Essure reversal is a specialized gynecologic procedure designed to remove the coils of a past sterilization device and restore the natural pathway for conception. The Essure device, a set of metal coils placed into the fallopian tubes, works by inducing scar tissue growth to permanently block the tubes. When a woman seeks to regain fertility, the reversal surgery attempts to excise the segment of the tube containing the device and re-establish a functional connection to the uterus. This complex microsurgical repair, known as tubouterine implantation, is an option for women who wish to pursue a natural pregnancy.
The Surgical Approach
The Essure reversal is a major abdominal operation requiring general anesthesia to ensure the patient’s comfort and immobility. The procedure is most often performed through a mini-laparotomy, a small, horizontal incision typically made just above the pubic hairline. This surgical entry allows the gynecologic surgeon direct access to the uterus and fallopian tubes.
The first step involves identifying and carefully excising the portion of the fallopian tube where the Essure coils are embedded. Because the device is situated in the interstitial segment that passes through the uterine muscle, this removal requires the surgeon to cut out the scarred tissue and the coil. The goal is to preserve as much healthy fallopian tube as possible, as the final length directly impacts the chance of future pregnancy.
Once the damaged section is removed, the surgeon performs a tubouterine implantation, which is a form of microsurgical re-anastomosis. This technique involves reconnecting the healthy portion of the fallopian tube directly into a new opening created in the wall of the uterus. The re-anastomosis is done using very fine sutures under high magnification to ensure precise alignment and create a patent (open) connection.
Surgeons may use a semi-rigid stent to guide the fallopian tube segment into the uterine cavity and maintain alignment during the initial suturing process. After the reconnection is complete, the surgeon injects a dye through the cervix and uterus (chromopertubation) to confirm that the repaired fallopian tube is open and that the dye flows freely out the fimbriated end.
Factors Influencing Success
The likelihood of achieving a subsequent pregnancy is influenced by several biological and surgical factors. The most significant determinant is the patient’s age, since female fertility declines progressively after the mid-thirties due to changes in egg quality and ovarian reserve. Younger women generally have a higher chance of success.
Another factor is the length of the remaining fallopian tube after the Essure coil and scarred tissue have been removed. A longer, healthy fallopian tube remnant provides a better environment for the egg and sperm to meet and for the resulting embryo to travel to the uterus. The surgeon’s ability to minimize tissue trauma during the microsurgical re-anastomosis also significantly affects the patency of the tube and the ultimate pregnancy outcome.
The overall fertility health of both partners is also a major consideration. This includes the patient’s ovarian function, the quality of the partner’s sperm, and the presence of any other underlying fertility issues, such as endometriosis or fibroids.
Potential Health Considerations
Like any major abdominal surgery, Essure reversal carries inherent risks, including post-operative infection, bleeding, and complications related to the general anesthesia. However, there are specific health considerations unique to this procedure due to the nature of the repair near the uterus.
One of the most serious risks is an increased likelihood of an ectopic pregnancy, where a fertilized egg implants outside the uterus. The rate of ectopic pregnancy following Essure reversal is reported to be between 4% and 8% of all subsequent pregnancies. This risk is elevated because the internal lining of the fallopian tube may be damaged, hindering the embryo’s transport to the uterus.
Another potential complication is the failure of the tubes to remain open, known as re-occlusion, which can occur due to scar tissue formation at the site where the tube was reimplanted into the uterine wall. A less common but serious concern is the potential for uterine rupture during a future pregnancy, which has been reported in around 4% of cases. This risk is associated with the method of reimplantation, as the surgical repair to the uterine muscle wall can create a weakened area.
Fertility Alternatives
For women seeking pregnancy after Essure sterilization, In Vitro Fertilization (IVF) is the primary and most common alternative to surgical reversal. IVF completely bypasses the need for open fallopian tubes by retrieving eggs directly from the ovaries, fertilizing them with sperm in a laboratory setting, and then transferring the resulting embryo directly into the uterus. This method is often recommended for older patients, typically those over 40, or for couples facing additional fertility challenges, such as poor sperm quality.
IVF offers a more predictable outcome per cycle compared to the variable success rates of reversal surgery, especially in women with diminished ovarian reserve. The process involves multiple stages, and the costs accumulate with each cycle attempted. The live birth rate per IVF cycle is highly dependent on maternal age and the quality of the embryos.
While reversal surgery offers the potential for multiple, natural pregnancies over time, IVF provides a direct route to conception in a single cycle. Some data suggest that if a woman chooses IVF, the Essure devices should be surgically removed beforehand, as leaving them in place may lower the success rate of the IVF procedure.