Incorrect position of Essure microinserts 3 months after successful bilateral placement

Objective: To describe incorrect positions of Essure microinserts detected at 3 months' follow-up. Design: Case report. Setting: Outpatient department of obstetrics and gynecology in a Dutch teaching hospital. Patient(s): Initial series of 100 patients who underwent hysteroscopic sterilization using Essure between December 2003 and June 2004. Intervention(s): Hysteroscopic placement of the Essure System, follow-up at 3 months with transvaginal ultrasound (TVU), and hysterosalpingography. Main Outcome Measure(s): Bilateral placement rate, tubal obstruction, and detection of incorrect Essure micro-insert localization at follow-up after apparent successful bilateral placement. Result(s): Bilateral placement of Essure microinserts in one session was successful in 93 women (93%). In 90 of these women (96.8%), tubal obstruction was proven at follow-up 3 months later. Three incorrect positions of an Essure insert were seen: two expulsions and one perforation into the abdominal cavity. Conclusion(s): Incorrect position of Essure microinserts was seen only when the initial placement procedure was difficult. When a placement procedure was difficult or other suboptimal conditions are present during the procedure, we advise performing a TVU or pelvic X-ray in these women 4 weeks after the procedure or after the first vaginal bleeding, instead of waiting for follow-up after 3 months. (Fertil Steril (R) 2009;91:930.e1-e5. (C) 2009 by American Society for Reproductive Medicine.)