Can You Reverse Essure Sterilization?
Essure sterilization is intended to be permanent, but with our expertise Essure does not have to be permanent and pregnancy is possible. We were the first doctors in the world to publish successful reports of full term pregnancies after surgical reversal of both Essure and Adiana sterilization procedures.1-2
Since our initial reports we have performed over one hundred and twenty-nine (129) outpatient surgeries to correct these newer types of tubal ligation procedures.
What Is Essure?
A brief overview
Essure coils in place
During an Essure procedure a small metal coil is placed inside the opening of each fallopian tube. This causes the tube to heal closed by the formation of scar tissue around the coil and inside the tube. This blockage only occurs in the very beginning of the fallopian tubes.
The Adiana procedure is similar to, but not as common as, Essure sterilization. Adiana has been removed from the market and is no longer being performed.
Removing Essure coils
Our statistics
From January 2008 to January 2014, we performed one hundred and twenty nine (129) Essure and Adiana corrective surgeries. Of this group, one hundred and twenty five (125) women had tubal blockage from Essure sterilization and four (4) had blockage from Adiana sterilization.
Of the 125 patients who underwent surgery to correct Essure and Adiana, 92 of these women had reversal to become pregnant. All surgeries were performed as outpatient procedures at our specialty center.
Of the 92 women who had reversal surgery, 68 have had 12 months or more to conceive. Of these 68 women, 24 have reported pregnancy. The pregnancy rate after reversal of Essure or Adiana at our center is 35.3%.
There have been a total of 17 separate patients who reported a total of 17 births after reversal of Essure
One patient had a vaginal birth. The other 16 underwent elective C-section, per our recommendation, to minimize the risk of pregnancy complications.
Readers are encouraged to view: Comments from our Essure reversal patients.
Risks of Essure reversal: Our statistics
One patient had unexplained abdominal pain 72 hours after reversal and underwent a laparoscopy by her local doctor with normal post surgical findings. She subsequently became pregnant and delivered a healthy baby (our first Essure reversal baby). None of our patients reported ectopic pregnancy or uterine rupture as delayed complications after Essure reversal.
Tubouterine implantation has been the historical gold standard for reversal of proximal tubal occlusion but has also been associated with an increased risk of uterine rupture during labor.3,4,5 For maximal safety of both mother and baby, we advise our Essure reversal patients to have a scheduled cesarean delivery with future pregnancies to minimize the possible risk of uterine rupture during labor.
Our experience demonstrates outpatient reversal of Essure at our center is safe.
We are getting better at reversing Essure!
Our initial Essure pregnancy analysis in early 2013 suggested the pregnancy rate was 29% after reversal.
With more follow-up time we have seen the chance of pregnancy after reversal of Essure increase to 35.3%.
With a larger number of Essure patients we have also been able to identify specific surgical techniques which are more likely to result in pregnancy for our patients.
We are definitely seeing improvement.
IVF or Essure reversal
The chance of pregnancy after Essure reversal at our center is 35.3%. The chance of pregnancy after in-vitro fertilization (IVF) is approximately 36.8 % for each cycle attempted.6
There is no data to suggest what the success rate of IVF is when the Essure coils are allowed to remain; however, several case reports do exist of successful IVF with Essure coils left in place.7,8
If the Essure coils project into the uterine cavity this may decrease the success of IVF and may increase the risks of a pregnancy complication. There are no studies to suggest what the success rate of IVF is when the coils are left in place. Limited studies exists suggesting minimal risks to pregnancy in women who become pregnant after Essure failure or with IVF.9,10
A single cycle of IVF costs approximately $12,000 to $14,000.
Costs of Essure reversal
For more information about the cost of Essure reversal, please visit: Essure reversal cost.
If you have any questions about Essure reversal or Essure coil removal then please call and speak with one of our nurses for a free Essure reversal consultation at (919) 968-4656.
Readers are also welcome to ask Dr. Monteith questions by submitting them through our Ask The Doctor section of our website.
Reference
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. 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.
4. Uterine rupture after tubal reimplantation. Horovitz J et al, J Gynecol Obstet Biol Reprod (Paris) 1988;17(5):650-2.
5. Uterine rupture after re-implantation of fallopian tubes. Brandt CA, Larsen B. Acta Obstet Gynecol Scand 1989;68(3):281-2.
6. 2010 Assisted Reproductive Technology Report. Centers for Disease Control and Prevention. 2010 National Report.
7. 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.
8. 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.
9. Outcomes of Pregnancies in Women with Hysteroscopically Placed Micro-Inserts In Situ. Veersema S et al, J Minim Invasive Gynecol 2013; Oct Suppl.
10. Essure for management of hydrosalpinx prior to in vitro fertilisation- a systematic review and pooled analysis. Arora P, Arora R, Cahill D, BJOG 2014; Jan 3.
