Salem S A, Peck A C, Salem R D, Sills E Scott
Clin Exp Obstet Gynecol. 2014;41(2):219-22.
This report describes a successful surgical approach to multiple in vitro fertilization (IVF) failures in the setting of hydrosalpinges, which had been previously treated with Essure inserts.
A non-smoking 33-year-old Caucasian G2 P0020 (body mass index: BMI = 22) attended for second opinion. Her history was significant for bilateral hydrosalpinges having been noted on hysterosalpingogram two years earlier. This was managed by hysteroscopic placement of Essure inserts bilaterally. One year later, and now with Essure in situ, the patient completed three IVF cycles elsewhere. Her first and third IVF attempts resulted in biochemical pregnancy, while human chorionic gonadotropin (hCG) was negative after the second cycle. Upon presentation at the authors' center and before beginning a fourth IVF cycle, further testing and surgical removal of the Essure devices was recommended.
Repeat hysteroscopy was unremarkable; laparoscopic bilateral salpingectomy and extirpation of Essure implants was accomplished without difficulty. Following menses, the patient initiated IVF with three embryos transferred. At day 60, a single intrauterine pregnancy was identified with positive cardiac activity (rate > 100/min). Her obstetrical course was uneventful; a healthy 4,195 gram male infant was delivered (breech) by Cesarean at 40 weeks' gestation.
Essure inserts comprise inner fibers of polyethylene terephthalate, a stainless steel coil, and a nickel-titanium coil. The product received FDA approval as a contraceptive in 2002 although its use for hydrosalpinx remains off-label. While successful outcomes with IVF following Essure placement have been reported, this is the first description of pregnancy and delivery from IVF after Essure removal. Essure may be considered for sterilization when laparoscopy is contraindicated, but experience with its use specifically for treating hydrosalpinges before IVF is limited. This observed association between prior poor IVF outcomes and Essure with subsequent delivery after surgical Essure removal is the first of its kind to be reported, and warrants further investigation.
本报告描述了一种针对输卵管积水导致多次体外受精（IVF）失败的成功手术方法，该患者此前已接受了爱舒丽植入物治疗。
一名33岁不吸烟的白种人女性，孕2产0020（体重指数：BMI = 22）前来寻求第二种意见。她的病史显示，两年前子宫输卵管造影检查发现双侧输卵管积水。对此，通过宫腔镜双侧植入爱舒丽进行处理。一年后，爱舒丽仍在原位，患者在其他地方完成了三个IVF周期。她的第一次和第三次IVF尝试导致生化妊娠，而第二次周期后人类绒毛膜促性腺激素（hCG）呈阴性。在到作者所在中心就诊并开始第四个IVF周期之前，建议进行进一步检查并手术取出爱舒丽装置。
再次宫腔镜检查未见异常；腹腔镜双侧输卵管切除术及取出爱舒丽植入物顺利完成。月经后，患者开始进行IVF并移植了三个胚胎。在第60天，确认单胎宫内妊娠且有阳性心搏（心率>100次/分钟）。她的产科过程顺利；在妊娠40周时通过剖宫产分娩了一名体重4195克健康男婴（臀位）。
爱舒丽植入物由聚对苯二甲酸乙二酯内纤维、不锈钢线圈和镍钛线圈组成。该产品于2002年获得美国食品药品监督管理局（FDA）作为避孕药具的批准，尽管其用于输卵管积水仍属于未获批准的使用范围。虽然已有报道称放置爱舒丽后IVF取得成功，但这是首次描述取出爱舒丽后IVF妊娠并分娩的情况。当腹腔镜检查禁忌时，可考虑使用爱舒丽进行绝育，但专门用于IVF前治疗输卵管积水的经验有限。此前IVF结果不佳与爱舒丽之间的关联以及手术取出爱舒丽后随后分娩的情况，是首次报道，值得进一步研究。
