Hysteroscopic sterilization in immunocompromised patients who have intrauterine devices in place: two case reports.
BACKGROUND
The micro-inserts used in the hysteroscopic sterilization procedure elicit a benign occlusive tissue response leading to permanent tubal occlusion. Little is known about whether immunosuppressed patients mount the immunological response necessary to ensure tubal occlusion. Theoretical concern for non-occlusion has limited the use of hysteroscopic sterilization in patients on immunosuppressive therapies. In all patient populations, if an intrauterine device is in place, it is usually removed at the time of hysteroscopic sterilization. Little is known about maintaining intrauterine devices during the 3-month period to tubal occlusion.


METHODS
Our patient in case 1 was a 35-year-old Hispanic woman, gravida 2, para 2002, with a history of a living donor kidney transplant. Our patient in case 2 was a 32-year-old Hispanic woman, gravida 3, para 2103, diagnosed with undifferentiated autoimmune disease. Both patients underwent hysteroscopic sterilization. In both cases, a levonorgestrel intrauterine device was in place for contraception. At the time of micro-insert placement, our patients were both on daily immunosuppressive medications, including long-term glucocorticoids. Three months after the hysteroscopic procedure, both patients had successful tubal occlusion, demonstrated by a hysterosalpingogram.


CONCLUSIONS
Hysteroscopic sterilization in an outpatient setting is a reasonable option for sterilization in immunocompromised patients on immunosuppressive therapies. Intrauterine devices can be maintained during the procedure and during the 3-month period to tubal occlusion.
Department of Obstetrics and Gynecology, Maine Medical Center, 22 Bramhall Street, Portland, ME, 04102, USA. Cladanyi5@gmail.com.
Camille
C
Ladanyi
Department of Obstetrics and Gynecology, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA, 98195, USA. carlie.field@gmail.edu.
Carlie
C
Field
Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12631 E. 17th Avenue, Room 4006, Aurora, CO, 80045, USA. Kristina.Tocce@ucdenver.edu.
Kristina
K
Tocce
D000328:Adult; D005260:Female; D006801:Humans; D007047:Hysterosalpingography; D015907:Hysteroscopy; D016867:Immunocompromised Host; D007434:Intrauterine Devices; D013246:Sterilization, Tubal / Q000379:methods*