title: Essure treatment of hydrosalpinges.
abstract: OBJECTIVE
  To describe the use of Essure microinsert placement in patients with hydrosalpinges before IVF.
  
  
  METHODS
  Retrospective case-series.
  
  
  METHODS
  An advanced endoscopic practice within a university-affiliated teaching hospital.
  
  
  METHODS
  Five women with unilateral or bilateral hydrosalpinges on transvaginal ultrasound, laparoscopy, or hysterosalpingogram who were planning further fertility therapy. In all patients, laparoscopy was felt to be relatively contraindicated because of previous extensive abdominopelvic surgery.
  
  
  METHODS
  Hysteroscopic placement of the Essure microinsert in four patients under general anesthesia. One patient underwent fluoroscopically guided placement.
  
  
  METHODS
  Placement rates and postoperative recovery, technical challenges in Essure placement, and results of subsequent treatment with IVF when available.
  
  
  RESULTS
  Successful bilateral Essure placement was confirmed in two of five patients. Unilateral placement was achieved in two of five. There were no postoperative complications. No pregnancies have occurred thus far.
  
  
  CONCLUSIONS
  Hysteroscopic placement of the Essure microinsert is a minimally invasive option for proximal tubal occlusion. In patients requiring occlusion of hydrosalpinges before IVF and with contraindications to abdominal surgery, this technique may offer a safer alternative. Preoperative documentation of proximal tubal patency helps predict placement success. Further research into this unique clinical scenario is required.
authors.affiliation: Department of Obstetrics and Gynaecology, Mt. Sinai Hospital, Toronto, Canada. JHitkari@mtsinai.on.ca
authors.forename: Jason A
authors.initials: JA
authors.lastname: Hitkari
authors.forename: Sukhbir S
authors.initials: SS
authors.lastname: Singh
authors.forename: Heather M
authors.initials: HM
authors.lastname: Shapiro
authors.forename: Nicholas
authors.initials: N
authors.lastname: Leyland
mesh_terms: D000328:Adult; D005184:Fallopian Tube Diseases / Q000209:etiology / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D012189:Retrospective Studies; D013246:Sterilization, Tubal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome