title: Hysteroscopic hydrosalpinx occlusion with Essure device in IVF patients when salpingectomy or laparoscopy is contraindicated.
abstract: OBJECTIVE
  To evaluate, in patients with hydrosalpinges, the effect on in vitro fertilization (IVF) outcome of the insertion by hysteroscopy of an intratubal blocking device, in cases where laparoscopic salpingectomy or laparoscopy was contraindicated.
  
  
  METHODS
  A prospective interventional case series study was conducted in fifteen women with unilateral (N=6) or bilateral hydrosalpinges (N=9) submitted for IVF. In all of them, laparoscopic salpingectomy was contraindicated. Hysteroscopic insertion of the Essure intratubal device in a consultation room setting was performed. IVF results were compared with those of women where hydrosalpinx was treated by laparoscopic salpingectomy (48 women, 76 cycles).
  
  
  RESULTS
  There were no complications during or immediately after the procedure in any of the patients. There were four pregnancies from 16 embryo-transfers with own oocytes, one spontaneous pregnancy after unilateral Essure insertion, and one pregnancy after oocyte donation. In one case the hydrosalpinx grew and pelvic inflammatory disease developed 6 months after the insertion, requiring bilateral adnexectomy. Although not of statistical significance, IVF pregnancy rates were somewhat lower than in the laparoscopic salpingectomy group, which was attributed to the lower ovarian reserve before Essure insertion.
  
  
  CONCLUSIONS
  The hysteroscopic insertion of the Essure intratubal device prior to IVF is a reasonable option in cases where laparoscopic salpingectomy is contraindicated. Larger series are required to assess pregnancy outcome.
authors.affiliation: Human Reproduction Unity, Department of Gynecology and Obstetrics, Hospital from Cruces, Basque Country University, Baracaldo, Vizcaya, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Matorras
authors.forename: Aintzane
authors.initials: A
authors.lastname: Rabanal
authors.forename: Begoña
authors.initials: B
authors.lastname: Prieto
authors.forename: Santiago
authors.initials: S
authors.lastname: Diez
authors.forename: Iñaki
authors.initials: I
authors.lastname: Brouard
authors.forename: Rosario
authors.initials: R
authors.lastname: Mendoza
authors.forename: Antonia
authors.initials: A
authors.lastname: Exposito
mesh_terms: D000328:Adult; D000075202:Contraindications; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D015907:Hysteroscopy; D010535:Laparoscopy; D011247:Pregnancy; D011446:Prospective Studies; D058994:Salpingectomy; D012488:Salpingitis / Q000601:surgery*; D013246:Sterilization, Tubal / Q000295:instrumentation*