title: Contraceptive failure after hysteroscopic sterilization: Analysis of clinical and demographic data from 103 unplanned pregnancies.
abstract: OBJECTIVE
  This investigation examined data on unplanned pregnancies following hysteroscopic sterilization (HS).
  
  
  METHODS
  A confidential questionnaire was used to collect data from women with medically confirmed pregnancy (n=103) registered after undergoing HS.
  
  
  RESULTS
  Mean (±SD) patient age and body mass index (BMI) were 29.5±4.6 years and 27.7±6.1 kg/m(2), respectively. Peak pregnancy incidence was reported at 10 months after HS, although <3% of unplanned pregnancies occurred within the first three months following HS. Mean (±SD) interval between HS and pregnancy was 19.6±14.9 (range, 2 to 84) months. Patients age ≥30 years and BMI <25 reported conception after HS somewhat sooner than younger patients, although the differences in time to pregnancy were not significant (P=0.24 and 0.09, respectively). The recommended post-HS hysterosalpingogram (to confirm proper placement and bilateral tubal occlusion) was obtained by 66% (68/103) of respondents.
  
  
  CONCLUSIONS
  This report is the first to provide patient-derived data on contraceptive failures after HS. While adherence to backup contraception 3 months after HS can be poor, many unintended pregnancies with HS occur long after the interval when alternate contraceptive is required. Many patients who obtain HS appear to ignore the manufacturer's guidance regarding the post-procedure hysterosalpingogram to confirm proper device placement, although limited insurance coverage likely contributes to this problem. The greatest number of unplanned pregnancies occurred 10 months after HS, but some unplanned pregnancies were reported up to 7 years later. Age, BMI, or surgical history are unlikely to predict contraceptive failure with HS. Further follow-up studies are planned to capture additional data on this issue.
authors.affiliation: Reproductive Research Section, Center for Advanced Genetics, Carlsbad, CA, USA. ; Department of Molecular & Applied Biosciences, University of Westminster, London, UK.
authors.forename: E Scott
authors.initials: ES
authors.lastname: Sills
authors.affiliation: Division of Quantitative Research, Rosenblatt Securities, Inc., New York, NY, USA.
authors.forename: Xiang
authors.initials: X
authors.lastname: Li
authors.affiliation: Global Health Economics Unit, 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: Reproductive Sciences Medical Center, San Diego, CA, USA. ; Progenesis, Inc., La Jolla, CA, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Wood
keywords: Contraception; Contraceptive failure; Essure; Pregnancy