High miscarriage rate in women submitted to Essure for hydrosalpinx before embryo transfer: a systematic review and meta-analysis.

OBJECTIVES: Essure has been tested as an alternative treatment for women with hydrosalpinx before embryo transfer (ET). However, the persistence of a foreign body inside the uterine cavity might have a negative impact on pregnancy outcomes. The present systematic review aimed to identify, appraise and summarize the available evidence regarding the effectiveness and safety of using Essure for women with hydrosalpinx prior to embryo transfer.

METHODS: We searched for studies in PubMed, Scopus, CENTRAL, Web of Science and ClinicalTrials.gov and in the reference list of eligible studies. All studies including at least 10 women with hydrosalpinx submitted to Essure, any other intervention or no treatment prior to ET were considered eligible. Study selection, data extraction, and evaluation of the risk of bias were performed independently by two authors. Our outcomes were miscarriage per clinical pregnancy, singleton preterm birth per singleton live birth, live birth/ongoing pregnancy and clinical pregnancy per embryo transfer. The pooled results for each outcome and intervention were summarized as proportions with their respective 95% confidence intervals (CI), using a random-effects model.

RESULTS: Our electronic search was performed in Nov-07-2015 and 26 studies with 43 study arms were considered eligible: 8 study arms evaluating Essure, 7 study arms assessing tubal aspiration, 7 study arms appraising effects of no treatment, 12 study arms evaluating salpingectomy, 2 study arms assessing tubal division and 7 study arms evaluating tubal occlusion. When compared to no intervention, women with Essure had a higher clinical pregnancy rate per embryo transfer: 36% (95%CI=30-43%) vs. 13% (9-17%). When compared to other interventions, women with Essure had a higher miscarriage rate per clinical pregnancy: 38% (27-49%) vs. 15% (10-19%).

CONCLUSIONS: The available evidence suggests that although Essure prior to embryo transfer in women with hydrosalpinx improves the chance of achieving clinical pregnancy compared to no intervention, it is associated with a higher miscarriage rate when compared to the other interventions. Although this evidence is based on observational studies, we believe that salpingectomy should be the first option for women who are eligible to videolaparoscopy. However, it is still premature to make recommendations for women who are not eligible to surgery and randomized controlled trials are needed to clarify which is the best treatment alternative in such scenario. Registration number: PROSPERO CRD42015029140.