Essure – Permanent Birth Control UR Medicine Ob/Gyn

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Essure – Permanent Birth Control UR Medicine Ob/Gyn What is Essure? Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. It is a type of tubal ligation, meaning that it is NOT reversible. You need to be sure you do not want any children in the future. How does it work? Unlike other permanent birth control, the Essure procedure does not require cutting into the body to “tie” the fallopian tubes. Instead, your doctor places flexible inserts through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes. There are no hormones and Essure will NOT interfere with your natural menstrual periods. To use Essure, a health care provider puts a tiny insert called a micro-insert coil into each of the fallopian tubes. Once in place, the inserts cause natural tissue to grow, blocking the tubes. This may be done in the office or in the operating room. You may be offered other medication to help you relax and reduce your discomfort. Some women report mild to moderate pain while the inserts are being placed if it is done in the office. A small, tube-like instrument with a camera, called a hysteroscope, is inserted into the vagina and through the cervix. The inserts are placed in the opening of the tubes. Unlike a tubal ligation, Essure is not effective right away. You must use a backup method of birth control for three months after the procedure. Three months after insertion, a special x-ray (HSG) is performed to make sure the tubes are fully blocked. What are the Pros and Cons of Essure? Pros Cons Very effective – 99.5% effectiveness Requires a procedure and sometimes anesthesia No surgery or scars; easy recovery Not effective right away – you need an x-ray 3 months later and another form of birth control for those 3 months What are the risks with Essure? - Small possibility of inserts not being able to be placed, and the need for a follow up procedure (HSG) - Rarely, the uterus may be injured during the procedure, and may require surgery - Infections or heavy bleeding are uncommon How much does it cost? Essure can cost several hundred dollars, but is covered by most insurance providers. For more information, please visit: www.bedsider.org www.essure.com http://www.plannedparenthood.org/health-topics/birth-control/sterilization-women-4248.htm .

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Counseling Issues in Tubal Sterilization I
Counseling Issues in Tubal Sterilization I. CORI BAILL, M.D., The Menopause Center, Orlando, Florida VANESSA E. CULLINS, M.D., M.P.H., M.B.A., Planned Parenthood Federation of America, New York, New York SANGEETA PATI, M.D., Washington, D.C. Female sterilization is the number one contraceptive choice among women in the United States. Counseling issues include ensuring that the woman understands the permanence of O A patient informa- the procedure and knowing the factors that correlate with future regret. The clinician should tion handout on tubal sterilization, written be aware of the cumulative failure rate of the procedure, which is reported to be about 1.85 by the authors of this percent during a 10-year period. Complications of tubal sterilization include problems with article, is provided on anesthesia, hemorrhage, organ damage, and mortality. Some women who undergo tubal lig- page 1301. ation may experience increased sexual satisfaction. While the procedure is commonly per- formed postpartum, it can be done readily, without relation to recent pregnancy, by laparoscopy or, when available, by minilaparotomy. Surgery should be timed immediately postpartum, or coincide with the first half of the woman’s menstrual cycle or during a time period when the woman is using a reliable form of contraception. (Am Fam Physician 2003;67:1287-94,1301-2. Copyright© 2003 American Academy of Family Physicians.) emale sterilization is the most com- In the United States, interval sterilizations are monly used “modern”contraceptive usually same-day procedures performed under in the United States.1,2 The most general anesthesia in an outpatient facility.5 recent cycle of the National Survey Most U.S.
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Essure Removal Reference Number: CP.MP.131 Coding Implications Last Review Date: 10/20 Revision Log
Clinical Policy: Essure Removal Reference Number: CP.MP.131 Coding Implications Last Review Date: 10/20 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Description This policy describes the medical necessity requirements for the removal of Essure®, a permanent birth control method that involves the bilateral placement of coils into the fallopian tubes, which results in the development of scar tissue and occlusion of the fallopian tubes. Policy/Criteria I. It is the policy of health plans affiliated with Centene Corporation® that the removal of Essure is medically necessary when meeting all of the following: A. Symptoms related to the device such as abdominal/pelvic pain or heavy/irregular menses not related to other gynecologic pathologies, device migration, or nickel allergy/hypersensitivity; B. Performed by a gynecologist or surgeon experienced in removing the device; C. Radiologic evaluation to determine the device location; D. One of the following procedures: 1. Hysteroscopy if ≤ 7 weeks post-placement; 2. Laparoscopy or laparotomy for one of the following: a. Linear salpingotomy, salpingostomy, or salpingo-oophorectomy; b. Cornual resection and repair; c. Removal of devices that have migrated from the fallopian tubes. Background Essure is a form of permanent birth control that can be performed in an office setting and does not require incisions or general anesthesia. It involves the placement of spring-like devices into the proximal section of each fallopian tube via hysteroscopy. Over the next three months, scar tissue forms around the Essure coils facilitating insert retention and pregnancy prevention. The build-up of tissue creates a barrier to block sperm from reaching the eggs, preventing pregnancy.
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Essure Post-Procedure Management Please see Important Safety Information, including Boxed Warning, on slides 3-8 of this presentation. For important information about Essure®, please see the accompanying Instructions for Use, including Boxed Warning. PP-250-US-1847 April2018 Table of Contents • Important Safety Information • Essure Post-Procedure Responsibilities • Essure Post-Procedure Adverse Events • Essure Confirmation Test • Interactions with Other Procedures • Management of Patients Unable to Rely • Insert Removal 2 Please see Important Safety Information, including Boxed Warning, on slides 3-8 of this presentation. For important information about Essure®, please see the accompanying Instructions for Use, including Boxed Warning. Indication and Important Safety Information Indication • Essure® is indicated for women who desire permanent birth control (female sterilization) by bilateral occlusion of the fallopian tubes. Important Safety Information WARNING: Some patients implanted with the Essure System for Permanent Birth Control have experienced and/or reported adverse events, including perforation of the uterus and/or fallopian tubes, identification of inserts in the abdominal or pelvic cavity, persistent pain, and suspected allergic or hypersensitivity reactions. If the device needs to be removed to address such an adverse event, a surgical procedure will be required. This information should be shared with patients considering sterilization with the Essure System for Permanent Birth Control during discussion of the benefits and risks of the device. IMPORTANT: • Caution: Federal law restricts this device to sale by or on the order of a physician. Device to be used only by physicians who are knowledgeable hysteroscopists; have read and understood the Instructions for Use and Physician Training Manual; and have successfully completed the Essure training program, including preceptoring in placement until competency is established, typically 5 cases.
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Table 7 Pregnancy Rates for Temporary Birth Control Method^^,^-^,* ;OB.^ I Iw1" ($1I -Wj
Anesthesia-Medically induced partial or complete loss of sensation, in all or part of the body, with or without loss of consciousness. General anesthesia is total loss of' consciousness and sensation Cervix-The passageway that connects the vagina to the uterus Contraceptive-Any process, device, or method that reduces the likelihood of pregnancy Delivery Catheter-A long tube-like device that helps the doctor place the Essure micro-inserts in the fallopian tubes Ectopic Pregnancy-The development of a fertilized egg outside of the uterus, but inside the body Expulsion-Forcing (expelling) something out Fallopian Tubes-The tubes that carry the eggs from the ovaries to the uterus Hystcrosalpingogram (HSG)-An X ray of the uterus and fallopian tubes after they have been filled with dye (contrast medium) Hysteroscope-A telescope-like instrument, which is used to view the inside of the uterus In Vitro Fertilization (rVF)-Fertilization of an egg outside of the body, followed by placement of the fertilized egg into the uterus Intrauterine Device (IUD)/Intrauterine System (IUS)-A medical device that is put into the uterus to prevent pregnancy Irreversible-Cannot be changed back to its original state Local Anesthetic-Medicine that is applied to or injected in a certain spot in the body to cause a loss of sensation in that part of the body Major Surgery-Surgery that requires general anesthesia and incisions in the body Micro-insert-A small, flexible, coil-type device that is put into your fallopian tube for permanent pregnancy prevention Occlusion-A closed or blocked part of a hollow tube Perforation-A hole in something Permancnt-Not able to change back and forth Reversible-Able to change back and forth Tubal Ligation-Permanent female sterilization by means of cutting, tying, burning, or clipping the fallopian tubes Uterus-'l'he womb in which a developing fetus grows Vasectomy-Permanent male sterilizatioii by meatis of cutting or blocking a segment of the vas deferens (the tube that carries the sperm) A 11 011 i t1.C i s io 11 il ~~~~~~~.~~~~~~~~to jP6'rgltLIIII:tll.
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