LYON, France — Essure implants arrived on the market in 2002 as permanent contraception for women older than age 45 years with children. They were recalled in 2017. Presented as an alternative to laparoscopic tubal ligation, this medical device resulted in rare side effects affecting thousands of women, most notably the nervous system, cardiovascular system, endocrine system, and musculoskeletal system.
Implant Analysis Protocol
A team from Lyon studied the wear debris from these medical devices and their possible toxic health effects. They discovered that tin could be the cause of the implant's toxicity. "My research focuses on a variety of medical devices, mostly joint replacements, and more specifically, hip replacements. I look at how these materials behave in humans and how the wear debris affects the body," explained Ana Maria Trunfio-Sfarghiu, bioengineering expert and research associate with the French National Center for Scientific Research at the Lyon National Institute of Applied Sciences' Contact and Structure Mechanics Laboratory.
"The problems with Essure implants started with a woman who had been using one for about 10 years and was experiencing side effects such as trouble concentrating and focusing, significant vaginal bleeding, extreme tiredness, hair loss, etc. She had the implant removed, and we retrieved it from her gynecologist and analyzed it alongside other implants," said Trunfio-Sfarghiu.
"Together with the hospital, we set up an implant analysis protocol. We visited hospital teams to demonstrate how to prepare the biopsies, embedded in paraffin blocks, before sending them to us for analysis. We gave the same specimen preparation instructions for all subjects," Trunfio-Sfarghiu explained.
After a year of clinical analysis, the Journal of Trace Elements in Medicine and Biology published an article about 18 cases.
Implant Weld Corrosion
The Essure implant measures a few centimeters long and resembles a small spring. Once released inside the fallopian tube, its goal is to create inflammation and block the tube. It triggers fibrosis, which prevents the sperm from reaching the egg. Premarketing tests had shown that the fibrosis surrounding the implant would keep it from moving. However, the pharmaceutical company hadn't assessed the mechanical integrity of the spring weld, which was made of silver-tin.
During their analysis in collaboration with the Minapath laboratory, Trunfio-Sfarghiu's team found that the weld had corroded and that tin particles had been released into the subjects' bodies. "The study included about 40 women, and we found tin in all of them," said Trunfio-Sfarghiu.
This weld corrosion has several possible consequences. "When the implant degrades, it can travel anywhere in the pelvis, like a needle moving through the body with no apparent destination. The surgeons who operate to remove it describe similar surgeries in military medicine when the patient has been hit by a bullet!"
Although tin is not especially toxic for the body when ingested, it can bind to organic compounds if it passes through to the blood. "When tin binds to a carbon atom, it becomes organotin, a neurotoxin," said Trunfio-Sfarghiu.
She believes that this organotin can travel to the brain and trigger symptoms like those found in patients with Essure implants. "For the time being, there is insufficient data to assert that we found organotin in all subjects. Another more in-depth study would be needed to assess migration to the brain. For the past 2 years, we have tried to obtain academic funding to continue our research, so far without success. Academic and political authorities seem to be a bit scared of what we've found," said Trunfio-Sfarghiu.
For her, "it's how the implant was marketed that is problematic. The implant was designed to create local inflammation, inflammation in itself being difficult to control. Some women need to have their entire uterus and ovaries removed to resolve problems caused by the implant."
Harm in the United States
Trunfio-Sfarghiu's research has helped American victims obtain acknowledgment of their suffering in the United States. "But the harm caused to women by defective implants has yet to be acknowledged in France," she added.
She explained that Essure was recalled in 2017 because sales were poor, not because it was deemed dangerous. Her conclusion? "No implant that creates inflammation should be authorized, especially if there is a surgical alternative, which there is here: tubal ligation."
This article was translated from the Medscape French edition.
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Cite this: Tin in Permanent Contraception ImplantsCauses Toxicity - Medscape - May 31, 2022.