Confirmation test for hysteroscopic sterilization: a descriptive study of patient tolerability and impressions

Hector O Chapa, Gonzalo Venegas

Department of Obstetrics and Gynecology, Methodist Medical and Women’s Specialty Center, Dallas, TX, USA

Background: This retrospective descriptive study describes patient follow-up and tolerability of the post-hysteroscopic sterilization confirmation test.
Methods: Recruitment for the original sterilization procedure was from January 2008 to March 2009; subsequent confirmation test (hysterosalpingogram) capture was from March 2008 to July 2009. Patients were given a 10 cm visual analog pain scale during the hysteroscopic sterilization procedure, and took the scale with them as a take-home sheet. Following hysterosalpingography (HSG), patients received a follow-up phone call within 24 hours, and were asked to rate their pain during the hysterosalpingogram as well as during the first 2 hours following the test.
Results: Eighty-nine hysteroscopic sterilizations were performed under local paracervical block and oral nonsteroidal medication. The median immediate post-sterilization visual analog pain score was 1.9 (range 1.7–2.1, 95% confidence interval [CI] 1.3–1.5). Of the 89 sterilization procedures, 79% (n = 70) patients underwent a confirmation test using HSG. Ten percent (n = 7) of the hysterosalpinograms were performed at least 3 months after sterilization (mean 17 [range 14–20] weeks). Median intratest visual analog pain score overall (n = 70) was 1.8 (range 1.6–1.9, 95% CI 1.5–1.9). Following the test, the median visual analog pain score was 1.7 (range 1.6–1.9, 95% CI 1.4–0.18). Of the 70 patients who participated in visual analog pain score capture, 64 had a paper copy of the scale had six had it via email. Of the 19 who did not complete hysterosalpinography, five were lost to follow-up. Reasons given by the remaining 14 for noncompliance with hysterosalpinography were: a busy schedule/childcare issues (62%), fear of the test (13%), trust in the sterilization procedure alone (13%), and forgetting the appointment (12%). Of the 70 HSGs performed, 69 revealed satisfactory micro insert positions with bilateral occlusion; one was unilaterally patent at 13 weeks post-sterilization, with satisfactory micro insert position. Repeat testing 10 weeks later documented bilateral occlusion.
Conclusion: Confirmation testing for hysteroscopic sterilization is well tolerated, with favorable patient impressions after completion.

Keywords: female permanent birth control, female sterilization, Essure confirmation test, contraception