Necessity of Hysterosalpingography After Essure Microinsert Placement for Contraception

OBECTIVE. The objective of our study was to determine whether hysterosalpingography is necessary after Essure microinsert placement by evaluating the rates of appropriate placement and of satisfactory tubal occlusion in a general population. MATERIALS AND METHODS. We identified all patients who underwent hysterosalpingography after Essure microinsert placement for desired sterility between January 1, 2008, and August 1, 2010. We recorded demographic information and the hysterosalpingographic results. The images and operative reports of all cases with abnormal hysterosalpingographic findings were reviewed. The hysterosalpingographic results were reviewed for appropriate placement of the microinsert, for successful tubal occlusion, and for any additional abnormalities. We also reviewed the medical records for documentation of subsequent pregnancies. RESULTS. Two hundred forty hysterosalpingographic examinations were performed after 237 hysteroscopic microinsert placement procedures in 235 women. The mean age of the subjects was 35 years (range, 20-50 years). Twenty-two examinations (9.2%) were abnormal. Fourteen (5.8%) revealed inappropriate placement: six with tubal occlusion, seven without tubal occlusion, and one with an indeterminate finding for tubal occlusion. Fifteen examinations (6.3%) showed tubal nonocclusion: Microinsert placement was inappropriate in seven cases and appropriate in eight. Of the 22 abnormal hysterosalpingographic examinations, 20 had operative reports available. Eleven (55%) described difficulties with device insertion. Forty-two endometrial abnormalities were described in hysterosalpingographic reports of 38 patients. One subsequent pregnancy was documented in a patient with satisfactory device placement and tubal occlusion on hysterosalpingography. CONCLUSION. Hysterosalpingography after Essure microinsert placement is necessary because 6.3% of examinations showed abnormalities requiring an alternative form of contraception.