1. Hysteroscopic Sterilisation ESSURE TM Sarah Wallage Gynae / SRH Consultant Aberdeen 2013

2. What is Essure ?

3. Vaginoscopy, 20 mins on table

4. Permanent IVF for subsequent pregnancy No effect on periods can have subsequent endometrial ablation Hysteroscopy not laparoscopy Not require GA Takes 3 months to work Confirmation test X ray / USS 15% need hysterosalpingogram ( HSG)

5. Who can have Essure TM Not suitable after previous tubal surgery previous endometrial ablation nickel allergy ??? immunesuppressed 6/12 + HSG Can offer if not suitable for lap sterilisation eg BMI >30 previous midline scar/ abdominoplasty not fit for GA

6. Essure TM 86-96% bilateral placement – endometrium/ tubal spasm distortion <2 % perforation/ migration - need removal <2% expulsion 1:1000 pregnancy rate after OK confirmation test ( 5yr data) Outpatient procedure if LA Back to normal within a day Must use contraception until confirmation test

7. Aberdeen experience Funding- £200 + HSG > lap steri hosp cost No unplanned overnight stay Clinic / Theatre ?? hysteroscope + kit 2 nurses 1 operator recovery – similar to IUD Cycle stage- need thin endometrium provera prep

8. Information- staff training / clerking proforma Preclinic pt info / GP awareness Demand? No increase in steri referrals 2012 Success - only 37/48 placed- ostia not clear/ tubal block Follow up - USS X ray often difficult to interpret almost all need HSG logistics/ staff / acceptability

9. Summary Another option if reversible methods are unacceptable Similar to vasectomy – no GA, recovery time and delay till effective Suitable for many women ineligible for lap steri Possible in specialised clinic setting Significant Failure rate for placing devices Confirmation test – most need HSG