A 25-year-old woman with one child requests permanent contraception. She undergoes hysteroscopic sterilization with the Essure microinsert. At 3-month follow-up, hysterosalpingography is performed. What is being assessed, and what is the mechanism of action of Essure?

• A Assessment of uterine cavity morphology; Essure microinsert delivers progesterone locally to prevent fertilization
• B Assessment of cornual patency; Essure microinsert contains nickel-titanium coil that induces a local fibrotic inflammatory reaction causing tubal occlusion over 3 months ✓
• C Assessment of tubal spasm; Essure is a biodegradable plug that dissolves after 3 months to cause permanent occlusion
• D Assessment of cornual anatomy; Essure microinsert uses microwave energy to ablate tubal epithelium

Explanation

Essure is a hysteroscopic permanent contraception device consisting of a flexible microinsert made of nitinol (nickel-titanium alloy) and polyethylene terephthalate (PET) fibers placed into the fallopian tube ostia. The PET fibers induce a chronic benign foreign-body inflammatory response in the tubal lumen, stimulating fibroblast proliferation and fibrous tissue ingrowth that occludes the tube over approximately 3 months. The 3-month confirmatory hysterosalpingogram (HSG) verifies bilateral tubal occlusion before relying on Essure as sole contraception. Women must use backup contraception for 3 months. Note: Essure was withdrawn from many markets (including USA in 2019) due to adverse event reports, but its mechanism remains a tested topic in NEET PG.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.