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Essure is a microinsert placed bilaterally into fallopian tube lumens under hysteroscopic visualization in patients seeking permanent contraception. Our multicenter clinical trial begun in 1998 required hysterosalpingography (HSG) be performed 3 months after placement to confirm tubal occlusion. The patency rate in satisfactorily placed devices was 4%. All of these underwent a repeat HSG 3-4 months later (due to a patency finding at the previous test). We present the results of our clinical use in patients out of the clinical trial. Of 78 insertions 65 (83.3%) were considered satisfactory, and the patients underwent pelvic radiography after 3 months. Only one patient had an abnormal radiograph, and an HSG was performed confirming bilateral tubal occlusion. In 12 patients (15.4%) the placement was considered unsatisfactory and underwent HSG. Ten confirmed bilateral tubal occlusion, and two had tubal patency. Therefore we repeated HSG 3 months later. We verified tubal occlusion in one patient and unilateral tubal patency in the other. In one patient with a satisfactory placement we performed an HSG that corroborated tubal occlusion. No pregnancies have been reported so far. Therefore we consider tubal occlusion successful in all the satisfactory microinsert placements (83.3%) after 3 months, performing only pelvic radiography. Additional HSG is required in the remaining 17% due to an unsatisfactory placement. Of these, 83% will be occluded after 3 months, increasing the rate to 91.6% after 6 months. These findings show that it is not necessary to conduct HSG when the bilateral placement is satisfactory and can be replaced by pelvic radiography at 3 months to confirm microinsert retention and location. HSG, with its unnecessary risks, costs, inconvenience and discomfort, can thus be avoided in many patients.

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