Essure is the trade name for bilateral tubal occlusion. This is a permanent sterilization procedure for women that can be performed in the doctor’s office with minimal or no anesthetic. Male sterilization is called vasectomy. The Essure procedure is performed by placing a small camera through the vagina into the uterus. Micro-inserts are then placed into the fallopian tubes on both sides. The camera is withdrawn and the patient is allowed to go home. Total time in the office for this procedure is about 30 – 45 minutes. Recovery is minimal and most women report minimal or no pain. The Essure is very effective and there is less than 1% lifetime risk of pregnancy 3 months after the Essure procedure is performed.
The Essure tubal occlusion is permanent and irreversible, much like a tubal ligation. To be a candidate for the Essure a woman must be absolutely certain that she never wants more children. Although this is considered a permanent and irreversible procedure, in vitro fertilization (IVF) could be performed after an Essure procedure is done. IVF is a process in which a woman’s eggs are harvested and mixed with the mans sperm outside of the body. The fertilized embryo is then placed into the woman’s uterus. IVF is very expensive and not always successful.
It is often recommended that a woman be pretreated with Depo Provera, the birth control shot, prior to Essure. This serves two purposes. It thins out the lining of the uterus, making the procedure simpler and more likely to be successful. It also provides birth control while waiting for the Essure to take effect. It can take up to three months for the Essure procedure to provide contraception after it is performed. Three months after the Essure procedure, the patient will need to have a dye study called a hysterosalpingogram, or HSG. This is done in the radiology department. A speculum is placed in the vagina and dye is placed in the uterus while x-rays are taken. This confirms that the Essure has occluded the tubes and is providing contraception.
Essure tubal occlusion has advantages and disadvantages over the traditional bilateral tubal ligation (BTL). The primary advantage of the Essure is the minimally invasive nature of the procedure. There are no incisions, and therefore, minimal recovery and pain. Essure can be performed in an office setting with either local or no anesthesia, while BTL requires an operating room and general anesthesia. Essure requires a smaller time commitment for the procedure itself, 30 – 45 minutes compared to 4 hours for BTL. Disadvantages of the Essure are that it can take up to 3 months to become effective, while BTL is effective immediately. Essure often requires pretreatment with Depo Provera which can cause irregular bleeding for several months after the procedure. Essure requires a follow-up dye study to confirm success. This HSG can cause menstrual like cramps for some women. For many women these disadvantages are more than offset by the advantages of the minimally invasive Essure.