title: Twelve-year retrospective review of unintended pregnancies after Essure sterilization in the Netherlands.
abstract: OBJECTIVE
  To identify factors contributing to the occurrence of unintended pregnancies after Essure sterilization in the Netherlands. Even though Essure is a permanent method of contraception, unintended pregnancies have been reported.
  
  
  METHODS
  Retrospective case series analysis.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Thirty-five pregnancies were reported in the Netherlands after Essure sterilization from 2002 through 2014 out of 27,346 placements.
  
  
  METHODS
  Data regarding Essure placement procedure, confirmation tests, and pregnancy outcome of the reported cases were obtained and analyzed to identify a possible cause of failure.
  
  
  METHODS
  Four causes of failure were identified: perforation (n = 10), expulsion (n = 7), unilateral placement (n = 7), and luteal pregnancy (n = 2).
  
  
  RESULTS
  The occurrence of most pregnancies was related to physician noncompliance (n = 14). The other cases were associated with patient noncompliance (n = 5) or misinterpretation of the confirmation test (n = 9). Most pregnancies occurred within the first 24 months after the 3-month confirmation test (n = 23).
  
  
  CONCLUSIONS
  The results of this study show that the incidence of pregnancies after Essure sterilization is low. Most pregnancies were related to incorrect positioning of a device or unilateral placement, and seem therefore preventable. Unilateral placement without prior history of salpingectomy should always be considered as unsuccessful sterilization. Furthermore, interpretation of the confirmation tests should be done by trained physicians, and with caution. We want to emphasize the importance of strictly adhering to placement and follow-up protocols.
authors.affiliation: Department of Gynecology and Obstetrics, St. Antonius Hospital, Nieuwegein, the Netherlands. Electronic address: ehitzerd@gmail.com.
authors.forename: Emilie
authors.initials: E
authors.lastname: Hitzerd
authors.affiliation: Division of Women and Baby, Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, the Netherlands.
authors.forename: Henk W R
authors.initials: HW
authors.lastname: Schreuder
authors.affiliation: Department of Gynecology and Obstetrics, Rivierenland Hospital, Tiel, the Netherlands.
authors.forename: Michel P H
authors.initials: MP
authors.lastname: Vleugels
authors.affiliation: Department of Gynecology and Obstetrics, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Veersema
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D009426:Netherlands / Q000453:epidemiology; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D012189:Retrospective Studies; D013245:Sterilization, Reproductive / Q000379:methods / Q000639:trends*; D013997:Time Factors
keywords: Essure; failure; pregnancy; sterilization; unintended