Contraceptive Coil Removal

Essure® is the trade name for a contraceptive coil device marketed as a permanent, non-surgical transcervical sterilization procedure for females. It was developed by Conceptus Inc., which is now a wholly-owned subsidiary of Bayer AG. This method of birth control was approved for use in USA by the F.D.A. in November 2002. In contrast, use of Essure® for management of tubal disease before IVF has never been evaluated by the F.D.A. and remains “off label”.

In a 2014 study, the product was found to have a high contraceptive failure rate: Pregnancy rates in the first year were 57 per 1,000 women, compared to only 3 to 7 per 1,000 women who underwent standard tubal ligation. Numerous women have also complained of serious side effects associated with a sharply negative quality of life subsequent to placement of the devices. In response to the public outcry, Erin Brockovich developed a highly-accessed website where patients can share their personal stories describing their troubles after having the procedure.

From a medical perspective, the literature on the non-F.D.A. approved use of Essure® before IVF has been mostly favorable. A recent review of the peer-reviewed literature covering use of Essure® before IVF revealed every published work but one supports use of Essure® before embryo transfer. Dr. Sills was the senior author on this “outlier” article, which was the first to call for removal of Essure® implants before IVF as a way to improve pregnancy rates and reduce incidence of miscarriage.

Dr. Sills is one of the few fellowship-trained fertility experts in the United States with surgical experience in laparoscopic (out-patient) Essure® removal. He continues to publish his findings so that patients—and other physicians—around the world can better understand which surgical techniques work best in specific clinical settings.

Surgical Removal of Contraceptive Coils
Frequently Asked Questions

I had these coils placed several years ago and really want them removed, but I am not sure about IVF later. Can Dr. Sills still help me?

Maybe. Dr. Sills’ primary clinical practice is centered on assisting those who want to achieve a healthy pregnancy, so operating on other patients who do not intend to do IVF is only possible if surgical schedules permit.

How is the actual removal surgery done?

In most situations, the procedure is in two stages completed in sequence on the same day. The first part of the surgery is called hysteroscopy, where the interior of the uterus is carefully examined from the cervix (this does not require any incision). This is important because the presence of trailing Essure® coils inside the uterine cavity will influence the surgical approach and must be documented before removal. Next, laparoscopy is done to remove the tubal segments with the device intact (i.e., the implant plus surrounding tissue is taken out). Procedure time for the entire case is generally about 60min, although the presence of scar tissue or other features could prolong some cases. Because laparoscopy is minimally invasive surgery, it can be done on an outpatient basis and no overnight hospital stay is typically required.

What are the risks of surgical removal of contraceptive coils?

Laparoscopy is often preferred to traditional “open” abdominal surgery because it is a generally safe alternative with reduced bleeding and faster recovery time. But laparoscopy is still surgery, and the absolute risk is never zero. Dr. Sills will discuss the risks of surgery with his patients before any decision is made to proceed.

One of the main risks associated with laparoscopy is injury as a result of trocar placement. The trocar is the device that is inserted into the abdomen at the beginning of surgery so that other tools can be passed through it to access and view the operation area. Risks of coil removal surgery include injury to tissues near the surgical site, blood vessel penetration, and infection. Vascular injury can cause life threatening hemorrhage and bowel injury can lead to peritonitis. These risks are higher for obese patients or those with a history of prior abdominal surgery.

The insertion of these coils was extremely painful. Am I going to be fully asleep during this removal procedure?
Yes, the surgery is performed under general anesthesia. Post-operative pain medication is not usually needed, but Dr. Sills assesses each case individually.

What is the usual recovery time after this surgery?

2-4 weeks.

What is the difference between removal and reversal?

There is a huge difference. “Removal” means surgically taking the device out. “Reversal” means attempting to restore the Fallopian tubes to the way they were before Essure® was there in the first place. Remember that the mechanism of action for contraceptive coils is that they result in an inflammatory response to cause scar tissue, thus blocking the tubal opening. In Dr. Sills’ experience, it is virtually impossible to restore the tubes after being damaged by the coils in this way, and so the “Reversal” procedure is no longer offered here.

Do I get to keep my coils after they are removed?

Maybe. This really depends on the facility where your surgery is performed. Some facilities have strict rules prohibiting patients retaining any tissue or devices for personal use, and stipulate that all specimens be submitted directly to pathology for evaluation.

How big is the scar after this surgery?

Dr. Sills can usually remove contraceptive coils using a 5mm laparoscope. This means that there will not be a “line” where the surgery is done, but rather there will be three “dots”. One will be in the belly-button, plus two additional laparoscopy access sites on the abdomen.

Could my case ever get published to help others who are struggling with contraceptive coils?

Perhaps, but this is only with your express permission. Medical papers take months to write, revise, submit, and undergo formal peer-review—and there’s no guarantee that anyone’s paper will ever be formally published. Dr. Sills prefers to obtain each patient’s specific written permission before surgery to allow him to use intraoperative photographs in a non-identifiable way for academic purposes. This includes submission for publication in medical articles, book chapters, or lectures specifically about the contraceptive coil removal operation. Your identity is never disclosed in any medical journal or textbook.

I don’t want to travel to California. Can Dr. Sills do my removal surgery at my local hospital?

No.

Copyright © 2015 CAG.All rights reserved.
E. Scott Sills, MD PhD and the Center for Advanced Genetics (CAG) is a reproductive medicine clinic located in Carlsbad, California USA, in North San Diego County, and serves the cities of Carlsbad, Oceanside, Vista, San Marcos, Encinitas, Escondido, Fallbrook, Bonsall, and Camp Pendleton. The fertility clinic specializes in in-vitro fertilization (IVF), frozen embryo transfer (FET), blastocyst transfer, pre-implantation genetic diagnosis/screening/testing of embryos (PGD, PGS) for possible genetic abnormalities and gender selection, Next Generation Sequencing (NGS), intra-uterine insemination (IUI), surrogacy, donor cycles, male-factor infertility, Essure® removal, treatment for recurrent pregnancy loss, and fertility preservation (egg freezing, sperm banking). Dr. Sills is published over 100 times in peer-reviewed publications and just published his book “Fighting at the Fertility Front,” a book that covers infertility, treatments, and issues that are unique to military personnel. CAG is committed to building families, including assisting those of the LGBT community. We offer low-interest fertility treatment financing to make having a baby a reality for virtually everyone.
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