Most health care providers are unaware Essure can be reversed. The reality is Essure can be reversed and natural pregnancy is possible.
Essure causes the fallopian tubes to become blocked at the very beginning of the tube. The beginning of the tube is often referred to as the proximal (closest to the uterus) portion of the tube. Blockage of the proximal portion of the fallopian tube can be surgically corrected. The historical gold standard procedure for the surgical correction of proximal tubal blockage is a tubouterine implantation. Most people, including health care providers, are unaware the first successful surgery to reverse proximal occlusion of the fallopian tubes occurred in the early 1900’s!
Before we ever performed our first Essure reversal surgery, we had been performing tubouterine implantation for the reversal of proximal tubal occlusion from other types of tubal ligation.
An uncommon reversal technique
Most infertility specialists do not perform tubal ligation reversal and even less will perform tubouterine implantation.
Tubouterine implantation is much different than other types of tubal reversal procedures because it requires deep incisions be made into the uterine muscle. This will often increase the risk of surgery. Most doctors either don’t have the training to perform this specialized repair procedure or the awareness the surgery can safely be performed as an outpatient procedure.
We have been doing this for years and have a high degree of comfort with this type of reversal technique in the outpatient setting.
A Long history
Tubouterine implantation was performed in the late19th century. The first reports of tubal implantation were in European Journals and were very limited in description and success rate. Dr. Turck described the first successful tubouterine implantation resulting in pregnancy in 1909 in the New York Medical Journal.
The first modern reports of tubouterine implantation indexed in PubMed begin to appear in the 1950’s. Tubouterine implantation was then performed with more frequency in the 1960’s and 1970’s and was found to have pregnancy success rates as high as 60%. In the 1980’s IVF, became more popular and tubal ligation reversal surgery, as well as tubouterine implantation, began to be performed less often. This is the reason most doctors are unfamiliar with many of the techniques of tubal repair surgery.
Many of todays doctors have never seen the procedure and are not even aware tubouterine implantation is possible or can provide a reasonable chance of pregnancy success. Although the American Society for Reproductive Medicine supports tubal ligation reversal surgery, these infertility experts are of the position tubouterine implantation is of historical interest only.
We have had success with tubouterine implantation and have observed success rates similar to a single cycle of IVF with this type of tubal repair procedure. We have found with the introduction of the ‘newer’ Essure sterilization procedure that a ‘historical’ tubal repair procedure has found a new indication for use.
How do we reverse Essure?
The Essure reversal procedure is performed under general anesthesia and can often be performed in less than 90 minutes. We attempt to use as small of an incision as possible and often we will make a 4 to 5 inch incision over the pubic hairline. Even our largest incision is smaller than the average Cesarean delivery incision.
The Essure devices are visualized where they exit from the uterus and in the very beginning of the fallopian tube. An incision is made into the tube and over the ends of the Essure devices. The Essure devices are then dissected away from the uterus intact and with the surrounding scar tissue. The remaining healthy fallopian tubes are then introduced into newly created openings and each tube is securely sutured into place. Often blood loss is minimal and patients will recover in our recovery room in less than one hour before they are ready to return to the hotel.
Patients return to the office the day after their procedure for evaluation. Essure reversal patients are advised they can attempt to become pregnant after their next menstrual cycle and they can return to limited work duties within the next two weeks. Patients are asked not to lift anything heavier than 15 lbs. for the first month after surgery. If heavy lifting is required at work then patients are asked to wait 4 weeks before returning to strenuous activity.
Most patients who become pregnant will do so within the first year.
Risks of Essure reversal surgery
In our experience, we have found Essure reversal to be a safe outpatient surgery. The main risk of Essure reversal is the increased risk of rupture of the uterus with future pregnancy. A uterine rupture is when the previous incision on the uterus tears during the later stages of pregnancy.
Why does uterine rupture happen?
Any incision made in the uterine muscle can increase the risk of a uterine rupture in future pregnancy. Previous Cesarean delivery is the single most common reason a rupture of the uterus will occur. The area where the incision was made can potentially become a source of weakness when stretched by a third trimester pregnancy and exposed to the forces of labor contractions.
Past medical literature on tubouterine implantation suggest uterine rupture is a risk of the tubouterine implantation procedure. For ultimate patient safety, we recommend a Cesarean delivery before the due date in any future pregnancy after Essure reversal. It is unclear what the exact risk of rupture of the uterus is after Essure reversal but we estimate it is likely less than 10%.
Most of our patients have followed our recommendations and none of our patients have reported rupture of the uterus as a complication of Essure reversal.
Are other Essure reversal techniques safer?
Some surgeons advocate surgical techniques other than tubouterine implantation for Essure reversal and imply these techniques have a lower risk of uterine rupture than tubouterine implantation. There is no supportive medical literature which demonstrates other techniques have either resulted in pregnancy after Essure reversal or have a lower risk of uterine rupture. Until adequate medical studies are published assertions other Essure reversal techniques have a lower risk of rupture are speculative.
For the optimal safety of both mom and baby, we recommend an elective Cesarean delivery before the estimated due date for any pregnancy after Essure reversal.
1. Normal pregnancy after outpatient tubouterine implantation in patient with Adiana sterilization
Monteith, Charles W. MD; Berger, Gary S. MD, MPH, Fertil Steril: July 2011 – Volume 98 – Issue Part 1 – pages e45-e46
2. Successful Pregnancies After Removal of Intratubal Microinserts
Monteith, Charles W. MD; Berger, Gary S. MD, MPH, Obstetrics & Gynecology: February 2012 – Volume 119 – Issue Part 2 – p 470–472
3. Pregnancy Success After Hysteroscopic Sterilization Reversal
Monteith, Charles W. MD; Berger, Gary S. MD; Zerden, Matthew L. MD, MPH, Obstetrics & Gynecology: December 2014 – Volume 124 – Issue 6 – p 1183–1189