Intrauterine DevicesAshley Krohn

Megan LeveranzMonicka Souksavong

Small object inserted through the cervix into the uterus

Protects against pregnancy Does not protect against HIV/AIDs & STDs

2000: approved in the U.S 2 types in the U.S

◦ ParaGard: copper wire◦ Mirena: releases hormones

What is an Intrauterine Device?

Made of tiny copper wire wrapped around plastic◦ Approved by FDA in 1984◦ Became available for use in 1988

Lasts up to 10-12 years Is the only copper IUD approved for use in the US

◦ In 2002 used by 1.3% of women Is about the size of a penny

◦ 1 ¼’’ across the top Copper is toxic to sperm, killing it May be used as emergency contraception if inserted

within 72 hrs 99% effective Copper IUD can inhibit expression of LIF, causing inhibition

of implantation stage (crucial stage)

ParaGard

Releases small amounts of progesterone Lasts up to 5 yrs Causes a subtle change in the endometrial

environment that impairs the implantation of egg in the uterine wall

Hormones (Progesterone &/or Progestin) reduce menstrual bleeding and cramps

Mirena

Mechanism of action◦ Not known

Prevent a developing human, already fertilized in the fallopian tube, from attaching to the endometrium of the uterus

Progesterone slowly releases that interferes with development of endometrium=no implantation

Levonorgetrel IUDs also prevent implantation Changes the lining of the uterus & fallopian tubes, affecting

movement of eggs=no fertilization Causes the mucus to become thicker=sperm cannot enter

the uterus

Uses

1902:precursors of IUD 1920: a ‘ring’ made of

surgical silk then switched to wire.◦ smaller than an inch in

diameter◦ Needed to dilate the cervix

for insertion with the wire-not the silk

1934: Japanese variation lowered the expulsion rate◦ Major problem: 1 in 10

expelled the IUD

History

Various forms of Intrauterine devices that have been used in the past

Fact: ◦ 25-30% of European women used the copper IUD and

less than 1% of Americans do◦ Dalkon Shield had over 10,000 lawsuits filed because it

allowed bacteria to travel from the vagina to the uterus causing PID due to the multifilament string- now changed to a monofilament string (similar to fishing wire)

More History

o1958: the first plastic IUD came outo1970’s: invention of the stainless steel ring and second generation Copper T-IUD

Uterus with a Dalkon shield inserted

Most cost-effective, reversible method of contraception today

Family Planning centers are usually cheaper than public clinics

Medicare and Insurance may cover some of the cost

Planned Parenthood◦ $175-$500 includes medical exam, insertion of IUD, and

follow-up visits Mirena Healthplan Coverage

◦ $585.89

Cost

Most widely used method of Reversible birth control◦ 160 million women use◦ Over 2/3rds are Chinese were it’s the most common mode

surpassing sterilization Usage measured by married women of reproductive age

◦ 1990 IUD usage 1.5% United States 18% Scandinavia 33% Russia and China 40% Kazakhstan

◦ 2008 IUD usage 0.7% North America 6.0% United Kingdom 33.1% Russia 36.4% China 36.7% Egypt 51.8% Uzbekistan

Prevalence

Worldwide IUDs are much more common Wider variety of brands are available

◦ In 2008 ten brands were available in the UK

World Views

Requires no daily attention Immediately effective after inserted 99.2-99.9% effective Allows sexual spontaneity Long-lasting Reduce menstrual

◦ Cramping◦ Bleeding

Advantages

Expulsion rate is 10% during the first year of use & higher in younger women or who have never given birth

If you become pregnant with it in, there is a 55% chance of a miscarriage

Women who have used if for 3+ years are 2 times as likely to have a tubal pregnancy than women who never used an IUD

Mirena causes ovarian cysts, and similar symptoms as the pill

Disadvantages

Insertion & removal must be done by a physician

May come out without realizing… chances are you notice too late

An individual should not use an IUD for specific reasons such as◦ Unexplained vaginal bleeding◦ PID◦ HIV/AIDs◦ Etc.

More Disadvantages

Major post fertilization effect: destruction of an early embryo in the fallopian tube

Most common contraception for its REVERSIBILITY Noxa, accumulates in the uterine lumen affects

the function and viability of gametes, decreasing rate of fertilization & lowering chances of survival of any embryo, before reaching the uterus

Ethical issues

oMany believe ‘contraception’ means to PREVENT fertilizationfrom occurringo1960s: redefined term as a method which prevents pregnancy

Federal Title X Program: Workers are taxed to help fund prevention clinics ◦ Example:

Right of confidentiality by the physician can cause harm to a minor◦ 16 yr. old girl came to Dr. Willkie’s clinic

after the clinic where she got the IUD simply told her “take an aspirin and rest”

◦ He immediate removed the device because she was experiencing “fatal blood poisoning” as a result of an infection

◦ Not able to inform her parents that she may be infertile now

Economic Issues

Federal Title X Program gives rise to societal issues

Conservatives fear that funding promotes premarital sex and decreases abstinence

IUD commercials such as Mirena are frequently aired on networks that are viewed by young adults◦ ABC◦ TLC◦ E!◦ Oxygen◦ MTV

Societal issues

IUDs have made major strides in the past century Are 99.2-99.9% effective Popular in many countries around the world IUDs have raised many concerns

◦ Ethical◦ Moral◦ Economic◦ Societal

Is the most common REVERSIBLE mode of contraception◦ Allows fertilization but then inhibits the implantation into

the uterine wall

Conclusion

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