Expulsion of an Essure® device is a known complica-tion of the procedure and possibly occurs due to prox-imal migration whenmorethan50% of thecoilifleft in the uterine cavity. In the phase II, the expulsion rate was 0.5 % and, in pivotal trials, the expulsion rate was 2.9 %. The women were instructed not to rely on the Essure® system for birth control even when the hyster-osalpingogram (HSG) may have demonstrated occlusion of the fallopian tubes. It is possible that the expulsion of device occurs in women where inadequate fibrosis occurs to anchor the device securely. In the clinical trials for Essure®, delayed fibrosis was noted in 3 % women who needed second HSG in 6 months before tubal occlusion was confirmed. It is therefore likely that there is inadequate anchoring of the device in some women making the device prone to displacement and expulsion [1–3]. Patulous or wider diameter fallopian tubes could also be predisposed to expulsion