Use of IUD and subsequent fertility – follow-up after participation in a randomized ­clinical trial

Department of Epidemiology, SINTEF Health Research and Institute of Laboratory Medicine, Children's and Women's Health, Norwegian University of Technology and Science, N-7465 Trondheim, Norway.
Contraception (Impact Factor: 2.34). 03/2007; 75(2):88-92. DOI: 10.1016/j.contraception.2006.09.010
Source: PubMed


Although the IUD has been a contraceptive method for about 50 years, how it affects subsequent fertility remains controversial. The aim of our study was to examine time to pregnancy, pregnancy outcome and the need for infertility workup in a cohort of previous copper IUD users.
From May 1993 to April 1995, 957 women were included in a prospective cohort IUD study in the city of Trondheim, Norway. From this randomized clinical trial, we identified 205 women eligible for study participation. Group A comprised 109 women who removed their IUD for purposes of planning to become pregnant, while Group B comprised 96 women who became pregnant or planned pregnancy after a complicated IUD use. Data were collected through a postal questionnaire. All information from the questionnaires was validated against data kept in the medical record at the general practitioner's office or in the hospital record of women who became pregnant or started an infertility workup. All analyses were done using SPSS.
In Group A, 93.6% (102/109) of the women became pregnant. Time to conception was unaffected by parity order, duration of use and age at time for removal of the IUD. Among the seven women who did not conceive, four women cancelled pregnancy plans, while three women started an infertility workup. The distribution of intra-/extrauterine pregnancies did not differ between Groups A and B. However, significantly more pregnancies were terminated as induced abortions in Group B. The two women (2%) who did not conceive in Group B did not start an infertility workup.
In line with results from other studies, there is no evidence that prior use of a copper-containing IUD increases the risk for impaired fertility regardless of the reason for removal.

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    • "A recent follow-up prospective study examined time to pregnancy and need for fertility evaluations in women randomized to two investigational copper devices in Norway . There was no difference in these 2 fertility outcomes in women who had their IUD removed to become pregnant compared to women who discontinued the IUD because of problems [31a]. In the best-designed study examining the association between IUD use and infertility, 1895 women who had primary tubal infertility were compared with several control groups. "
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    ABSTRACT: Intrauterine contraception is the most widely used method of reversible fertility regulation in the world. Finally, IUC is undergoing a renaissance in the US and it's role will expand as new devices and systems are developed and as old biases among clinicians and women are erased. Successful fertility regulation is a defining factor of the overall health of a population; the expanded use of IUC can help achieve that public health success.
    Obstetrics and Gynecology Clinics of North America 04/2007; 34(1):91-111, ix. DOI:10.1016/j.ogc.2007.02.004 · 1.38 Impact Factor
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    ABSTRACT: unpublished not peer reviewed
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    ABSTRACT: Kurzfassung: Die intrauterine Verhütung ist eine sehr effektive Methode, die allerdings im Vergleich zur oralen hormonellen Kontrazeption noch recht selten benutzt wird. Neue Entwick- lungen auf diesem Gebiet mit kleineren, rahmen- losen, Kupfer oder Levonorgestrel freisetzen- den Systemen können zur Weiterverbreitung dieser Methode vor allem bei Jugendlichen oder kinderlosen Frauen beitragen. Jugendliche tragen zu einem unverhältnismäßig hohen Anteil unerwünschter Schwangerschaften bei. Deshalb sollten lang wirksame Methoden zur Kontrazeption als Mittel der ersten Wahl für diese Bevölkerungsgruppe erwogen werden, sei es als vorübergehende und Notfallverhütung oder direkt nach einem Schwangerschaftsabbruch. Angepasste intrauterine Systeme (IUD) sind für diese Patientengruppe besser geeignet, da das Uteruscavum gewöhnlich viel kleiner ist als bei Frauen, die geboren haben. Dies wiederum führt zu einer größeren Akzeptanz der IUD und damit zu einer Verlängerung des Anwendungs- zeitraums - eine Voraussetzung zur Minimie- rung unerwünschter Schwangerschaften. Die Überlegenheit dieser Systeme in dieser Alters- gruppe gegenüber der Pille zeigt sich in der für die Patientin leichten Anwendbarkeit ("fit and forget"). Aus Furcht vor aufsteigenden genitalen Infektionen gelten IUD nicht als Methode der ersten Wahl. Neuere Hinweise der WHO und des "American College of Obstetricians and Gyneco- logists" bestätigen jedoch, dass diese Methode verwendet werden kann und für die meisten Frauen einschließlich der Jugendlichen eine sichere Verhütung darstellt. Abstract: New intrauterine technologies for contraception and treatment in nullipa- rous adolescent and parous women. The IUD (intra uterine device) is a highly effective method of contraception that is underused. New developments in intrauterine technology, smaller frameless copper and levonorgestrel- releasing devices, could help increase the prevalence of use in adolescents and nullipa- rous women. Because adolescents and young nulliparous women contribute disproportionately to the epidemic of unintended pregnancies, long-act- ing methods of contraception, particularly IUDs, should be considered as first-line choices for in- terval, emergency and immediate post-abortal contraception in this population of women. As the uterine cavity is generally much smaller in this group than in older women, adapted IUDs may be very useful. Compatibility of the IUD with the small uterine cavity leads to high acceptability and continuation of use, a prerequisite to reduce unintended pregnancies. A strategic advantage of IUDs is that, unlike the Pill, they are genuinely 'fit and forget'. In use, they are much more effective than Pills in this age group. However, copper intrauterine de- vices do not offer protection against sexually transmitted infections (STIs) and, therefore, they are not always the methods of first choice for teenagers and nulliparous women. New evi- dence, however, from the World Health Organi- zation and the American College of Obstetri- cians and Gynecologists, shows that IUDs can be used and that they are safe for most women, including adolescents.
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