title: Endometrial fluid associated with Essure implants placed before in vitro fertilization: Considerations for patient counseling and surgical management.
abstract: Essure (Bayer) received approval from the U.S. Food and Drugs Administration as a permanent non-hormonal contraceptive implant in November 2002. While the use of Essure in the management of hydrosalpinx prior to in vitro fertilization (IVF) remains off-label, it has been used specifically for this purpose since at least 2007. Although most published reports on Essure placement before IVF have been reassuring, clinical experience remains limited, and no randomized studies have demonstrated the safety or efficacy of Essure in this context. In fact, no published guidelines deal with patient selection or counseling regarding the Essure procedure specifically in the context of IVF. Although Essure is an irreversible birth control option, some patients request the surgical removal of the implants for various reasons. While these patients could eventually undergo hysterectomy, at present no standardized technique exists for simple Essure removal with conservation of the uterus. This article emphasizes new aspects of the Essure procedure, as we describe the first known association between the placement of Essure implants and the subsequent development of fluid within the uterine cavity, which resolved after the surgical removal of both devices.
authors.affiliation: Reproductive Research Section, Center for Advanced Genetics, Carlsbad, CA, USA. ; Department of Molecular and Applied Biosciences, Faculty of Science and Technology, University of Westminster, London, UK.
authors.forename: E Scott
authors.initials: ES
authors.lastname: Sills
authors.affiliation: Division of Reproductive Endocrinology, Sims IVF/The Sims Institute, Dublin, Ireland. ; Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: David J
authors.initials: DJ
authors.lastname: Walsh
authors.affiliation: Global Health Economics Unit, Vermont Center for Clinical and Translational Science, University of Vermont, College of Medicine, Burlington, VT, USA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Jones
authors.affiliation: Progenesis, La Jolla, CA, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Wood
keywords: Endometrial fluid; Essure; Fertilization in vitro; Hydrosalpinx; Laparoscopy