A randomized comparative trial of the MLCu375, TCu220C, steel ring and uterine cavity-shaped IUDs

The evaluation of 318 intrauterine pregnancy cases with an intrauterine device

OBJECTIVE

To determine the factors affecting the pregnancies with intrauterine devices.

DESIGN AND METHODS

The intrauterine device (IUD) locations in pregnancies with IUDs referring to SSK Aegean Maternity Hospital were determined by ultrasonography (USG) in a 6 year period. Three hundred and eighteen pregnancy cases (pregnancy group) were observed together with intrauterine devices. All intervally applied IUDs were CeT380A. All demographic characteristics of the cases together with determination of IUD localizations were recorded, and these cases were compared with 300 cases (control group) using CuT380A and under routine follow-up in our clinic.

RESULTS

Ultrasonographic examination revealed IUD dislocation in 64% of 318 cases, whereas only 11% of the control group had dislocated IUDs. The difference between two groups was statistically significant. Especially in cases where the pregnancy group was less than 20 years old, IUD dislocations were recorded in 87.5%. The statistical analysis revealed a significant correlation in the distribution of IUD pregnancies according to years. When the demographic characteristics of two groups were compared, no statistically significant correlation was observed between the demographic characteristics and pregnancies with IUDs. There were 89 cases (27.9%) who decided on the continuation of IUD pregnancies. Unfortunately, 40% of these cases resulted in abortion. Only in 27% of 56 cases after IUD extraction because of IUD dislocation was miscarriage recorded. Meanwhile, 77% of the 26 cases with IUD left in the uterine cavity presented with miscarriage. Of the total of 36 miscarriages, 33% were =6 weeks pregnancy, and 27% were over 10 weeks.

CONCLUSION

IUD dislocation is a significant factor affecting IUD pregnancies. The fact that dislocation is most common in the first year reveals the necessity for more frequent controls in this period.

Contraceptive efficacy of intrauterine devices

To compare the contraceptive efficacy of various types of intrauterine devices (IUD; copper devices, Nova-T, intrauterine contraceptive systems, levonorgestrel-releasing devices), we reviewed all relevant publications on this subject that have been published over the last 2 decades. The first point to be highlighted by this review is the excellent effectiveness of IUDs, with a global cumulative pregnancy rate <2% at 5 years, whatever the type of device used. We observed a large variation in efficacy rate according to the type of IUD and also according to study design. Nevertheless, of all the types of IUDs, the levonorgestrel-releasing IUD and to a lesser extent the TCu380A IUD seem to be the most effective, with a cumulative pregnancy rate at 5 years of <0.5% for the levonorgestrel-releasing IUD and between 0.3% and 0.6% for the TCu380A IUD.

Copper containing, framed intra-uterine devices for contraception

BACKGROUND

Intrauterine devices (IUD) are safe and effective methods of long term reversible contraception. The design, and copper content as well as placement of the copper on IUDs could affect their effectiveness and side-effect profile.

OBJECTIVES

We compared different copper IUDs for their effectiveness and side effects.

SEARCH STRATEGY

Multiple electronic databases were searched with appropriate key words and names of the IUDs known to be in the market. We searched the reference lists of papers identified and contacted trialists when possible. There was no language restriction.

SELECTION CRITERIA

Randomised controlled trials comparing different IUDs were considered. Trials needed to report on clinical outcomes.

DATA COLLECTION AND ANALYSIS

Data on outcomes and trial characteristics were extracted in duplicate and independently by two reviewers. Meta-analysis results are expressed as rate difference (RD) using a fixed-effects model with 95% confidence interval (CI). In the presence of significant heterogeneity a random-effects model was applied.

MAIN RESULTS

We included 35 trials, resulting in 18 comparisons of 10 different IUDs in approximately 48,000 women. TCu380A was more effective in preventing pregnancy than MLCu375 (RD 1.70%, 95% CI 0.07% to 2.95% after 4 years of use). TCu380A was also more effective than MLCu250, TCu220 and TCu200. There tended to be fewer pregnancies with TCu380S compared to TCu380A after the first year of use, a difference which was statistically significant in the fourth year (RD -1.62%, 95% CI -3.00% to -0.24%). This occurred despite more expulsions with TCu380S (RD 3.50%, 95% CI 0.36% to 6.63% at 4 years). MLCu375 was no more effective than TCu220 at 1 year of use, or MLCu250 and NovaT up to 3 years. Compared to TCu380A or TCu380S, none of the IUDs showed any benefits in terms of bleeding or pain, or any of the other reasons for early discontinuation. None of the trials that reported events at insertion found one IUD easier to insert than another or caused less pain at insertion. There is no evidence that uterine perforation rates vary by type of device. There are minimal randomised data on IUD use in nulliparous women.

AUTHORS' CONCLUSIONS

TCu380A or TCu380S appear to be more effective than other IUDs. No IUD showed consistently lower removal rates for bleeding and pain in comparison to other IUDs. There is no evidence that any particular framed copper device is better suited to women who have not had children.

Copper containing, framed intra-uterine devices for contraception

BACKGROUND

Intrauterine devices (IUD) are safe and effective methods of long term reversible contraception. Design and copper content of IUDs could affect their effectiveness and side-effect profile.

OBJECTIVES

We compared different copper IUDs for their effectiveness and side effects.

SEARCH STRATEGY

Multiple electronic databases were searched with appropriate key words and names of the IUDs known to be in the market. We searched the reference lists of papers identified and contacted trialists when possible.

SELECTION CRITERIA

Randomised controlled trials comparing different IUDs were considered. Trials needed to report on clinical outcomes.

DATA COLLECTION AND ANALYSIS

Data on outcomes and trial characteristics were extracted in duplicate and independently by two reviewers. Meta-analysis results are expressed as rate difference (RD) using a fixed-effects model with 95% confidence interval (CI). In the presence of significant heterogeneity a random-effects model was applied.

MAIN RESULTS

We included 34 trials, resulting in 16 comparisons of different IUDs. TCu380A was more effective than MLCu375, MLCu250, TCu220 and TCu200. Changing the position of the copper on the arm of the IUD for TCu380S did not improve the efficacy of TCu380A. MLCu375 was no more effective than TCu220, at 1 year, MLCu250 to 3 years or NovaT to 3 years Compared to TCu380A, none of the IUDs showed any benefits in terms of bleeding or pain, or any of the other reasons for early discontinuation.

AUTHORS' CONCLUSIONS

TCu380A is more effective compared to other IUDs. There is no data available comparing different IUDs in special subgroups, such as nulliparous women.

Factors influencing discontinuation of intrauterine contraceptive devices: an assessment in the Indian context

Sociocultural and behavioral factors are associated with decision to use and the selection of a contraceptive method, continuation of use and reasons for discontinuation of a contraceptive. This paper tries to distinctly outline the determinants of discontinuation of the intrauterine contraceptive device (IUCD), especially in the Indian context. Data on medical reasons for discontinuation are available through clinical trials. However, sociodemographic studies provide one with a wider spectrum to analyze the factors associated with the discontinuation of IUCDs. Information on service providers can be used to improve the quality of family planning services in the country. In India, a thorough review of birth spacing methods, especially the IUCD, is needed since the surveys show a high rate of discontinuation. The emphasis in this paper is upon compilation of reasons for discontinuation of the IUCD and research thereof. The review of the literature is directed towards giving a new direction to assessment of family planning programs, especially in India where population control is largely dependent upon permanent methods. Delineation of factors is important to improve the family planning program.

Mechanism of action of intrauterine contraceptive devices and its relation to informed consent

The purposes of this review are to evaluate the available evidence for the mechanisms of action of copper-impregnated intrauterine contraceptive devices and to describe the informed consent consequences of those mechanisms. The medical literature was reviewed with the use of the Bioethics and Medline databases (1966 to present). Reports that supported or refuted the two major postulated mechanisms (interference with implantation of the fertilized ovum or spermicidal inhibition of fertilization) were assessed for their relative strength and support for the exclusivity of one or the other mechanism. The analysis of the evidence strongly suggests that the contraceptive effectiveness of intrauterine contraceptive devices is achieved by both a prefertilization spermicidal action and a postfertilization inhibition of uterine implantation. Patient informed consent for intrauterine contraceptive device insertion should include a discussion of these mechanisms of actions so as to avoid their use in patients with moral objections to postfertilization contraception.

Immediate postplacental insertion of the intrauterine device: a review of Chinese and the world's experiences

The postpartum period is an ideal time to begin contraception, as women are more highly motivated to adopt contraception at this time and it is convenient for both patients and service providers. For intrauterine device (IUD) contraception, this period offers other advantages, such as ease of insertion and minimal adverse impacts on breastfeeding. Among early studies, most postpartum insertions were performed anywhere from a few hours to seven days or more after delivery, and retention of the IUD in the uterus was poor. Since the 1970s, immediate postplacental insertion (IPPI), i.e., IUD insertion performed within 10 minutes after placental delivery, has been advocated, and fairly, low expulsion rates have been reported. Up to now, IPPI has not been widely accepted in clinics because its expulsion rate still appears to be higher than that of interval insertion. In order to further study IPPI and perfect this contraceptive technique, it is essential to comprehensively review IPPI results and compare the Chinese experience with that of the rest of the world.

The new intrauterine contraceptive devices: safe and effective

Reviews of the safety of intrauterine contraception usually are based on studies that do not reflect changes in clinical practice that have occurred over time, and that include many types of IUDs that are no longer used. Studies of insertions of the Multiload 375 and Copper T 380 performed since 1980, which more accurately reflect current clinical practice, show that these IUDs provide a high level of protection against pregnancy and are associated with low rates of complications. Current clinical opinion regarding the safety of IUDs needs to be reassessed in light of the positive safety record of these IUDs.