Pregnancy after Essure® placement: report of two cases

Objective To report two cases of pregnancy after placement of Essure® micro-inserts. Design Case report. Setting University-based Department of Obstetrics and Gynecology. Patient(s) Patient 1, a 38-year-old woman, presented with a positive pregnancy test 7 months after Essure® hysteroscopic sterilization. Patient 2, a 35-year-old female, became pregnant approximately 1 year after undergoing the Essure® procedure. Intervention(s) Patient 1 received obstetric ultrasounds, a prophylactic cerclage, a cesarean section, and a tubal ligation. Patient 2 underwent a postprocedure hysterosalpingogram, an obstetric ultrasound, pregnancy termination, diagnostic pelvic ultrasound, and a hysterectomy. Main Outcome Measure(s) Documentation of normal progress of pregnancy after Essure® placement. Result(s) Patient 1 carried an uncomplicated pregnancy to term with an Essure® micro-insert in place. Patient 2 became pregnant despite an hysterosalpingogram showing tubal occlusion and was ultimately found to have a micro-insert perforating the uterine wall. Conclusion(s) The presence of Essure® micro-inserts in the fallopian tubes do not appear to interfere with implantation and pregnancy. Uterine perforation by an Essure® micro-insert in proximity to the tubal ostia may mimic proper micro-insert placement and bilateral tubal occlusion on both hysterosalpingogram and saline infusion sonography.