Statement on intrauterine devices.
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Numerous studies have reported IUD-related events in evaluating the rates of pregnancy, expulsion, and removal for bleeding and pain, but the inability to successfully insert an IUD has been overlooked. This study analyzed data on 51 unsuccessful insertions from 22 international centers collected on standard forms. The incidence of insertion failures was estimated to be between 2.3 and 8.3/1000 attempted insertions. No statistically significant risk factors in patient characteristics were delineated through a case-control analysis. The incidence of insertion failures among postpartum cases was highest for the Delta Loop (16.8/1000 insertions). Data suggest that failure to successfully insert an IUD may not be directly attributable to any specific host characteristic but rather is contingent on agent (IUD type) and provider (inserter) factors.
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A randomized study was conducted to compare the clinical performance of the ML Cu 25-standard and the ML Cu 250-short devices. 375 insertions were performed postmenstrually to mainly parous women 16-43 years of age. Over 90% of the women in both IUD groups had uterine sound lengths from 7-9 cm. The rates are based on the total of 4273 woman months of use. The lost-to-follow-up rates at 12 months were 6.7 and 4.6% for standard and short ML series, respectively. The ML Cu 250-standard had a lower pregnancy rate and a lower removal rate for bleeding and/or pain, but a higher expulsion rate that the short model. However, these differences were not statistically significant. The shortening of the vertical arm of the Multiload device has no remarkable effect on its clinical performance.
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The nylon T IUD is identical to the copper T 200 except for the composition of nylon/copper. A study conducted at the Family Planning Institute in Ljubljana, Yugoslavia compared the nylon T with the copper T. Devices were randomly administered to women who had not been pregnant during the month prior to insertion. The pregnancy rate for the nylon T group was 13.0 at 12 months, significantly higher (Por= 0.01) than the rate of 0.0 for the copper T group. Effectiveness of copper devices is related to the copper itself, rather than being an effect of the increased surface area alone.
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