Tissue encapsulation of the proximal Essure micro-insert from the uterine cavity following hysteroscopic sterilization.
OBJECTIVE
To assess the interaction between the trailing ends of a sterilization micro-insert extending into the uterine cavity and the surrounding uterine tissue environment over time.


METHODS
Multicenter, retrospective observational study (Canadian Task Force classification II-1).


METHODS
Hospital-based clinical research centers.


METHODS
A subset of a study population of 545 women who had undergone a hysteroscopic sterilization procedure.


METHODS
A second-look hysteroscopy was performed in 22 (20 with uterine bleeding, 2 pre IVF) of these 545 women between 4 and 43 months from the sterilization procedure.


RESULTS
Over a mean time period of 19.73 months, the trailing coils of the micro-inserts into the uterine cavity shortened from a mean of 5.7 mm to 2.0 mm and from 5.4 mm to 1.8 mm on the right and left sides, respectively. In cases observed within 12 months or fewer post-procedure, the complete tissue encapsulation of both micro-inserts had already occurred in 17% of the observations. Among cases evaluated from 13 to 43 months post-procedure, 25% evidenced complete encapsulation.


CONCLUSIONS
Two mechanisms appear to be responsible for this process. First, there is an initial mechanical "winding-in" of the micro-insert of approximately 1 rotation of its outer coil, accounting for 1 mm of its length, after release from its delivery system. Second, the tissue around the ostium appears to use the trailing coils of the micro-insert as a scaffolding structure, gradually encapsulating and excluding them from the uterine cavity. The gradual tissue exclusion of the micro-insert from the uterine cavity may make it pregnancy-compatible after in vitro fertilization and embryo transfer procedures.
Kerin
John F
JF
Flinders Reproductive Medicine, Flinders University and Flinders Medical Centre, South Australia.
Munday
David
D
Ritossa
Martin
M
Rosen
David
D
D000328:Adult; D001672:Biocompatible Materials; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000379:methods*
D001672:Biocompatible Materials