Since the introduction of Essure, cited adverse events include abnormal bleeding, perforation of the uterus or fallopian tubes from device migration, and allergy or hypersensitivity reactions, especially to the nickel component (Al-Sai, 2013; IIao, 2015). Some events resulted in device removal that requires abdominal surgery (Casey, 2016; Lazorwitz, 2017). To provide more information of the risks and beneits, the Food and Drug Administration (2016) has drafted a black box warning and patient-decision checklist to aid counseling.
Because complete tubal blockage is not 100 percent, it must be conirmed by hysterosalpingography (HSG) 3 months following surgery (Bayer Healthcare, 2002). With such confirmation, eicacy rates for these devices reach 98 to 99 percent (Chudnof, 2015; Munro, 2014). In real-world settings, pregnancies following transcervical sterilization are most frequently attributed to conception before insertion or HSG and to noncompliance with HSG or its misinterpretation. Although data are limited to small case series, pregnancies conceived with Essure in place do not appear to be at increased risk from the device (Arora, 2014; Veersema, 2014).
Another insert, Adiana, also stimulates tissue ingrowth for tubal occlusion using a cylindrical, nonabsorbent silicone elastomer matrix. However, for inancial reasons, production of this device has now been discontinued by the manufacturer
Vasectomy is safer than tubal sterilization because it is less invasive and is performed with local analgesia (American College of Obstetricians and Gynecologists, 2017a). In a review to compare the two, Hendrix and associates (1999) found that, compared with vasectomy, female tubal sterilization rate, a 10-to 37 -fold failure rate, and costs three times as much.
Incision on left side of One disadvantage is that sterilizascrotum, and in tunica tion following vasectomy is not immediate. Complete release of sperm stored
V2" of duct removed
Incision on in the reproductive tract beyond the right side Ends are sealed interrupted vas deferens takes approximately 3 months or 20 ejaculations.Epididymis The American Urological Association recommends a postprocedural semen analysis at 8 to 16 weeks to document sterility (Sharlip, 2012). During the period before azoospermia is documented, another form of contraception should be used.
FIGURE 39-5 Anatomy of male reproductive system showing procedure for vasectomy.
The failure rate for vasectomy dur (Hologic, 2012). hat said, patients with these inserts may be encountered and can consider their device efective.
lthough not currently available in the United States, quinacrine pellets cause sclerosis at the tubal ostia. Placement at the uterine fundus with an IUD-type inserter method allows pellet migration into the tubal ostia. Of drawbacks, prior cancer associations have been disproved (Sokal, 201 Oa,b). Eicacy appears enhanced by technique modification. In one early cohort of 1335 treated women, pregnancy rates at 10 years were 12 percent (Sokal, 2008). Following insertion technique improvement, a 2-year failure rate of 1.2 percent was calculated by Lippes (2015).