Essure and Adiana are newer tubal sterilization procedures that cause tubal blockage in the narrowest section of each fallopian tube (the isthmic segment next to the uterus).
Essure and Adiana procedures are referred to as transcervical hysteroscopic sterilization because they are performed through a hysteroscope (small camera) passed through the cervical canal into the uterine cavity.
During the Essure procedure a small metal coil is placed inside each tube and during the Adiana procedure a small silicone matrix is placed into each tube. Adiana sterilization includes an additional step in which microwave energy is applied to the inside of the tube and this energy enhances tubal blockage.
Hysteroscopic sterilization procedures cause the fallopian tube to heal closed by causing the formation of scar tissue inside the tube and resulting in the fallopian tube closing from the inside. The Essure coil and Adiana insert are intended to permanently remain in the closed fallopian tubes after the scar tissue has formed.
These procedures are considered permanent by doctors and the manufacturers of these devices, but they can be surgically reversed at A Personal Choice.
Essure Reversal And Adiana Reversal
Dr. Charles Monteith and Dr. Gary Berger, the expert tubal reversal surgeons at A Personal Choice, published the first reports of successful reversal and pregnancy after both Adiana and Essure reversal in the peer reviewed medical literature.1-2 Both the Essure and Adiana procedures are reversed at A Personal Choice through a 90 minute, out-patient operation called tubouterine implantation .
Tubouterine implantation has been the gold standard for the reversal of proximal (isthmic) tubal occlusion caused by other forms of tubal blockage. We have improved upon the traditional tubouterine procedure by developing special techniques that allow this procedure to be performed safely as out-patient surgery.
During this procedure, the healthy portion of each fallopian tube is separated from the uterus. The metal Essure coils are then removed to prevent possible complications with future pregnancies. The Adiana inserts are extremely small and may not be able to be removed but unlike the Essure coils they do not protrude into the uterine cavity.
An incision is then made through the uterine muscle and the healthy portion of each tube is inserted into the uterine cavity. The uterine incision is then closed around the implanted tubes. The tubouterine implantation procedure is necessary to bypass the scarred portion of the fallopian tube caused by both the Essure and Adiana procedures.
Pregnancy After Essure Reversal And Adiana Reversal
We performed 23 reversals of hysteroscopic sterilization (Essure and Adiana) between January 2009 through December 2010.
Of these 23 women, 19 desired to become pregnant and 4 were having Essure removal only and not attempting to become pregnant. Of the 19 women who were attempting to become pregnant, 5 women have reported pregnancies and 3 reported live births so far. During this time period, the pregnancy rate for hysteroscopic sterilization reversal was 26% and the live birth rate was 16%.
During 2011 we performed 19 reversals for hysteroscopic sterilization. Of these 19 women, 18 were actively trying to become pregnant and one patient was for Essure coil removal only.
Of these 18 women from 2011, 3 have reported pregnancies so far, all of which are currently ongoing (not yet delivered). Follow-up for 2011 is not complete at this time but the 2011 pregnancy rate for hysteroscopic sterilization reversal is 17% thus far.
In comparison, the success of a single cycle of in-vitro fertilization utilizing fresh non-donor eggs is approximately 36% for each cycle of in-vitro fertilization.3
Hysteroscopic Sterilization Reversal or IVF?
IVF may provide a higher pregnancy success rate when compared to surgical reversal of hysteroscopic sterilization; however, when comparing in-vitro fertilization (IVF) success to hysteroscopic sterilization reversal success, readers should understand:
IVF patients as a group have different reasons for infertility than patients with tubal blockage
IVF data above does not reflect pregnancy miscarriage
Our patient’s ages ranged from 26 to 44
With additional time sterilization reversal pregnancy rates may be higher as more patients become pregnant
For a better understanding of what the average IVF success rate means readers should visit this supplemental article: Essure Reversal Or In Vitro Fertilization?
It has not yet been determined if the Essure devices should be removed prior to IVF to increase the chance of success and minimize the risk of pregnancy complication. Several case reports exist of successful IVF with Essure coils left in place.4,5
Costs of Essure And Adiana Reversal
Both Essure reversal and Adiana reversal cost is $7500. This fee is all-inclusive and covers the pre-operative consultation, surgery, anesthesia, and the postoperative recovery. In comparison, the average cost for a single IVF treatment cycle is $12,000 in the US.
Most health insurances will not cover the cost of IVF or sterilization reversal. We offer a tubal reversal pre-payment option that allows patients to pay towards their reversal surgeries over time. We do not participate in reversal surgery financing due to the additional and often excessive costs of financing charged to patients.
Essure Side Effects and Essure Removal
Some women experience side effects after Essure has been performed and desire removal of their Essure coils.
Between January 2009 and January 2012, we performed 5 Essure removals for women who reported adverse side effects after their Essure procedures.
Four of these patients have reported improvement in their symptoms after Essure coil removal.
For women who desire removal only of the Essure coils without the possibility of future pregnancy, we offer a reduced surgical fee. If you are interested only having the Essure coils removed, call (919) 968-4656 to inquire about the reduced fee for Essure coil removal.
Safety Of Essure And Adiana Reversal
Tubouterine implantation can be safely performed as an out-patient procedure but may increase the risk of uterine rupture during labor.
Of the 42 hysteroscopic sterilization reversals and 5 Essure removal surgeries we have performed, there have been no immediate surgical complications and no patient has reported a uterine rupture.
For maximal safety of both mother and baby, we advise our Essure and Adiana reversal patients after tubouterine implantations to undergo a scheduled cesarean delivery with all future pregnancies to minimize the possible risk of uterine rupture. 6-8
References
1. Normal pregnancy after outpatient tubouterine implantation in patient with Adiana sterilization. Monteith CW, Berger GS. Fertility Sterility 2011;Jul 96(1) 45-6.
2. Successful Pregnancies After Removal of Intratubal Microinserts. Monteith CW, Berger GS. Obstet Gyncecol 2012;119:470-472.
3. 2008 Assisted Reproductive Technology Report. Centers for Disease Control and Prevention. 2008 National Report.
4. Successful pregnancy outcome with the use of in vitro fertilization after Essure hysteroscopic sterilization. Kerin JF, Cattanach S. Fertility Sterility 2007; May 87(5) 1212.
5. Essure multicenter off-label treatment for hydrosalpinx before in vitro fertilization. Galen DI, Khan N, Richter KS. J Minim Invasive Gynecol 2011; May-June;18(3):338-42.
6. Uterine rupture following tubal reimplantation. Review of the literature and report of three additional cases. Shortle B, Jewelewicz R. Obstet Gynecology Surv 1984 Jul;39(7):407-15.
7. Uterine rupture after tubal reimplantation. Horovitz J et al, J Gynecol Obstet Biol Reprod (Paris) 1988;17(5):650-2.
8. Uterine rupture after re-implantation of fallopian tubes. Brandt CA, Larsen B. Acta Obstet Gynecol Scand 1989;68(3):281-2.
