Complex Birth Control Case Resolved at American Fertility Center

Background:

Hysteroscopic tubal sterilization (Essure) is a minimally invasive option for permanent contraception with high reported rates of patient satisfaction. Three months after the device is inserted, it is recommended that the patient undergoes a hysterosalpingogram to confirm that the fallopian tubes are blocked. Until this confirmation is performed, the patient must use a back-up form of birth control. A small percentage of these women subsequently choose to have the tubal inserts removed due to regret or perceived side effects such as late-onset pelvic pain secondary to placement of the Essure device.

Case report:

This 37 years old lady came to our center for Essure removal and tubal reanastomosis. The patient came with a two-year complaint of chronic pelvic pain, irregular cycle, and dyspareunia after the hysteroscopic placement of an Essure device for sterilization. She is P3 and all were normal vaginal deliveries with two females and one male baby, the last baby born 17 yrs. Essure was inserted in 2010. she came to us for the removal of Essure. After pre-op preparation, consent and blood work along with infectious screening, Dr. Rizwan Malik Medical Consultant at American Fertility Center did the laparotomy with pf incision and carefully dissected the fallopian tubes, removed Essure and reconnect the tubes to the uterus i-e tubal reanastomosis. This allowed the patient to reverse sterilization and conceive naturally. The intraoperative finding was notable for normal fallopian tubes and ovaries, without any evidence of endometriosis, adhesions, or any other pelvic pathology.

At the one-month postoperative and subsequent interval gynecology visits, the patient reported complete resolution of presenting pelvic symptoms. For the procedure to be successful, a clear view of the tubal Ostia is required. Also, the endometrium should be thin when the procedure is performed. This was accomplished by pretreating our patient with a progestin-containing contraceptive. After pre-treatment, the procedure performed during the cycle except for during menstruation.

Dr. Rizwan Malik performed this one of a kind surgery in Pakistan. American Fertility Center Islamabad is top class, IVF and Fertility Clinic in Pakistan. At AFC we treated hundreds of complex cases like this and give hope to people about conceiving and fight infertility.