A Personal Choice
Experts in reversing Essure
From January 2008 to May 2014, we performed one hundred and forty-three (143) tubal surgeries to correct either Essure or Adiana sterilization. Of the 143 women who sought treatment from our center, one hundred and thirty-nine (139) had tubal blockage from Essure sterilization.
Of the 139 patients who came for Essure removal, 97 women requested Essure reversal to become pregnant and 39 women wanted Essure removal only for treatment of symptoms after Essure. All surgeries were performed as outpatient procedures at our specialty center.
In December of 2014, we published the pregnancy results of the above patients in the Journal of Obstetrics and Gynecology: Pregnancy Success After Hysteroscopic Sterilization Reversal.
Essure reversal pregnancy statistics
The average Essure reversal patient was 36 years of age but patients ranged in age from 25 to 46 years of age. Patients had an average of 2 children before having Essure sterilization; however, some patients had never had a child before having Essure and one patient had as many as 6 children before having Essure sterilization.
Patients waited an average of 4 years after their Essure procedure before having Essure reversal surgery; however, one patient sought Essure reversal 4 months after having Essure and another patient sought reversal 8 years after having Essure.
The average Body Mass Index (BMI) was 26 kg/m2 but ranged from a BMI of 18.4 kg/m2 to a BMI of 36.8 kg/m2.
Surgery time and blood loss
Most Essure reversal surgeries were less than 90 minutes. Our quickest Essure reversal surgery time was 51 minutes and our longest Essure reversal surgery time was 135 minutes. Our average estimated blood loss for Essure reversal was 87 milliliters (6 tablespoons). The least amount of blood lost during an Essure reversal surgery was 5 milliliters (1 teaspoon) and the most amount of blood lost during an Essure reversal surgery was 325 milliliters (1.5 cups).
Time to first pregnancy
The average time after surgery to a positive pregnancy test was 118 days (4 months). The earliest time to a positive pregnancy test was 65 days (2 months) and the latest time to a positive pregnancy was 614 days (20 months).
Risks of Essure reversal
Complications of surgery
Outpatient Essure reversal at our center is safe. Five patients experienced complications within 30 days of surgery.
One patient developed an abnormal heart rhythm during Essure reversal surgery and was in the hospital for three nights of observation.
A second patient had unexplained abdominal pain 72 hours after Essure reversal and underwent a laparoscopic evaluation by her local doctor. No additional interventions were required.
A third patient developed an infection in the surgical incision and this was treated with oral antibiotics.
A fourth patient experienced a heavy first menstrual cycle after Essure reversal and went to her local emergency room for evaluation.
A fifth patient experienced pelvic pain and was diagnosed with an ovarian cyst due to normal ovulation and was unrelated to surgery.
Chances of pregnancy
A total of 27 separate women became pregnant after Essure reversal. These women had a total of 33 pregnancies; 21 births, 8 miscarriages, and 1 ectopic pregnancy. Four (4) pregnancies were ongoing at the time this was written.
During the study period no patient an ectopic pregnancy and no patient reported a uterine rupture. We did not record the mode of delivery in all Essure patients. We are aware of one patient having a vaginal birth and the remainder indicated planned Cesarean delivery as per our recommendations.
The chance of pregnancy after Essure reversal at our center was 28% but this number included patients who had recently had surgery and did not have enough time to become pregnant.
When we calculated the chance of pregnancy among women who had 12 months or more to become pregnant then the chance of pregnancy was 40%. We feel this number is the most accurate chance of pregnancy after Essure reversal.
Essure reversal risks: Ectopic Pregnancy and Uterine Rupture
Ectopic pregnancy. After our initial study cohort was submitted for publication one patient reported a confirmed ectopic (tubal) pregnancy.
Ectopic pregnancy is always a risk after any tubal or ovarian surgery. The chance of ectopic pregnancy after reversal of tubal clips, rings, coagulation, or ligation and resection type tubal ligations is 10% to 15%. We are uncertain of what the exact chance of ectopic pregnancy is after Essure reversal. The risk of ectopic pregnancy after Essure reversal seems lower than the risk of ectopic pregnancy after tubal ligation reversal.
Uterine rupture. No patient in the published study reported a uterine rupture; however, one patient reported uterine rupture 9 months after the observational study was completed. This occurred at 36 weeks gestation. Both mom and baby are healthy and did not suffer any complications because of excellent and attentive care by the primary obstetrician.
Some surgeons are advocating surgical techniques for Essure reversal, which provide a similar chance of pregnancy with lower or no risk of uterine rupture. It is important to be aware these assertions are speculative at best and have not been demonstrated or supported within published, peer reviewed medical literature.
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