Desired Pregnancy after Essure Placement
While permanent methods of sterilization should be considered just that, permanent, patients and their partners can and do change their minds. Pregnancies after permanent sterilization procedures can occur spontaneously. In the clinical studies of the Essure device, approximately 1 out of every 7 women were not able to have the device placed in both fallopian tubes during the first placement procedure. Adherence to the recommended confirmatory hysterosalpingogram (HSG) at 3 months has been reported to vary widely, from as low as 13% to greater than 85%. At routine 3-month follow-up, 4% of the women who did receive placement in both tubes were found to have the inserts in an incorrect position, including having too much or too little of the device within the tube, expulsion from the tube, or perforation through the tube or uterine wall. In these cases, the device cannot and should not be trusted for contraception. Even with hysterosalpingography that confirms correct placement and apparent tubal occlusion, late pregnancies have been reported. The exact frequency of subsequent pregnancy is not known, though in clinical studies the device was shown to be 99.74% effective at 5 years of follow-up, if the recommended HSG confirmed tubal occlusion. Women who undergo sterilization by Essure or incisional tubal ligation are more likely to have an ectopic pregnancy if they spontaneously conceive.
Options for pregnancy may be even more limited after Essure than after other methods of sterilization. With tubal ligation procedures performed on the mid-portions of the fallopian tube, tubal reanastomosis can be attempted, but such procedures are not typically undertaken after Essure placement. IVF offers the ability to bypass the obstructed fallopian tube. There are limited data on the safety or effectiveness of IVF after Essure. Because the procedure for introducing the conceptus following IVF may snag the portion of the device that is in the uterus, or the devices could interfere with successful implantation of the fertilized egg, a slightly higher failure rate might be expected. Some fertility specialists may attempt to remove any visible Essure that protrudes into the uterine cavity before embryo transfer, though the coils are difficult to cut with hysteroscopic instruments. The risks of the Essure devices to the fetus or mother are unknown if pregnancy is achieved, as is the rate of continuation of the pregnancy. Miscarriage after IVF may be more common with Essure in place. There are reports of successful pregnancy following hysteroscopic extraction of the implants, but given the degree of tubal scarring caused by the device placement and damage caused by the removal, successful conception or an intrauterine pregnancy would not be assured.
ACOG Practice Bulletin No. 208 Summary: Benefits and Risks of Sterilization. Obstet Gynecol. 2019 Mar;133(3):592-594. doi: 10.1097/AOG.0000000000003134.
Initial Approval August 2011; Reviewed January 2017, Revised November 2018, Revised November 2019
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