Essure hysteroscopic sterilization is a modern non-surgical method of irreversible contraception. It is an alternative to laparoscopic or laparotomic tubal ligation. It consists of installing micro implants (flexible springs consisting of titanium, nickel and polyester fibers) into the fallopian tubes. The polyester fibers of Essure spirals interact with body tissues, stimulating the growth of fibrous tissue, which completely occludes the tube and makes it impossible for the egg to penetrate into the uterine cavity. The effectiveness of the technique is more than 99%. Essure implants are inserted through the vagina into the uterine cavity and then into the fallopian tubes. Manipulation is performed without skin incisions under local anesthesia. The recovery period takes 2-3 days.
Essure hysteroscopic sterilization is a new method of female sterilization. It was developed at the end of the 20th century and approved in Europe in 2001. It was approved by the FDA (US Food and Drug Administration) in 2002. Currently, Essure sterilization is used in the USA, Australia, New Zealand, Russia, Europe, the Middle East, Central America and South America. Along with electrocoagulation of the orifices of fallopian tubes and the introduction of chemicals (phenol, talc, formaldehyde), the Essure is one of three methods of hysteroscopic sterilization.
The risk of an unplanned pregnancy after sterilization of Essure is comparable to the likelihood of gestation after laparoscopic sterilization. The effectiveness of the method in both cases is more than 99%, which is significantly higher than with salpingemphraxis with the use of chemical preparations (88-94%). During electrocoagulation, the gynecologist has to almost blindly perform cauterization of the orifice of fallopian tubes using a probe, which can result in perforation of the organ wall and damage to the intestine. When installing a mechanical implant Essure the risk of accidental damage to organs is minimal.
The disadvantage of the technique is a 3-month gap between the installation of the implant and the complete blockage of the tube lumen by the growth of fibrous tissue. The short period of use of the Essure technology does not yet allow to fully appreciate the long-term effects of this method. The probability of reproductive function restoration after irreversible contraception using an Essure implant is comparable to the probability of restoring fertility after the use of other methods. Microsurgical surgery for plastics of tubes is necessary, at the same time plastic does not provide a 100% return of fertility, and with successful restoration of the tubes’ patency increases the risk of developing an ectopic pregnancy.
The technique can be used at the request of a woman or used in the presence of diseases incompatible with pregnancy in case of intolerance to other contraceptives. According to American legislation, at the request of the patient, sterilization of Essure can be performed for women aged 35 years and older who have one or more children. Necessary conditions for sterilization due to the reluctance to preserve reproductive function in other countries depend on the peculiarities of local legislation.
Medical indications for sterilization of Essure in the USA are determined by the relevant order of the FDA. Essure’s indications include leukemia, chronic cardiovascular diseases, congenital heart disease, severe diabetes mellitus, malignant neoplasias, conditions after removal of vital organs (eg, kidneys), multiple cesarean sections, and some severe mental diseases. The list contains 55 nosological forms. In order to determine the medical indications for the Essure procedure, a commission consists of 3 specialists: a gynecologist, a physician performing the treatment of the underlying pathology, and the head of the medical institution.
Contraindications to sterilization of Essure are established or suspected pregnancy, a period of fewer than 6 weeks from the date of delivery, miscarriage or induced abortion, acute inflammatory processes in the pelvic organs and venereal diseases. In addition, Essure sterilization is not carried out with pathological changes in the uterus and fallopian tubes, which impede access to the orifices of one or both tubes, and hypersensitivity to nickel, confirmed by skin test.
At III-IV degree of bacterial contamination of the vagina before sterilization of Essure carry out sanitation. In the presence of severe somatic diseases, treatment of the identified pathology is performed, the procedure is carried out after reaching the state of compensation. Experts note that 2-3% of women who choose irreversible contraception, including Essure sterilization, later regret their decision, so the manipulation is usually performed after a month or more from the first treatment to give the patient time to think about the consequences of the procedure.