Hysteroscopic Sterilization Device Follow-Up Rate: Hysterosalpingogram Versus Transvaginal Ultrasound

Abstract

Study Objective To assess if follow-up confirmation testing 3 months after hysteroscopic sterilization with the Essure device improved with recommendation for transvaginal ultrasound (TVUS) versus hysterosalpingogram (HSG). Design Retrospective, observational case-controlled cohort study (Canadian Task Force classification II-2) Setting Two physician private practice in Evansville, Indiana Patients Compliance rates for a TVUS confirmation test on 100 women who underwent hysteroscopic sterilization compared to a previously published cohort of 1004 women who were scheduled to undergo HSG confirmation test. Intervention Acquisition of 3 month confirmation testing after Essure hysteroscopic sterilization Measurement and Main Results All women who underwent Essure hysteroscopic sterilization with recommendation for TVUS confirmation testing between July 2015 and January 2017 were compared to a previously published cohort of 1004 patients with recommendation for HSG confirmation testing (HSG cohort). In addition, an HSG subgroup cohort (HSG subgroup) similar in size and closest chronology to the TVUS cohort was drawn from the original 1004 patients and analyzed for HSG follow-up. Records for all patients were reviewed for demographic, procedural, confirmation testing, and outcome data. One hundred patients were identified with successful Essure device placement and a recommendation for TVUS confirmation testing. Eighty-eight (88.0%) patients returned for TVUS at 3 months. In the HSG cohort, 1004 successful Essure devices were placed and 778 patients returned for the recommended HSG follow-up (77.5%). There was a significantly higher follow-up rate for TVUS compared to the HSG cohort (88.0% vs 77.5%, p = 0.008). In the HSG subgroup, 184 patients were identified and 133 patients presented for HSG follow-up (72.3%) indicating a significantly higher follow-up rate in the TVUS cohort (88.0% vs 72.3%, p = 0.001). No pregnancies after any confirmation testing were noted. Conclusion Confirmation testing with transvaginal ultrasound rather than hysterosalpingogram 3 months after Essure device placement results in increased patient compliance that may lead to improved patient outcomes with reduction of unintended pregnancy.