Initial Asian experience in hysteroscopic sterilisation using the Essure permanent birth control device

Abstract

Objective To present our initial experience in the use of the Essure permanent birth control device in a predominately Asian population. Design A retrospective study. Setting Minimally Invasive Surgery Unit, KK Women's and Children's Hospital, Singapore. Population Eighty women seeking permanent birth control. Methods From 22 June 2001, women who sought sterilisation were counselled with regards to the various options of permanent birth control. Informed consent for hysteroscopic sterilisation was obtained only after the woman met the criteria for Essure permanent birth control. The sterilisation procedure was carried out without the need for general anaesthesia in a day surgery centre using the Essure permanent birth control device. The surgical details and post procedure follow up were analysed. Main outcome measures Feasibility and safety of the Essure permanent birth control device in Asians and its non‐placement rate. Results No serious adverse events or complications were encountered in using the Essure device. No pregnancies have been reported in our series to date. A significant reduction in the Essure device non‐placement rate (20.0%vs 4.0%, P= 0.021) and mean operation time (27.3 vs 19.6 minutes, P= 0.006) were seen when patients were pre‐medicated with spasmolytic agent and analgesia. Conclusions The Essure permanent birth control device is safe and suitable for Asians. Its non‐placement rate may be improved with pre‐medication of spasmolytic agent and analgesia.

The effect of menstrual phase and hormonal contraception on successful bilateral placement of the Essure micro-insert tubal coil

“…The initial pressure setting selected was 200 mmHg which was further increased to 300 mmHg if the endometrium was thickened. The 200 mmHg pressure is higher than has been previously reported [5,13]. Anecdotally, the resultant increase in uterine distention can result in some minimal baroceptor-related discomfort for the patient; however, with adequate analgesia, this very transient effect is well tolerated.…”

“…The reported bilateral placement rate ranges from 81% [1] to 98% [2]. It has been suggested that the procedure be completed in the follicular phase to improve visualization of the tubal ostia, and thus the successful placement of the coils [3][4][5]. Alternatively, hormonal endometrial suppression with the oral contraceptive pill, a progestin, or leuprolide before the procedure has been proposed to improve visualization [6].…”

The Essure™ hysteroscopic sterilisation procedure: initial experience in Sheffield, UK

“…The use of antispasmodics has not been shown to reduce the incidence of tubal spasm. However, in a recent study from Singapore a significant increase in placement rates and decreased mean operation time were seen when patients were pre-medicated with spasmolytics (hyoscine) [11].…”

A Meta-Analysis of Bilateral Essure® Procedural Placement Success Rates on First Attempt

“…Four studies included separate placement rates for study group subsets but did not supply overall placement rates, 7,17,21,29 thus, the total number of placements in both groups was divided by the total number of patients in each study. For one study 61 only one group was included because the second group met the current review's exclusion criteria.…”

“…Some explanations for placement success include procedure-related factors such as an in-patient setting, 16,21 a shorter procedure time, 3 greater provider experience, 3,5 and various types of medications and medication procedures. 3,5,7,21,22,29,38,47 Placement success associated with patient-related factors include prior use of an intrauterine device (IUD), 13 a history of sexually transmitted infections (STIs), 33 a lower body mass index (BMI), 11 and follicular phase of the menstrual cycle. 8,11,22 To date, there are no systematic analyses of variables associated with placement rates.…”