Hysteroscopic sterilization in patients with a Mirena intrauterine device: transition from extended interval to permanent contraception.
OBJECTIVE
To estimate the feasibility and elucidate the benefits of performing hysteroscopic sterilization in patients who have a Mirena intrauterine device (IUD) in place.


METHODS
Retrospective case-controlled study with 3:1 ratio (Canadian Task Force Classification II-2).


METHODS
Procedures were performed in an outpatient or office setting affiliated with an academic medical center. Hysterosalpingograms were obtained and interpreted jointly by an investigator and a radiologist using standard protocol.


METHODS
Subjects included all patients undergoing hysteroscopic sterilization July 2007 thru December 2008 with a Mirena IUD in place. Patients without an IUD served as a comparison group.


METHODS
All procedures were performed with a 4.2-mm Bettocchi continuous-flow hysteroscope with saline solution insufflation. Delivery catheters were passed through a 5F operative channel. Essure implants were positioned and released per standard protocol. IUD devices were removed after confirmation of bilateral tubal occlusion. MEASUREMENTS & MAIN RESULTS: There were 12 patients currently using a Mirena IUD for contraception who elected to undergo hysteroscopic sterilization. Procedures were performed in the usual manner. Chart review identified the most recently treated patients without an IUD in place matched for age and body mass index to study patients. Recorded details included age, body mass index, parity, procedure time, placement success, and tubal occlusion. There were no significant differences between the groups with respect to any metric except completion of the 3- month hysterosalpingogram.


CONCLUSIONS
Hysteroscopic sterilization can be performed successfully with a Mirena IUD in place. Advantages include flexibility in timing of the procedure, assurance of contraception until confirmation of tubal occlusion, and increased likelihood of appropriate follow-up.
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
Jennifer M
JM
Tatalovich
Ted L
TL
Anderson
D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D020878:Device Removal; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D015907:Hysteroscopy; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D012189:Retrospective Studies; D013246:Sterilization, Tubal; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D003271:Contraceptive Agents, Female; D016912:Levonorgestrel