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Essure ® for management of hydrosalpinx prior to in vitro fertilisation—a systematic review and pooled analysis
Author(s) -
Arora P,
Arora RS,
Cahill D
Publication year - 2014
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12533
Subject(s) - essure , hydrosalpinx , medicine , obstetrics , gynecology , in vitro fertilisation , hysterosalpingography , confidence interval , infertility , pregnancy , population , family planning , research methodology , environmental health , biology , genetics
Background Hydrosalpinges in infertile women reduce the success of in vitro fertilisation ( IVF ) by 50%. Surgical management of hydrosalpinges before IVF improves outcome but these procedures are often contraindicated in women with dense pelvic adhesions. Tubal occlusion achieved by E ssure ® via hysteroscopy provides an alternative. Objectives To conduct a systematic review on the efficacy and safety of E ssure ® in the management of hydrosalpinx before IVF . Search strategy We searched MEDLINE (January 1950 to July 2013), EMBASE (January 1980 to July 2013) and Web of Science (1899 to July 2013). We also searched reference lists of relevant articles and proceedings of relevant international conferences (2000–2013). Selection criteria All types of studies where women with suspected infertility and presence of hydrosalpinx had hysteroscopic tubal occlusion with E ssure ® before IVF . Data collection and analysis Two authors independently selected studies and extracted data. Where necessary, study authors were contacted for further data. Main results In all, 115 women in 11 studies received E ssure ® , mainly in the outpatient setting where local anaesthesia by paracervical block and/or intravenous sedation was used. Successful placement of E ssure ® was achieved in 96.5% (95% confidence interval [95% CI ] 91.1–98.9%) of women and tubal occlusion in 98.1% (95% CI 93.1–99.9%). Subsequent IVF resulted in 38.6% pregnancy rate (95% CI 30.9–46.8%), 27.9% live birth rate (95% CI 21.1–35.8%) and 28.6% combined ongoing pregnancy and live birth rate (95% CI 21.7–36.6%) per embryo transfer. Author's conclusions E ssure ® appears to be an effective option for management of hydrosalpinx in women before IVF although evidence from a randomised controlled clinical trial is lacking.