Connor reported excellent concordance (31/33 tubes) between HyCoSy and HSG; in addition, her patients experienced less discomfort with the HyCoSy and expressed that “the confirmatory test performed by their gynecologist in the familiar office setting was preferable to the one performed by an unfamiliar physician in radiology.”6 Of the 700,000 tubal sterilizations performed in the United States annually if, as predicted, most of them will switch to hysteroscopic sterilization, the use of HyCoSy instead of HSG will significantly reduce unnecessary radiation exposure to women, as well as reduce costs.
Available at www.sciencedirect.com and www.jmig.org
This study was funded in part by Conceptus, Inc.