This has been a busy month here for patients with prior tubal ligations. Although some patients with a prior tubal ligation will opt for a surgery to reverse their tubal ligation, most will pursue IVF. The data seems to favor IVF over tubal reversal if the patient is over age 37. Of course, other factors also come into play when making this decision. The presence of male factor infertility, the ovarian reserve of the patient, the desire for additional children etc…
More recently those patients seeking sterilization have undergone hysteroscopic sterilization with Essure. Essure is a procedure in which silicone-free inserts made of a polyester fiber, nickel-titanium and stainless steel alloy titanium coils are placed into the fallopian tubes from the uterus during hysteroscopy. The resulting inflammation causes the fallopian tubes to become blocked as they exit the uterus (proximal occlusion). Patients like Essure because the procedure is done hysteroscopically and is therefore less invasive than a traditional tubal ligation performed laparoscopically.
Although there have been a few reports of pregnancies using IVF in patients with Essure inserts in place, none have been in Natural Cycle IVF to my knowledge…until now that is. I have been concerned that the presence of the inserts could decrease implantation rates. Our patient had inserts that were clearly visible on sonogram. She and her husband did not desire stimulated IVF and were much happier with the NC IVF option since no extra embryos would be created. She conceived on her 2nd NC IVF attempt and everything looks great so far on sonogram.
Essure has also been suggested as an option for patients with hydrosalpinges who need surgery to block off the tubes prior to IVF. Although several studies have looked at this option, again the numbers are pretty small but reassuring. I may consider suggesting this option in the future but would still like to see some additional published series that address this question.