The Essure sterilization procedure is a procedure for achieving permanent birth control using a non-incisional surgical approach. The Essure procedure involves placing micro-inserts via hysteroscopic guided catheters into each of the fallopian tubes vaginally through the cervix and uterus. The micro inserts are made from polyethylene terephathalate (PET) fibers and a nickel titanium alloy, similar to other devices and technology that have been studied and used safely in the heart and neurosurgical procedures. Once the micro inserts are in place, over a three-month period, benign tissue growth is elicited into the micro inserts, effectively blocking the fallopian tubes, thereby preventing pregnancy.

The Essure procedure is done on an outpatient basis using local anesthetic and/or intravenous sedation, and it requires no incisions and usually takes approximately 35 minutes to complete. Most patients are able to go home within an hour of the procedure. Typical temporary effects are cramps, a discharge like a light menstrual flow or spotting, mild nausea or vomiting, and light-headedness. Usually the strongest pain medication required after the procedure by most women is ibuprofen. Most women who have the procedure done can return to regular activities within one to two days.

Patients are required to do a follow-up evaluation with a hysterosalpingram (HSG) at three months to make sure that both Essure micro-inserts are in the correct location and that both tubes have been blocked. Patients are also advised to use some other method of contraception such as birth control pills, the patch or ring, or depo provera for at least three months after the procedure to avoid pregnancy until the micro inserts have blocked the fallopian tubes. Women are also advised to use usually this same form of contraception prior to the procedure to prevent pregnancy as well as thin the uterine lining to allow for easier visualization of the tubal ostia where the inserts are placed. Once it is confirmed that the inserts are properly positioned and the fallopian tubes are fully blocked, a woman who has had the procedure done should not have to worry about contraception for the rest of her reproductive life.

The BENEFITS OF ESSURE:

• No incisions or scars.

• No cutting, crushing or burning of the fallopian tubes.

• The Essure procedure can be performed without general anesthesia and is usually performed with intravenous sedation and local anesthesia.

• Little or no pain.

• The Essure micro inserts do not contain or release any hormones.

• Done on an outpatient basis. Most women are typically discharged forty-five minutes to one hour after the procedure.

• Can return to work the next day. The majority of women return to normal activity within twenty-four hours with their comfort rated as good to excellent a short time after the procedure

• None of the women who have relied on Essure for contraception have become pregnant over the five years of follow-up. However, no method of contraception is 100% effective.

Do not use Essure if a patients:

• Are uncertain about their desire to end fertility.

• Are pregnant or suspect that they are pregnant.

• Have delivered a baby or had a miscarriage within six weeks before the procedure.

• Have an active or recent pelvic infection.

• Have an unusual uterine shape.

• Have a known allergy to dye.

• Have a known hypersensitivity or allergy to nickel.

• Are unwilling to use another method of contraception for at least three months after the procedure.

• Are unwilling to undergo the dye test approximately three months after the procedure to ensure tubes are blocked.

• Have had a prior tubal ligation.

Several studies have confirmed the safety and effectiveness of this method. Essure, as opposed to traditional laparoscopic tubal ligations which require general anesthesia and one or more incisions in the abdomen, is done safely with sedation and without any abdominal incisions thereby avoiding the potential complications of abdominal surgery including bowel injury. Recently reported, three and five year effectiveness rates of 99%, makes it a very reliable method of contraception. The Essure procedure is appropriate for women who are certain they do not want any more children and who want permanent birth control.

Since I have incorporated Essure into my practice, I have found women to be extremely satisfied with their experience, so much so that others are coming in requesting it. I have been extremely satisfied with the safety profile and effectiveness of the procedure that I have dramatically decreased the number of laparoscopic sterilizations that I have performed in the last year. I hope to someday soon being doing it in my office.