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Return of fertility after use of IUDs (Nova-T, MLCu250 and MLCu375).

In a randomized prospective study of three copper-containing IUDs, those women who terminated contraception in order to become pregnant were studied for return of fertility. The gross cumulative pregnancy rate was 79.3 after 11 months and 90.4 after 23 months of observation. There were no significant differences in the return of fertility related to the type of IUD, duration of use, parity or maternal age. However, parous women showed a tendency to initiate pregnancy more easily than nulliparous women (p less than 0.10). The seven women who did not conceive within 18 months of IUD removal had a fertility work-up. Five of these women later became pregnant after clomiphene stimulation. In no case could tubal pathology be identified as the sole explanation for infertility. After 35 months of observation, 95 out of 97 past users of IUDs have conceived. The use of copper-containing IUDs does not seem to affect subsequent fertility among women living in stable relationships.

Adult↗

Bacterial colonization of intrauterine devices (IUDs).

The bacterial colonizing of the intrauterine device (IUD) and its tail were studied in 152 IUDs obtained from 70 symptomless IUD wearers, 13 women with dysfunctional bleeding, 23 women with pelvic inflammatory disease, 31 women in whom the tail of an IUD was no longer visible and 17 women who were pregnant with an IUD in situ. The IUDs were either removed by the transcervical route or through a fundal incision in the uterus after hysterectomy. Most IUD were heavily contaminated by bacteria, especially Staphylococcus epidermidis, Enterococci and anaerobic Lactobacilli. The number of colonies was higher in women with dysfunctional bleeding and pelvic inflammatory disease than in others with a predominance of pathogenic bacteria, namely beta-hemolytic Streptococci, Staphylococcus aureus and Escherichia coli. Almost half of the IUDs without a tail protruding through the cervix were sterile. With pregnancy in the presence of an IUD, 71% of devices grew bacteria which were mainly anaerobic.

Bacteria↗

Factors affecting intrauterine contraceptive device performance. I. Endometrial cavity length.

The relationship of endometrial cavity length to intrauterine contraceptive device (IUD) performance was evaluated in 319 patients wearing three types of devices. The rate of events, defined as pregnancy, expulsion, or medical removal, increased significantly when the length of the IUD was equal to, exceeded, or was shorter by two or more centimeters than the length of the endometrial cavity. Total uterine length was found to be a less accurate prognostic indicator of IUD performance than endometrial cavity length alone.

Adult↗

Comparison of three different models of the copper T intrauterine contraceptive device.

A random sequential comparative study of three models of the Copper T intrauterine contraceptive device (IUD) was undertaken in 1,792 women. For 7 months, the TCu 300 and TCu 220C were randomly inserted, and then the TCu 380A and 220C were randomly inserted for the next 12 months. The log-risk method of life-table analysis of event rates was performed at the end of each of the first 3 years of use of each device. The TCu 380A had the lowest pregnancy rate during each year of use, although the difference was not significant. At the end of each of the first 2 years, the TCu 300 was removed significantly less than the TCu 220C and TCu 380A for bleeding and pain. At the end of three years, the rates of removal for bleeding and pain for the TCu 380A and TCu 300 were similar and lower than that for the TCu 220C, but the overall difference was not significant. There were no differences among the devices for any other relevant use-related reasons. The TCu 380A was removed for other medical reasons significantly more frequently than the other devices at the end of 2 and 3 years. Adjusting for parity did not alter the results. The findings of this study suggest that the copper sleeves along the horizontal arms together with copper wire on the vertical arm in the TCu 380A model provide greater protection against intrauterine pregnancy, whereas the copper sleeves along the vertical arm as in the TCu 220C caused increased removals for bleeding and pain. The TCu 380A should be studied in a larger number of patients for a longer period of time to determine its clinical effectiveness. It may become the IUD of choice for all women irrespective of parity.

Female↗

A randomized prospective study of the use-effectiveness of two methods of natural family planning.

The final results of a prospective comparative study of two methods of natural family planning indicate a significant difference in the 12 month net cumulative pregnancy rates between the ovulation and symptothermal methods. These differences are on the order of two to one in favor of the symptothermal method. Pearl pregnancy rates confirm similar differentials between the two methods. Dropout rates for both methods were high. Lack of interest or dissatisfaction with the method was the major reason for dropout training while pregnancy or desire for pregnancy were the major reasons for dropout during the formal phase of the study.

Adult↗

Discontinued use of intrauterine contraceptive device and pregnancy loss.

To evaluate the risk of spontaneous abortion among former intrauterine contraceptive device (IUD) users, we compared the contraceptive history of 328 women with a spontaneous abortion up to 28 weeks' gestation with that of 1715 women having a term delivery. A similar percentage of case and comparison subjects reported prior IUD use as well as IUD use within the year before pregnancy. However, IUD use lasting more than 12 months was associated with a 1.5-fold increase in the crude risk of spontaneous abortion up to 28 weeks' gestation (p less than 0.05), a 1.8-fold increased risk of first-trimester spontaneous abortion, and a 1.7-fold increased risk of incomplete abortion (p less than 0.01). The results were not altered by control of individual confounding factors. When confounding factors were controlled simultaneously in a multiple logistic regression analysis, the relative risks were 1.4, 1.7 and 1.6, respectively; however, they were no longer statistically significant. The results suggest that prolonged IUD use may be associated with a modest increase in risk of subsequent spontaneous abortion.

Abortion, Incomplete↗

A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices for conception and because of complications: a four-year study.

A prospective New Zealand study was started in 1982 to determine fertility rates and pregnancy outcomes after removal of copper intrauterine contraceptive devices to allow conception or because of complications. In a combined 4-year study, there were 887 removals to allow conception and 164 due to complications. Participants were 375 (35.7%) nulligravid and 676 (64.3%) gravid women. Within 48 months, 91.5% of the nulligravid and 95.7% of the gravid women had conceived. A 2-year combined study, with regard to longer use of intrauterine contraceptive devices (greater than 2 years), did not show any significant reduction in fertility or increase in ectopic gestation within 24 months. However, in gravid women of similar age distribution, there was a significant increase in the miscarriage rate, compared with use of intrauterine contraceptive devices for less than 2 years or compared with nulligravid women. In a 1-year study, removals because of complications did not cause a significant reduction in fertility or an increase in ectopic gestation, miscarriage, or preterm delivery rates within 12 months, compared with removals to allow conception.

Abortion, Spontaneous↗

Neurovascular injury during removal of levonorgestrel implants.

Injury to major neurovascular structures of the upper arm is a complication to be kept in mind, especially during difficult levonorgestrel implant removal. The risk of such an injury may be higher if the implants are inserted deeply over the brachial groove, where four major structures, namely, the basilic vein, the ulnar and median nerves, and the brachial artery, are located.

Arm↗

Pre-introductory clinical trials of Norplant implants: a comparison of seventeen countries' experience.

This report summarizes the data collected in pre-introductory Norplant implants clinical trials in 17 countries in Latin America, Asia and Africa that were coordinated by either the Population Council or Family Health International (FHI) between 1984 and 1991. A total of 16,282 women between the ages of 18 and 40 years participated in the studies with semi-annual or annual follow-up visits for up to 5 years. Gross cumulative pregnancy rates were < 0.6 per 100 women in the first year and < 1.5 in the second year in all countries. Significant differences in cumulative 5-year pregnancy rates were observed between weight groups 40-49 and 50-59 kg and between 50-59 and 60-69 kg body weight but not between 60-69 kg and those > or = 70 kg. Total cumulative discontinuation rates after five years of Norplant implants use ranged from 35.8 to 60.0 per 100 women. Younger age and low parity were associated with a higher discontinuation rate. Cumulative discontinuation rates for menstrual reasons more than doubled between the end of the first year and second year of use in 13 of 17 countries. This analysis and one previous review provide the only comparison of Norplant contraceptive system study results across a wide diversity of countries; thus allowing an appreciation of the range of clinical experience with Norplant implants and the regional differences in that experience.

Adolescent↗