Intrauterine contraceptive devices for diabetics.
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Serum concentrations of the immunoglobulins IgG, IgM and IgA were assayed by single radial immunodiffusion in 37 women before insertion of Copper T IUD and 6 to 12 months subsequently. There was a tendency towards an increase in immuno-globulin levels with the IUD in situ, but the results were not of statistical significance.
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Reported in this paper is a case of bilateral tubal pregnancies, differing by gestational age, in one and the same woman, 31 years of age, who used an intra-uterine device. A combination of two pregnancies, resulting from two independent conceptions, is assumed because of the given case history and histological findings.
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Data from the Fertility and Contraception Survey undertaken in the Jilin Province in 1988 were used to examine both the rates of side effects and discontinuation among women using intrauterine devices (IUDs). The results show that among the 1,912 first time IUD users, the combined side effects rate comprising excessive bleeding, irregular menstruation, or abdominal pain was 11.7 percent; 0.2 percent of first time IUD users became seriously ill due to faulty insertion techniques. The gross cumulative failure rates at the end of the first, second and third year following insertion were 5.3%, 9.2% and 11.9%, respectively. Total gross cumulative discontinuation rates for these three time periods were 9.9%, 19.3%, and 28.3%, respectively. It was also found that selected social and service factors such as nationality, farm/non-farm residency, medical institution where the insertion was provided, interval between the data of last pregnancy and the date of the insertion, and the number of children at the time of insertion were associated with IUD-related side effects and/or discontinuation. The findings are further discussed with respect to governmental intervention in regulating family size, in terms of the reliability of the self-reported data, and other IUD related effects.
Already in 1909 methods of an intrauterine contraception were indicated in Germany. Their practical use was intiated twenty years later by Ernst Graefenberg. Further development almost exclusively takes place in the USA, whereas the major part of basic investigations has been done. The introduction of copper bearing IUD's undoubtedly increased the safety of intrauterine contraception. Investigations concerning the morphology of the endometrial contact area (f.e. by SEM) and the evaluation of certain biochemical facts associated with the release of copper ions, lead to hypotheses of the mode of action. A randomized comparative study of CuT 200 verus Lippes Loop D demonstrates similar pregnancy rates with both types of IUD, but a moderate advantage of the CuT 200 in regard of the expulsion rate and the removal rates due to bleeding and/or pains. The author stresses that it might be medically indicated to terminate pregnancy when a woman has conceived in spite of a copper bearing IUD in situ. His statement is in correspondence to the recommendations of the Population Council, but nevertheless, this problem as yet is far of being solved unanimously. Most complications associated with the IUD are due to incorrect insertion. It is therefore postulated to insert the IUD menstrually, maintaining strictly sterile conditions, a non-deformed uterus being hooked on a bullet forceps. As already anticipated by Ludwig Fraenkel a careful insertion should be done by experienced doctors only, this fact counteracting the widespread use of this contraceptive method to be in the second place as compared to hormonal contraception.
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