Assessment of three-dimensional ultrasound examination classification to check the position of the tubal sterilization microinsert

Objective: To assess the accuracy of three-dimensional (3D) ultrasound to determine the position of Essure microinserts. Design: Prospective observational study. Setting: Gynecology department in a teaching hospital. Patient(s): Forty women who underwent hysteroscopic sterilization from March through October 2008. Intervention(s): Both 3D ultrasound and hysterosalpingography (HSG) were performed 3 months after the procedure to verify device position. Positions seen on 3D ultrasound were classified in four categories: a perfect position (1 + 2 + 3), a proximal position (1 + 2), a distal position (2 + 3), and a very distal position (3-only). Main Outcome and Measure(s): Microinsert position on 3D ultrasound and correlation with HSG. Result(s): Overall, 93% of the devices for 40 patients were found to have been placed successfully. The final sample comprised 64 Essure devices. HSG showed tubal patency for only three devices, all classified as 3-only. No tubal permeability was noted for the other 61 positions. This 3-only location on 3D ultrasound was statistically associated with a failure of sterilization in comparison with the other locations (3/16 [18%] vs. 0/48 [0%]). Conclusion(s): 3D ultrasound is a simple and reproducible technique to assess the position of the Essure microinsert and appears to protect most patients from the negative aspects of pelvic radiography and of HSG. Using the 3D ultrasound classification presented in this study appears to make it possible to use HSG for backup confirmation only when Essure is found to be in the 3-only position on 3D ultrasound. (Fertil Steril (R) 2010;94:2732-5. (C) 2010 by American Society for Reproductive Medicine.)