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Wednesday, February 22, 2012

Natural Cycle IVF Success After Essure

This has been a busy month for patients with prior tubal ligations. Although some patients with a prior tubal ligation will opt for a surgery to reverse their tubal ligation, most will pursue IVF. The data seems to favor IVF over tubal reversal if the patient is over age 37. Of course, other factors also come into play when making this decision. The presence of male factor infertility, the ovarian reserve of the patient, the desire for additional children etc…

More recently those patients seeking sterilization have undergone hysteroscopic sterilization with Essure. Essure is a procedure in which silicone-free inserts made of a polyester fiber, nickel-titanium and stainless steel alloy titanium coils are placed into the fallopian tubes from the uterus during hysteroscopy. The resulting inflammation causes the fallopian tubes to become blocked as they exit the uterus (proximal occlusion). Patients like Essure because the procedure is done hysteroscopically and is therefore less invasive than a traditional tubal ligation performed laparoscopically.

Although there have been a few reports of pregnancies using IVF in patients with Essure inserts in place, none have been in Natural Cycle IVF to my knowledge…until now that is. I have been concerned that the presence of the inserts could decrease implantation rates. Our patient had inserts that were clearly visible on sonogram. She and her husband did not desire stimulated IVF and were much happier with the NC IVF option since no extra embryos would be created. She conceived on her 2nd NC IVF attempt and everything looks great so far on sonogram.

Essure has also been suggested as an option for patients with hydrosalpinges who need surgery to block off the tubes prior to IVF. Although several studies have looked at this option, again the numbers are pretty small but reassuring. I may consider suggesting this option in the future but would still like to see some additional published series that address this question.

5 comments:

kokomo35 said...

hi doctor i had a day 2 embryo transfer 6 days ago should i be feeling anything..I got spotting a day after the transfer which only lasted a couple of hour it was brown in color.I haven't had anything since,i am so scared of getting a negative result as i have no more embie's as our other 1 didnt make the thawing,my embryo transfer was on a natural cycle i am on no medication.Should i be worried about getting a negative result.since the transfer i have been getting cramping pains like i am getting my period and i also feel really bloated.PLZ help me i am really scared have i got anything to worry about.

DrG said...

Hi Kokomo35,

Unfortunately subjective feelings are just that so we really never know for sure until we check a pregnancy test. I have seen it both ways: pregnant patients with no symptoms so they stopped all medications and non-pregnant patients so sure that they were pregnant that they refuse to stop their prog....

Good luck

DrG

llane said...

Dr Gordon,

Do you know if part of the coil was still present in the uterine cavity? I had an Essure about 10 years ago. Now that I am remarried my husband and I would like to have a child together. Unfortunately, my left coil is still partially in the uterus (about 5 loops of the coils). I do not know if it is encapsulated. Congrats on the success of the NC with the Essure! I hope the pregnancy has progressed beautifully!

DrG said...

Hi llane (9/9/12)

I am pretty sure that the essure was partially protruding into the cavity. I think that it would be OK to give it a try with the Essure in place as removing the Essure is not simple....

Good luck

DrG

Anonymous said...

Hi Dr.... I had essure put in 3 years ago but have now had second thoughts on having more children. Im 38 and have had issues with diverticulitis and had a sigmoid colectomy last year along with the repair of 4 hernia's. I'm in good health now but will my previous health issues impact a physican's choice to do IVF or a reversal?