Essure is a method of permanent birth control involving the placement of flexible metal coils into the fallopian tubes. These micro-inserts induce a localized inflammatory response, causing scar tissue to form and permanently block the tubes. This blockage prevents sperm from reaching the egg, achieving sterilization without a surgical incision. For women who later desire pregnancy, the core question is whether fertility can be restored after the surgical removal of the device.
Surgical Options for Essure Removal and Reversal
The terms “Essure removal” and “Essure reversal” describe two distinct surgical goals. Simple device removal is often performed to alleviate adverse symptoms like chronic pain or allergic reactions attributed to the coils. However, removal alone does not automatically restore the ability to conceive, as the fallopian tubes remain blocked or damaged.
Fertility restoration requires a procedure known as tubouterine anastomosis. This complex microsurgical technique involves excising the Essure coil and the surrounding scarred section of the fallopian tube. The remaining healthy segment of the tube is then reconnected and re-implanted into the uterine wall.
This procedure is significantly more difficult than a standard tubal ligation reversal because the device is placed deep inside the tube where it meets the uterus. Surgeons often use a laparoscopic approach to remove the device and perform the delicate re-implantation. The success of this surgery relies heavily on the technical skill of the surgeon and the ability to achieve a patent, functional connection.
Patient and Anatomical Factors Influencing Conception
A successful surgical reversal only addresses the physical blockage; multiple patient and anatomical variables dictate the likelihood of conception afterward. The woman’s age is the most significant predictor of live birth success, primarily because it relates to underlying egg quality and ovarian reserve.
The health and remaining length of the fallopian tube segments after the scarred tissue is removed also play a large role in post-operative function. If the tube is too short or is left with residual damage, its ability to capture the egg and transport the fertilized embryo may be impaired. The experience and specialized microsurgical training of the surgeon performing the tubouterine anastomosis are important elements. Conception attempts should also consider the partner’s sperm health, as male factors contribute to overall fertility success.
Expected Pregnancy Success Rates and Ectopic Risk
Published data suggest that the chance of achieving a pregnancy after Essure reversal ranges from approximately 26% to 40%. Live birth rates following the procedure are reported to be around 16% to 21%. These rates are generally lower than those associated with the reversal of other forms of tubal sterilization.
The possibility of an ectopic pregnancy is the most serious complication following Essure reversal. An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, most commonly within the newly reconnected fallopian tube. The risk is estimated to be around 5%. This complication arises because a reconnected tube may lack the normal ciliary function needed to propel the embryo into the uterus.
Another potential, though rare, obstetric risk is uterine rupture, which is associated with the surgical technique used to re-implant the fallopian tube into the uterus. Patients who conceive after this procedure require careful monitoring by their obstetric provider due to these unique pregnancy-related risks. The decision to pursue surgical reversal must balance the desire for natural conception against these known complications and the modest success rates.
Alternative Paths to Conception
For women seeking pregnancy after Essure placement, In Vitro Fertilization (IVF) offers a reliable alternative to surgical reversal. IVF completely bypasses the need for functional fallopian tubes by retrieving eggs and fertilizing them in a laboratory. The resulting embryo is then transferred into the uterus.
IVF offers a higher per-cycle success rate than surgical reversal, making it a preferred choice for women with additional fertility concerns. While some women have successfully undergone IVF with the Essure device still in place, removing the coils may improve live birth rates during the IVF process. For many couples, IVF provides a more direct and sometimes more cost-effective path to conception.