Combining NovaSure® endometrial ablation and Essure® hysteroscopic sterilization: a feasibility study to evaluate the confirmation tests

Abstract

Since NovaSure® endometrial ablation (GEA) is not reliable as contraception, a reliable permanent contraceptive method which can be offered during the same operative session is often preferred by patients. We present a series of 24 patients treated by NovaSure® GEA followed by Essure® hysteroscopic sterilization at the same session. Bilateral placement of the micro-inserts after GEA was successful in all 24 patients. Confirmation by ultrasound and plain X-ray of the pelvis indicated a correct position in all 48 tubes. Routine follow-up by hysterosalpingography (HSG) to document bilateral tubal occlusion was only possible in 17/23 (74%) patients; these 34 tubes were blocked. In 6/23 (26%) patients, tubal occlusion could not be determined by HSG because of minimal filling of the uterine cavity with contrast medium. The latter was caused by severe uterine synechiae. All patients were satisfied with the result of GEA at 3 months; 19 women (83%) reported amenorrhea and the others, a strong reduction in menstrual blood loss. The combination of Essure® hysteroscopic sterilization and NovaSure® GEA is feasible and safe. However, after this combined approach the HSG as confirmation test is not always useful because of severe synechiae.

Amenorrhea and Endometrial Ablation: A Review and New Insights

“…Although it is attractive to combine these minimal invasive procedures a serious concern is the reliability of the hysterosalpingography (HSG) as confirmation of the sterilisation. In about 26% tubal occlusion can not be determined by HSG because of severe uterine synechiae, probably caused by the endometrial ablation (Detollenaere, 2011). Whether or not endometrial ablation can safely be performed after an earlier hysteroscopic sterilisation remains to be established.…”