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PubMedDate not supplied

The determinants of IUD discontinuation in China: a discrete-time competing risk model analysis.

This research examines the social, demographic, and family-planning-program factors that influence the occurrence of IUD discontinuation among Chinese women, using a sample of 14,639 IUD use segments from the 1988 Chinese National Survey of Fertility and Contraceptive Prevalence. A discrete-time competing-risk event history method is employed to identify the determinants of IUD discontinuation by five kinds of reasons: contraceptive failure, expulsion, switching method, side-effects and other nonmethod-related reasons. The predictors of IUD discontinuation suggest that a number of mechanisms are in operation. Some of the determinants may reflect the effects of the family planning program; some may illustrate women's physiological and biological reactions to IUD's; some may be related to women's previous history of contraceptive use; and still others may indicate social characteristics of women that lead them to have their IUD's removed.

Adult↗
PubMed1991

Effects of various IUDs on the composition of cervical mucus.

The influence of three different intrauterine devices on the composition of cervical mucus was studied. The amount of mucin, albumin and immunoglobulin G was estimated. After the insertion of an inert IUD, a decrease in mucin was observed. During copper-IUD use the content of mucin, albumin and IgG was increased in cervical mucus, while weight was not affected. In the levonorgestrel-IUD users, ovulation was inhibited in 2 out of 8 women. Mucus weight was increased. The amounts of mucin, albumin and IgG were not changed. In an in vitro experiment the effect of copper-IUDs on autooxidation of cholesterol was studied. There was an extensive conversion of cholesterol but addition of albumin quenched the oxidation of cholesterol. It is suggested that the increased secretion of albumin induced by copper-IUD users may offer protection against copper-induced cell damage.

Body Weight↗
PubMed1981

Ultrastructural changes in human endometrium with copper and nonmedicated IUDs in utero.

Scanning and transmission electron microscopy were used for a study of the surface and glandular ultrastructure of human endometrium in the presence of different types of IUDs at comparable phases of the menstrual cycle. The aim of the study was to compare the effect of the nonmedicated with the copper and multiload copper devices to further explain the differences in their contraceptive potencies and their mechanism of action. The endometrium was evaluated at and away from the IUD; emphasis was put on the ultrastructure of endometrial gland openings, secretory activity, cellular glycogen content, ciliated cells, microvillous pattern, and kinocilia. The changes of the surface ultrastructure of the endometrium in the presence of copper IUDs were more extensive in this study than those previously reported. There seems to be a direct relationship between the amount of copper incorporated in the device, the degree of ultrastructure changes, and the area of endometrium involved. Copper devices affect the endometrial cells away from the IUD. The altered secretory function with disturbed macroapocrine secretion, the abnormality of ciliated cells, and the defective microvillous growth seem to interfere with the physiologic and functional integrity of the endometrium, reducing the chances of contraception in the presence of copper IUDs.

Cilia↗
PubMed1985

Evaluation of Copper I IUD's.

The development of the Copper 1 IUD (Cu 1) was an attempt to decrease the incidence of unpleasant side effects (primarily pain and bleeding) associated with IUD use, by reducing the size of the vector carrying the copper. The Cu 1 consists of a straight stem with crossarms in an "X" configuration, designed to anchor the IUD in place. The device was tested in 98 interval women in the Hospital Barros Luco in Santiago, Chile who were asked to return at 1, 3, 6, and 12 months post-insertion for follow-up examinations. There was only 1 removal for bleeding and pain; however, both pregnancy and expulsion rates were high at 9.0 and 16.0 respectively after 12 months. The crossarms did not keep the device in place as expected. The high pregnancy rate may have been due to the reduced size of the IUD and to increased displacement/expulsion. Future efforts to decrease IUD size will be dependent on designing an IUD which will be less easily expelled or displaced.

Americas↗
PubMed1985

A comparison of the actual and expected response following removal of an IUD.

The expected pain before insertion and immediate and 3 minutes pain response following IUD insertion was evaluated in 38 nulliparous women undergoing a 1st IUD removal. Expected pain was significantly greater than immediate pain and both were significantly greater than 3 minute pain. Immediate pain after IUD removal was positively related to expected pain, but the relationship was not strong enough to be clinically useful. IUD removal was highly significantly related to cervical resistance, and this relationship was made very much greater by the use of expected pain as a clinical parameter. IUD removal pain is probably related to IUD retention forces, and this relationship should be investigated.

Contraception↗
PubMed1983

[Clinical effects in 1136 cases of Beijing silicon rubber IUD and its effect on the endometrium].

Beijing Silicon Rubber IUD was designed by Xuan Wu Hospital and Beijing Silicon Rubber Manufacturing Research Institute in 1980. Animal experiments of the silicon rubber were done, and toxic effect studied before clinical use. 1136 cases were reported at the end of 12 months by 6 hospitals in Beijing. The followup rate was 93.75%. Life table of 12 months showed the cumulative continuation rate of the IUD was 82.45%, pregnancy rate 4.5%, expulsion rate 8.49%, removal for medical cause 3.9%, and removal for personal reasons 0.64%. Among the side effects, menstrual irregularity was 5.03%, blood discharge 6.35%, dysmenorrhea 11.95%, backache 31.1%, and leucorrhea 18.12%. Menstrual blood loss was measured in 30 cases before and after 1, 2, 3 months of insertion. The mean blood loss before insertion was 51.96 ml (51.71 +or- 15.95), while 1 month after insertion it was 62.9 ml (70.59 +or- 26.81), 2 months after insertion 71 ml, and 3 months after insertion 75 ml. The morphological endometrial change as compared with that by induced stainless steel ring is not much heavier especially in regard to glandular and stromal changes. The endometrial cytologic count of white cells of the IUD group (34 cases) in comparison with that of the control group (36 cases) was about twice as much in number. As Moyer reported, the endometrial cell count of IUD cases was about 6-10 times that of control cases. The authors consider that the cellular reaction of this IUD is not much greater than that of other types of IUDs.

Birth Rate↗
PubMed1985

Guidelines for IUD sterilization.

At its recent meetings, the IPPF International Medical Advisory Panel formulated guidelines for sterilizing bulk packaged IUDs which are supplied by IPPF to many family planning associations. They may also be supplied in the family planning field by other organizations. These guidelines are set out below to help our readers. Any of the following solutions are acceptable for sterilizing IUDs: benzalkonium chloride (1:750); aqueous iodine solution (1:2500); isopropyl alcohol (75%). The iodine solution should be freshly prepared daily as follows: 25 ml of 2% tincture of iodine in 1 liter of water, or 7 ml of 7% tincture of iodine in 1 liter of water. The IUDs and inserters should be presterilized for 24 hours in the benzalkonium chloride solution or for 10 minutes in the aqueous iodine solution or the isopropyl alcohol solution. The IUD should not be left in the benzalkonium-chloride solution for more than 24 hours at a time as the plastic may become brittle. Metal instruments should be sterilized in an autoclave or by boiling, depending on the procedure routinely used in the clinic. Chlorhexidine gluconate (Savlon) should not be used. IUDs should be stored dry, not in a sterilizing solution. At present it is not recommended that IUDs be sterilized more than 3 times.

Clinical Laboratory Techniques↗
PubMed1994

[The IUD and uterine perforation].

The intrauterine device (IUD) is an effective and relatively safe contraceptive. Approximately 15% of women of child-bearing age in Italy use the IUD. The major health risks associated with IUD use are perforation of the uterus, pregnancy (both intrauterine and ectopic), and pelvic inflammatory disease. Perforation of the uterus by an IUD is a serious complication and this is possible both during the insertion and later. Perforation of the uterus is rare, but potentially fatal. The incidence is of 0.12-0.68/1000 insertion. Although some patients have signs and symptoms suggestive of perforation (pain or bleeding), many are apparently asymptomatic at the time the diagnosis of perforation is made. Perforation is often suspected or diagnosed when the IUD string is no longer visible at the external os. A patient who has sustained a perforation is not protected against pregnancy. Numerous factors affect perforation: the type of IUD, the uterine size and position, timing of the insertion in relation to the last delivery or abortion and the experience of the clinical. Serious consequences have been described, such as severe damage to the viscera (i.e. bowel, kidney) and/or peritonitis. The diagnosis is clinical, ultrasonic, radiological and coelioscopic. Coelioscopic diagnosis makes it possible to choose the method of treatment. In experienced hands, this method is rapid, the hospitalization required short and the sequelae simple.

Adolescent↗
PubMed1993

Levonorgestrel levels in serum and uterine flushings in women bearing LNG-Cu-IUD.

Radioimmunoassay was employed to measure levonorgestrel levels in serum and uterine flushings in women using intrauterine device releasing both copper ions and levonorgestrel (LNG-Cu-IUD) after one-year insertion. In the meanwhile physical characteristics of cervical mucus have been observed in women using LNG-Cu-IUD and compared with those using Tcu-220c-IUD. The mean concentrations of levonorgestrel in serum and uterine flushings (5 ml) were 84.53 pg/ml and 266.93 pg/ml respectively. In LNG-Cu-IUD group, the cervical mucus lacking in ferny crystals had a viscosity significantly higher than that in Tcu-220c-IUD group, suggesting that the local high concentration of levonorgestrel changed the environment of the uterine cavity and the cervical mucus status.

Adult↗
PubMed1991

Prolonged intrauterine contraception: a seven-year randomized study of the levonorgestrel 20 mcg/day (LNg 20) and the Copper T380 Ag IUDS.

A levonorgestrel-releasing IUD and the Copper T 380Ag IUD were in randomized comparison for seven years in five clinics. In two other clinics the randomized study was truncated at five years, but use of the Copper T continued. No pregnancies occurred to users of either device in years 6 and 7. Cumulative pregnancy rates were 1.1 per 100 at seven years for the steroid-releasing and 1.4 per 100 for the copper-releasing IUDs. Cumulative rates of PID did not differ between devices. Infection rates appeared to be lowest during the sixth and seventh years of the study. Termination attributable to amenorrhea was the principal contributor to differences in cumulative continuation rates between devices. At the five clinics that carried the comparative study to seven years, cumulative continuation rates were 24.9 per 100 for LNg20 IUD users and 29.4 per 100 for TCu 380Ag users. Women who used either method for periods of five to seven years experienced, on average, marked to mild increases in hemoglobin as compared with levels at admission. The Copper T380 family and the LNg20 IUDs represent the most effective reversible contraceptive methods yet studied in long-term randomized trials.

Adolescent↗
PubMed1996

A comparative study of two techniques used in immediate postplacental insertion (IPPI) of the Copper T-380A IUD in Shanghai, People's Republic of China.

Chinese women in Shanghai who delivered vaginally and who chose to use an IUD for contraception received a Copper T-380A IUD inserted vaginally within 10 minutes after delivery of the placenta (i.e., immediate postplacental insertion, IPPI). Among them, 97.7% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD via ring forceps. The follow-up rate of six months was 95.2%. Using Tietze's life table method and log rank test, the expulsion and other discontinuation rates were compared at three and six months postinsertion between these two different insertion techniques. Expulsions were the main reason for discontinuation. The six-month gross cumulative expulsion rates were 13.3 and 12.7 per 100 women in the hand-insertion group and ring forceps-insertion group, respectively. Discontinuation rates for medical removals (bleeding/pain) were 2.1 and 1.0 in these two groups, respectively. Neither of the differences was statistically significant (p > 0.05). No uterine perforation, infection or pregnancy occurred. The results suggest that these two different insertion techniques do not significantly affect discontinuation rates in vaginal IPPI using the TCu 380A, and the TCu 380A appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breastfeeding and IUD placement in uterine cavity, are also analyzed and discussed in this report.

Adult↗
PubMed1983

Effects of non-medicated and copper IUDs on sperm migration.

35 women of proven fertility who were scheduled for surgical sterilization by salpingectomy were selected for this study; 15 control patients, 10 patients using the Multiload (ML) Cu 250 IUD, and 10 fitted with nonmedicated IUDs. Increased copper concentration did not affect sperm receptivity by the cervical mucus, but did significantly affect sperm motility and survival. Nonmedicated IUDs did not interfere with sperm transport in the oviduct. ML Cu IUDs inhibited sperm transport in the oviduct. The effects of the ML Cu IUD on sperm migration were more evident at the tubal level than at the cervical level.

Biology↗
PubMed1984

The lost IUD.

Ultrasonic B-scanning is a convenient method of confirming the presence of an IUD within the endometrial cavity. The acoustic properties of each device from normal uterine tissue are demonstrated according to the particular type of device used. These produce easily recognizable patterns. The value of ultrasonic scanning the the event of malposition, expulsion, perforation, and unplanned pregnancy with an IUD in situ are discussed. Ultrasonic scanning is a safe, noninvasive method of locating an IUD within the uterine cavity and thereby assessing correct placement. Difficulties encountered in localization of the IUD within the uterine cavity are also discussed. Methods of management of a misplaced IUD are further presented.

Contraception↗
PubMedDate not supplied

A colposcopic study of the effect of IUDs on cervical epithelium.

A case-control study was undertaken to investigate the effects of intrauterine contraceptive devices (IUDs) on the histology of cervical epithelium. Ninety-one women who had used IUDs for 2--13 years were case subjects and were compared with the same number of women who had never used any form of contraception (control subjects). Two subgroups were investigated, group A and group B. Group A consisted of 53 IUD users and 53 controls coming to family planning and gynecology clinics, and group B consisted of 38 IUD users and 38 controls from dysplasia clinics. Cervical cytology and colposcopically directed cervical biopsies were taken in all women. There was no difference between IUD users and control subjects in the proportion or the severity of dysplasia in either group A or group B. There was no evidence of an increase in the prevalence or severity of dysplasia with prolonged IUD use.

Adult↗
PubMed1993

Assessment of olefin-based IUD tail strings.

The "tail string" that extends from a contraceptive intrauterine device (IUD) into the vagina is an illustrative case in materials engineering design. The strings must satisfy certain criteria for strength and other properties in order to fulfill the function of providing a means of insuring that the IUD has not been ejected, and eventually of helping remove the IUD. This must be done without contributing to an additional risk of unwanted medical side effects beyond those that may be inherent in any such device. Oriented monofilament olefins appear to satisfy these criteria, and have been used successfully in several IUD designs. This article describes a study of two such monofilaments taken from new IUDs, showing how the material's processing, structure, and properties lead to effective performance as tail strings. Several types of used IUDs were also studied, to insure that nothing occurred during use that would alter the conclusions drawn from the study of new strings.

Equipment Design↗
PubMed1986

Uterine geometry and IUD-induced pain.

Sixty women using IUDs were included in two equal groups in the present study. Group I consisted of women presenting with pelvic pain for which they requested removal of the IUD, while the comparison group (group II) requested removal of the IUD for non-medical reasons. After extraction of the IUD, the Wing Sound II device was used to measure uterine cavity length and fundal transverse diameter. The uterine cavity measurements in both groups were not significantly different. When the ratios of IUD dimensions to uterine cavity measurements were compared, it was also found that there were no significant differences between groups. Factors other than discrepancies in size probably contribute to the pathogenesis of IUD-induced pain.

Adult↗
PubMed1986

Pregnancy after IUD use.

Much has been written about the risks of PID to IUD users, but very little about the subsequent fertility status of these patients. Is tubal infertility increased in an IUD user who has been asymptomatic? Does the addition of copper make the device harmless? Was the Dalkon Shield so harmful in the nulliparous woman? Our study (89 and 90% follow-up after 12-14 years) of 200 Dalkon Shield and 142 TCu-200 users allows us to answer 'No' to the three previous questions. We conclude that wearing an IUD per se does not cause infertility since all our patients who had IUDs removed for intended pregnancy did become pregnant; the addition of copper per se does not make an IUD safer although it does make it more efficient; the Dalkon Shield used in nulligravidas was not more dangerous than other types of IUD.

Female↗
PubMed1990

The role of echosonography in diagnosing IUD complications.

One hundred and one healthy women with intrauterine devices (IUDs) were studied by echosonography; 46 women had Multiload Cu375 IUD (group I), 30 Ginetik TCu220 IUD (group II) and 25 Lippes loop IUD (group III). In groups I and II echosonography was performed 30 minutes, 30 days and 3 and 6 months following insertion. Group III was investigated only when complications developed. Echosonography showed high accuracy in detecting IUD expulsion or incorrect position, and pregnancy in the IUD wearer.

Adolescent↗