Hysteroscopic Sterilization:
Counseling
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Patient Selection

Unhappy with current form of birth control or
contraindicated (i.e., smokers over 35, hypertensive on OCs)

OB patients pregnant with last child

Contraindicated for pregnancy or tubal ligation

Patients waiting for husband to have a vasectomy

Patients considering endometrial ablation (Essure should be
done first and then ablation after HSG confirms bilateral
tubal occlusion)
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Patient Considerations

Like all methods of birth control, the Essure procedure should
not be considered 100% effective

Insert placement may not be successful

NOT REVERSIBLE; knowledge of insert compatibility with IVF is
limited

Placement discouraged in women undergoing
immunosuppressive therapy — therapy may negatively affect
tissue response that leads to tubal occlusion

Systemic corticosteroids

Chemotherapy
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Patient Counseling

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Set appropriate expectations
 High placement success – small percentage unable to
place
 Discomfort is similar to menstrual cramps
 Average procedure time 10 minutes or less –
in and out of the office in 45 minutes
 Return to normal activity within one day
 Compliance with Essure Confirmation Test is critical
 MUST USE RELIABLE CONTRACEPTION UNTIL TUBAL
OCCLUSION IS DOCUMENTED ON HSG (3 MONTHS
AFTER PLACEMENT)
©2012 All rights reserved. Conceptus and Essure are registered trademarks. CC-3022 06MAR12F
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Talking with the Patient
Instead of…
Consider Using…
Sterilization
Permanent Birth Control
Spring/coil
Essure insert
Non-incisional
No cutting
Surgery
Procedure
New procedure
FDA approved since 2002
HSG
Essure Confirmation Test
Scar tissue
Natural barrier
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Essure Procedure Contraindications*
 Uncertain
 Has
about her desire to end her fertility
previously undergone a tubal ligation
 Pregnant
or suspected pregnancy
 Delivery
or termination less than 6 weeks prior
 Active
or recent upper or lower pelvic infection
 Known
allergy to contrast media**
 See
Essure packaging for complete
warnings/contraindications
* See complete Instructions for Use in Essure packaging
** Non-iodine containing contrast medias are available
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Optimizing Visualization
 Cycle Timing

Cycle day 4-8 (Early Proliferative Phase)
 Endometrial
Preparation
 DMPA
 OCPs, Ring, Patch
 Implant
 LNG
secreting IUD
 Letrozole
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Some Issues That Have Gotten
Press

Chronic pain

Bloating/weight gain

“Extreme” Fatigue

Depression

Rash/allergy
©2012 All rights reserved. Conceptus and Essure are registered trademarks. CC-3022 06MAR12F
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Nickel Allergy?

June 2011 FDA removed nickel as a contraindication and
recommendation that patients get skin testing prior to Essure

Our counseling (University of CO):

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
Explain to patients that nickel is usually a contact dermatitis
reaction. If allergy occurs, can remove coils.

Ask if they have any reaction to buttons on jeans.
700+ procedures1 allergy

Coils removed with hysteroscopy 8 days after placement

Symptoms resolved in <24 hours
©2012 All rights reserved. Conceptus and Essure are registered trademarks. CC-3022 06MAR12F
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©2012 All rights reserved. Conceptus and Essure are registered trademarks. CC-3022 06MAR12F
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Pain?

Cramping; chronic

Can’t predict

Offer removal: hysteroscopically vs laparoscopic bilateral
salpingectomy

Laparoscopic b/l salpingectomy has benefit of sterilizing the
patient

University of Colorado:

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700+ procedures3 cases where Essure implants removed
secondary to complaints of pain
All symptoms resolved
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Prior to placement/during general
counseling:

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Laparoscopic and Hysteroscopic Sterilization: both have risks

Lpsc: mortality1-2/10,000 from GET anesthesia

Lpsc: also involves foreign body (Filshie Clips, Falope Rings)

Explain that removal of Essure is typically a simple
procedure, if it is needed for any reason

Explain how it is done

Hysteroscopically

Laparoscopically

SHOULD NOT NEED HYSTERECTOMY
©2012 All rights reserved. Conceptus and Essure are registered trademarks. CC-3022 06MAR12F
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Points to Remember

Safe; no incisions & no GET anesthesia

Effective (99.83%)

High rate of bilateral placement in one visit (96.9%)

Typically done in office; minimal recovery time

Not immediate: need 3 month HSG for confirmation

Uterine lining prep and contraception until HSG confirmation

Screen for metal/nickel allergies
©2012 All rights reserved. Conceptus and Essure are registered trademarks. CC-3022 06MAR12F