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La Saponara V, Wan S, Nagarkar B, Zwain F, Creinin MD. Understanding the mechanical behavior of intrauterine devices during simulated removal. Contraception 2024; 133:110399. [PMID: 38369271 DOI: 10.1016/j.contraception.2024.110399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 02/11/2024] [Indexed: 02/20/2024]
Abstract
OBJECTIVE To evaluate differences based on intrauterine device (IUD) frame geometry in force, and stress, and strain at the stem/arms junction during simulated IUD removal. STUDY DESIGN We manufactured injection-molded frame models for three Nova-T IUDs (Mirena [model M]; Liletta [model L]; Kyleena [model K]) and a Tatum-T IUD (Paragard [model P]) at two-times scaling. We created a custom fixture to simulate the uterus and used a screw-driven machine to pull models at various displacement rates through the 10 cm fixture cavity to measure force and strain and calculate stress at the IUD stem/arms junction. We tested models at 30 mm/min and higher displacement rates for exploratory analyses. We used Mann-Whitney U test for statistical testing. RESULTS We completed testing at 30 mm/min using five of each Nova-T model and nine model P samples. Resistance against the cavity walls created significantly more force on model P (11.83, interquartile range [IQR] 11.61-12.31) than any Nova-T model samples (p < 0.001). The smaller model K created slightly more median stress (MPa) than the larger model M (0.36 [IQR 0.33-0.38] and 0.79 [IQR 0.76-0.80], respectively, p = 0.008); model P samples generated significantly more median stress than other models (1.70 [IQR 1.67-1.77], p < 0.001). Strain plots demonstrated permanent deformation for some samples during IUD removal simulation. We tested 20 samples at various higher displacement rates up to 2500 mm/min, with stress notably increasing for model P samples with increasing rates. No fractures occurred. CONCLUSIONS Force and stress at the stem/arms junction are higher with Tatum-T-shaped compared to Nova-T-shaped IUD models under the same testing conditions, and a higher speed of extraction causes more stress. IMPLICATIONS Sharp corners create vulnerability under static and fatigue loading in structural components due to increased local stresses. Our findings suggest that IUDs with Tatum-T frames should be removed slowly to minimize the stress at the stem/arms junction. Future studies can provide more information if performed with commercially available products.
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Affiliation(s)
- Valeria La Saponara
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Shuhao Wan
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Bhagyashree Nagarkar
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Faress Zwain
- Department of Mechanical and Aerospace Engineering, University of California, Davis, Davis, CA, USA
| | - Mitchell D Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA.
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Hubacher D, Schreiber CA, Turok DK, Jensen JT, Creinin MD, Nanda K, White KO, Dayananda I, Teal SB, Chen PL, Chen BA, Goldberg AB, Kerns JL, Dart C, Nelson AL, Thomas MA, Archer DF, Brown JE, Castaño PM, Burke AE, Kaneshiro B, Blithe DL. Continuation rates of two different-sized copper intrauterine devices among nulliparous women: Interim 12-month results of a single-blind, randomised, multicentre trial. EClinicalMedicine 2022; 51:101554. [PMID: 35865736 PMCID: PMC9294241 DOI: 10.1016/j.eclinm.2022.101554] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The most widely used copper intrauterine device (IUD) in the world (the TCu380A), and the only product available in many countries, causes side effects and early removals for many users. These problems are exacerbated in nulliparous women, who have smaller uterine cavities compared to parous women. We compared first-year continuation rates and reasons/probabilities for early removal of the TCu380A versus a smaller Belgian copper IUD among nulliparous users. METHODS This 12-month interim report is derived from a pre-planned interim analysis of a sub population and focused on key secondary comparative endpoints. In this participant-blinded trial at 16 centres in the USA, we randomised participants aged 17-40 in a 4:1 ratio to the NT380-Mini or the TCu380A. In the first year, participants had follow-up visits at 6-weeks and 3, 6, and 12-months, and a phone contact at 9 months; we documented continued use, expulsions, and reasons for removal. Among participants with successful IUD placement, we compared probabilities of IUD continuation and specific reasons for discontinuation using log-rank tests. This trial is registered with ClinicalTrials.gov number NCT03124160 and is closed to recruitment. FINDINGS Between June 1, 2017, and February 25, 2019, we assigned 927 nulliparous women to either the NT380-Mini (n = 744) or the TCu380A (n = 183); the analysis population was 732 (NT380-Mini) and 176 (TCu380A). Participants using the NT380-Mini, compared to the TCu380A, had higher 12-month continuation rates (78·7% [95% CI: 72·9-84·5%] vs. 70·2% [95% CI: 59·7-80·7], p = 0·014), lower rates of removal for bleeding and/or pain (8·1% vs. 16·2%, p = 0·003) and lower IUD expulsion rates (4·8% vs. 8·9%, p = 0·023), respectively. INTERPRETATION The NT380-Mini offers important benefits for a nulliparous population compared to the TCu380A in the first twelve months, when pivotal experiences typically occur. Higher continuation rates with the NT380-Mini may avert disruptions in contraceptive use and help users avoid unintended pregnancy. FUNDING Bill & Melinda Gates Foundation, Eunice Kennedy Shriver National Institute of Child Health and Human Development, and Mona Lisa, N.V. (Belgium).
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Affiliation(s)
- David Hubacher
- FHI 360, Durham, NC, USA
- Corresponding author at: FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701 USA.
| | - Courtney A. Schreiber
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - David K. Turok
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT, USA
| | - Jeffrey T. Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Mitchell D. Creinin
- Department of Obstetrics and Gynecology, University of California, Davis, Sacramento, CA, USA
| | | | | | - Ila Dayananda
- Planned Parenthood Greater New York, New York, NY, USA
| | - Stephanie B. Teal
- Department of Obstetrics and Gynecology, University Hospitals Medical Center and Case Western Reserve University, Cleveland, OH, USA
| | | | - Beatrice A. Chen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh and Magee-Womens Research Institute, Pittsburgh, PA, USA
| | | | - Jennifer L. Kerns
- Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Michael A. Thomas
- Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, OH, USA
| | - David F. Archer
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Jill E. Brown
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Paula M. Castaño
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anne E. Burke
- Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - Bliss Kaneshiro
- Department of Obstetrics, Gynecology, and Women's Health, University of Hawaii, Honolulu, HI, USA
| | - Diana L. Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Baldauf P, Tönnes R, Simon S, David M. A Report on the Hysteroscopic Removal of a Gräfenberg Ring After Almost Fifty Years in Utero. Geburtshilfe Frauenheilkd 2014; 74:1023-1025. [PMID: 25484377 DOI: 10.1055/s-0034-1383130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/08/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022] Open
Abstract
A report on the hysteroscopic removal of a Gräfenberg ring after almost fifty years in utero. In addition to the differential diagnostic considerations, the medical history aspects of this case are particularly interesting.
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Affiliation(s)
- P Baldauf
- Gynaecology, Vivantes Klinikum Am Urban, Berlin
| | | | - S Simon
- Rathgen Research Laboratory, Berlin State Museum, Berlin
| | - M David
- Gynaecology Clinic, Charité Campus Virchow-Klinikum, Berlin
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4
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Influence of Drug Properties and Routes of Drug Administration on the Design of Sustained and Controlled Release Systems. ACTA ACUST UNITED AC 2013. [DOI: 10.1201/b14193-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
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Dueñas-Garcia OF, Young C. Unusual finding of a metallic intrauterine device in postmenopausal bleeding. J OBSTET GYNAECOL 2012; 32:401-2. [PMID: 22519496 DOI: 10.3109/01443615.2012.664583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- O F Dueñas-Garcia
- Department of Obstetrics and Gynecology, Bronx Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, New York 10457, USA.
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6
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Kaneshiro B, Aeby T. Long-term safety, efficacy, and patient acceptability of the intrauterine Copper T-380A contraceptive device. Int J Womens Health 2010; 2:211-20. [PMID: 21072313 PMCID: PMC2971735 DOI: 10.2147/ijwh.s6914] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Indexed: 11/23/2022] Open
Abstract
The intrauterine device (IUD), primarily in the form of the copper IUD, is used by more than 150 million women around the world, making it the most widely used reversible method of contraception. With a remarkably low failure rate of less than 1 per 100 women in the first year of use, the Copper T-380A is in the top tier of contraceptives in terms of efficacy. Risks of utilization include perforation and an increased risk of infection in the first 20 days following insertion. Overall, the number of adverse events is low, making the Copper T-380A a very safe contraceptive method. The most common reasons for the discontinuation of this method are menstrual bleeding and dysmenorrhea. However, cumulative discontinuation rates of Copper T-380A are lower than that have been reported for other methods, indicating that the Copper T-380A is highly acceptable to women. After 5 years, approximately 50% of all women, who have a Copper T-380A inserted, will continue to use this highly effective contraceptive method.
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Affiliation(s)
- Bliss Kaneshiro
- Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Tod Aeby
- Department of Obstetrics and Gynecology, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
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7
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Bluett DG. The Nova T Copper 200 Ag: a preliminary appraisal. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443618009067362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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8
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Verma U, Verma N. Ovarian embedding of a transmigrated intrauterine device: a case report and literature review. Arch Gynecol Obstet 2008; 280:275-8. [DOI: 10.1007/s00404-008-0882-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Accepted: 12/01/2008] [Indexed: 10/21/2022]
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9
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Copper-containing, framed intrauterine devices for contraception: a systematic review of randomized controlled trials. Contraception 2008; 77:318-27. [DOI: 10.1016/j.contraception.2007.12.011] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 12/21/2007] [Accepted: 12/21/2007] [Indexed: 11/22/2022]
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10
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Thonneau PF, Almont T. Contraceptive efficacy of intrauterine devices. Am J Obstet Gynecol 2008; 198:248-53. [PMID: 18221924 DOI: 10.1016/j.ajog.2007.10.787] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Revised: 10/01/2007] [Accepted: 10/01/2007] [Indexed: 11/17/2022]
Abstract
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.
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11
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Kulier R, O'Brien PA, Helmerhorst FM, Usher-Patel M, D'Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev 2007:CD005347. [PMID: 17943851 DOI: 10.1002/14651858.cd005347.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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.
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Affiliation(s)
- R Kulier
- Geneva Foundation for Medical Education and Research, Route de Florissant 3, Geneva, Switzerland, CH-1208,
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12
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Peri N, Graham D, Levine D. Imaging of intrauterine contraceptive devices. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1389-401. [PMID: 17901142 DOI: 10.7863/jum.2007.26.10.1389] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE Intrauterine contraceptive devices (IUDs) are reemerging as common methods of birth control in the United States. Imaging, especially sonography, has an important role in their evaluation. This review illustrates the normal and abnormal imaging appearances of IUDs. METHODS We describe and illustrate the appearance of different types of IUDs on different imaging modalities as well as radiologically relevant complications associated with IUDs. RESULTS On sonography, the IUD should be visualized as centrally located within the endometrial cavity, with the crossbar (if present) in the fundal portion of the endometrial cavity. Some older patients have IUDs in place that are no longer commonly used, such as the Lippes Loop (Ortho Pharmaceutical, Raritan, NJ) and Saf-T-Coil (Julius Schmid Laboratories, Little Falls, NJ), which have a pathognomonic appearance. Newer IUDs, such as the early version of the Mirena IUD (Leiras Oy, Turku, Finland), may be difficult to visualize on sonography. Patients from China frequently have a ring-shaped IUD. Sonography is important in assessing the complications of IUDs, including a low position, associated infection, myometrial migration, uterine perforation, intrauterine or extrauterine pregnancy associated with the IUD, and retention and fragmentation of the IUD. If an IUD is known to be present but not visualized sonographically, plain radiography is helpful in assessing the location. Computed tomography and magnetic resonance imaging are not typically used to assess IUDs, but the appearances of IUDs should be recognized with these modalities. CONCLUSIONS Imaging, specifically sonography, has a crucial role in the evaluation and management of IUDs and associated complications.
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Affiliation(s)
- Nagamani Peri
- Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215, USA
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13
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Kulier R, Helmerhorst FM, O'Brien P, Usher-Patel M, d'Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev 2006:CD005347. [PMID: 16856094 DOI: 10.1002/14651858.cd005347.pub2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
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.
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Affiliation(s)
- R Kulier
- Geneva Foundation for Medical Education and Research, Route de Florissant 3, Geneva, Switzerland CH-1208.
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Batár I, Kuukankorpi A, Siljander M, Elomaa K, Rauramo I. Five-year clinical experiences with NOVA T 380 copper IUD. Contraception 2002; 66:309-14. [PMID: 12443960 DOI: 10.1016/s0010-7824(02)00385-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In an open, single-group, phase III clinical trial of 5 years, the clinical performance of NOVA T 380 was investigated in three centers. The device having a higher copper surface of 380 mm(2) is a modification of NOVA T. A total of 400 voluntary women were enrolled in the study. The mean age was 31.4 years (SD 5.5) with the minimum of 18 and the maximum of 44 years. At the end of the study, 211 women had passed the 60-month visit. Cumulative discontinuation rates at the end of the first and the fifth year calculated by Kaplan-Meier estimates, were respectively as follows: pregnancy 0.5 and 1.9, expulsion 1.3 and 4.1, bleeding 4.4 and 14.0, pain 1.3 and 4.2, removal for other medical reason 1.4 and 6.4, planning pregnancy 0.8 and 13.5, and removal for other personal reason 2.4 and 11.9 per 100 users. Neither ectopic pregnancies nor episodes of pelvic inflammatory diseases (PIDs) occurred. One perforation was recorded; the calculated rate is 0.3 per 100 women (first year). The continuation rate was 88.3 and 52.5 at 1 and 5 years, respectively. In conclusion, the 5-year performance of NOVA T 380 was good compared to other "high-loaded" copper devices. Safety was acceptable over the entire study period.
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Affiliation(s)
- I Batár
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary.
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Abstract
After reviewing the literature on intrauterine devices (IUDs) published over the last 30 years, we selected and analyzed recent and most relevant (with appropriate methodology design) articles dealing with the risk factors for IUD failure. There is sufficient evidence to conclude that the TCu380 and levonorgestrel-releasing (LNG) IUD are the most effective, with a cumulative pregnancy rate of less than 2% at 12 years for the TCu380 and around 1% for the LNG IUD at 7 years. In addition, advancing age increases IUD effectiveness, and displacement of the IUD decreases effectiveness. The IUDs with the highest copper concentrations are clearly less prone to failure than those with lower copper concentrations.
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Affiliation(s)
- P Thonneau
- Human Fertility Research Group, La Grave Hospital, Toulouse, France.
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16
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Affiliation(s)
- D R Mishell
- Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Women's and Children's Hospital, Los Angeles 90033, USA
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Faúndes D, Bahamondes L, Faúndes A, Petta C, Díaz J, Marchi N. No relationship between the IUD position evaluated by ultrasound and complaints of bleeding and pain. Contraception 1997; 56:43-7. [PMID: 9306030 DOI: 10.1016/s0010-7824(97)00072-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The objectives of this study were to define the "normal" position of the T-shaped intrauterine device (IUD) in the endometrial cavity, using transvaginal ultrasound, and to compare the IUD's position in women with and without complaints of bleeding and/or pain. Vaginal ultrasound was carried out in women who had used a T-Cu 200 or T-Cu 380 for at least 6 months. Of these women, 236 registered bleeding complaints and/or pain and 245 had no complaints. The distances, IUD-endometrium, IUD-myometrium, and IUD-fundus, were measured in each woman. Our results showed that women with and without complaints presented no significant differences in age, parity, type of IUD, duration of use, previous contraceptive method used, hysterometry, uterine position, or period of the cycle in which the ultrasound was performed. The values of the three distances in users without complaints were widely dispersed. The 90th percentile of the IUD-endometrium, IUD-myometrium, and IUD-fundus distances were 7, 11, and 27 mm, respectively. The curve of the values for the three distances among women with complaints was similar to that of the subjects without complaints. Using the generally accepted measurement of 20 or 25 mm as the limits of normality of the distance IUD-fundus, and the 90th percentile of the distance IUD-endometrium as the gold standard, 77% and 43% of the women were false positives for "incorrect IUD position." Similar results were obtained when the 90th percentile of the distance IUD-myometrium was used as a gold standard. We concluded that the 90th percentiles of the distance IUD-endometrium, IUD-myometrium, and IUD-fundus were 7, 11 and 27 mm, respectively, among users without complaints. The ultrasonographic diagnosis of the IUD position was unable to discriminate between women who did or did not have complaints of bleeding and/or pain. If ultrasound were to be performed in T-shaped IUD users, the IUD-myometrium distance is likely to be the most reliable measurement.
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Affiliation(s)
- D Faúndes
- Departamento de Tocoginecologia, Universidade Estadual de Campinas, Brazil
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18
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Affiliation(s)
- C Westhoff
- Department of Obstetrics and Gynecology, Columbia University, New York, New York, USA
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19
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Abstract
Pelvic inflammatory disease (PID) has been associated with the use of intrauterine devices (IUDs) ever since they were introduced. In several mostly retrospective studies the incidence of PID was suggested to be as high as three- to ninefold in IUD users compared to non-users. Later epidemiological prospective studies showed a considerably lower risk comparing different types of contraception. Compared to non-contraceptive users the relative risk ranged from 1.8 in patients with copper-containing IUDs to 3.3 in patients using the older insert IUDs like the Dalkon Shield. More recent studies indicate that PID among IUD users is strongly related to the insertion process and to background risk of sexually transmissible disease. The incidence rate of PID decreases from 9.66 per 1000 woman years during the first 20 days following insertion to 1.38 per 1000 woman years beyond the first 20 days. This incidence is similar to the incidence in non-IUD users. PID is more prevalent in younger single women with different sexual partners. Nulliparous women with stable monogamous relationships are not at higher risk of PID than parous women. In conclusion, IUD users, selected for low risk of sexually transmissible disease, do not have excess PID. Proper counselling and selection is of the utmost importance. As there is a higher risk shortly after insertion, limiting IUD replacements will help diminish PID incidence.
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Affiliation(s)
- R J Beerthuizen
- Department of Obstetrics and Gynecology, University of Ghent, Belgium
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Díaz J, Pinto Neto A, Díaz M, Marchi NM, Bahamondes L. Long-term evaluation of the clinical performance of the TCu200B and the TCu380A in Campinas, Brazil. ADVANCES IN CONTRACEPTION : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE ADVANCEMENT OF CONTRACEPTION 1992; 8:67-72. [PMID: 1590103 DOI: 10.1007/bf01849351] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The clinical performance of the TCu200B and TCu380A was evaluated by life table analysis in a cohort of women who wore an IUD from July 1979 to July 1982. This paper presents the results up to five years of use. No significant differences in age and parity were found between the users in the two groups. Overall performance was very good with both models. The cumulative continuation rate was 83.6, 60.9 and 46.1 at one, three and five years with the TCu200 and 84.0, 64.7 and 49.3 with the TCu380A in the same periods. Differences between both IUDs were not significant. The pregnancy rate was lower with the TCu380A and reached statistical significance from the fourth year on. The authors conclude that both IUDs presented very good performance, the TCu380A being more effective, the only significant difference observed.
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Affiliation(s)
- J Díaz
- Department of Obstetrics and Gynecology, State University of Campinas, SP Brazil
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21
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Intrauterine contraceptive devices. Contraception 1989. [DOI: 10.1016/b978-0-407-01720-7.50013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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22
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Rob U, Phillips JF, Chakraborty J, Koenig MA. The use effectiveness of the Copper T-200 in Matlab, Bangladesh. Int J Gynaecol Obstet 1987; 25:315-22. [PMID: 2887467 DOI: 10.1016/0020-7292(87)90292-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Using a unique record keeping system, the use effectiveness of the Copper T-200 is examined in rural Bangladesh. In Matlab the Copper T-200 is a highly effective contraceptive modality. The adopters are typically low to medium parity women under 30 years of age. The most important cause of termination among women in the study was voluntary removal of the device. The complaint most often reported was bleeding followed by pain and weakness. The Matlab experience suggests that sustained motivation and regular resupply are the two key components of this highly successful family planning program.
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23
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Frenkel K, Blum F, Troll W. Copper ions and hydrogen peroxide form hypochlorite from NaCl thereby mimicking myeloperoxidase. J Cell Biochem 1986; 30:181-93. [PMID: 3009503 DOI: 10.1002/jcb.240300302] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sea urchins have elaborated multiple defenses to assure monospermic fertilization. In this work, we have concentrated on a study of the mechanism(s) by which hydrogen peroxide (H2O2) prevents polyspermy in Arbacia punctulata. We found that it is not H2O2 but probably hypochlorous acid/hypochlorite (HOCl/OCl-) derived from H2O2 that is toxic to the supernumerary sperm. The spermicidal activity of H2O2 is potentiated by at least one order of magnitude by cupric ions (Cu2+). This increased toxicity is not due to the formation of hydroxyl radicals (.OH) because .OH scavengers did not counteract the activity of Cu2+. Moreover, substitution of Cu2+ by ferrous ions (Fe2+), which are known to cause formation of .OH from H2O2, had no effect on fertilization even at 10(2)-10(3) times higher concentrations. In contrast, 3-amino-1,2,4-triazole (AT), and HOCl/OCl- scavenger, totally reversed the toxic effects of Cu2+. Furthermore, we found that HOCl/OCl- is generated in solutions of H2O2 and Cu2+ in the presence of 0.5 M NaCl and that its accumulation is abolished by AT. Thus it is possible that the antifertility properties of copper are due to its ability to mediate formation of HOCl/OCl-. HOCl/OCl- generated by Cu2+ from H2O2 and Cl-, a low concentration of exogenously added HOCl/OCl-, or increased concentrations of H2O2 has similar inhibitory effects on the fertilization process in sea urchins. Therefore, we suggest that polyspermy is prevented by the action of a myeloperoxidase that affects the formation of HOCl/OCl- from the Cl- present in sea water through reaction with H2O2 generated by the newly fertilized egg.
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24
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Merchant RN. An IUD to fit any uterus. ADVANCES IN CONTRACEPTION : THE OFFICIAL JOURNAL OF THE SOCIETY FOR THE ADVANCEMENT OF CONTRACEPTION 1985; 1:151-6. [PMID: 3842215 DOI: 10.1007/bf01849795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A new copper intrauterine device is described. Experience during 40 000 woman-months of use indicates that there have been no pregnancies and only 0.4 expulsions. At the end of 30 months of follow-up, 87.5% of the women are still wearing the device.
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25
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Lehfeldt H. Immediate postabortion insertion of an IUD. Eur J Obstet Gynecol Reprod Biol 1984; 17:141-7. [PMID: 6376197 DOI: 10.1016/0028-2243(84)90137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Conception may occur as early as 10 days postabortion. Therefore, immediate postabortum insertion (IPI) of an IUD reduces the danger of exposure to an unwanted pregnancy in the interval and offers better protection against repeat abortion than delayed insertion. Patient motivation to use contraception appears to be highest at the time of termination of an unwanted pregnancy. Complication and pregnancy rates of IPI are comparable with postmenstrual insertion. No serious complications are on record in the world literature; particularly, no cases of infection or perforation have been reported. These facts make IPI not only an acceptable but a highly advisable technique of family planning. In 1977, the American Food and Drug Administration rescinded its earlier prohibition and approved the IPI method. Nulliparous women should be inserted with a copper device, parous women with a Lippes loop.
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26
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Nayel SA, Elgazaierly SA, Fahmy SM. The effect of intra-uterine device on the endometrial pattern. ASIA-OCEANIA JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1983; 9:155-8. [PMID: 6615327 DOI: 10.1111/j.1447-0756.1983.tb00614.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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27
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Abstract
Drug delivery systems have unusual materials requirements which derive mainly from their therapeutic role: to administer drugs over prolonged periods of time at rates that are independent of patient-to-patient variables. The chemical nature of the surfaces of such devices may stimulate biorejection processes which can be enhanced or suppressed by the simultaneous presence of the drug that is being administered. Selection of materials for such systems is further complicated by the need for compatibility with the drug contained within the system. A review of selected drug delivery systems is presented. This leads to a definition of the technologies required to develop successfully such systems as well as to categorize the classes of drug delivery systems available to the therapist. A summary of the applications of drug delivery systems will also be presented. There are five major challenges to the biomaterials scientist: (1) how to minimize the influence on delivery rate of the transient biological response that accompanies implantation of any object; (2) how to select a composition, size, shape, and flexibility that optimizes biocompatibility; (3) how to make an intravascular delivery system that will retain long-term functionality; (4) how to make a percutaneous lead for those delivery systems that cannot be implanted but which must retain functionality for extended periods; and (5) how to make biosensors of adequate compatibility and stability to use with the ultimate drug delivery system-a system that operates with feedback control.
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Newton JR. Copper intrauterine devices: evaluation for long-term use a review. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1982; 89:20-31. [PMID: 6758837 DOI: 10.1111/j.1471-0528.1982.tb15066.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Abstract
The endometrial cavity is an isosceles trapezoid that changes in shape with the phase of the cycle. The distance from the fundus to where the cavity narrows to 12 mm is the effective length. This and the total length of the uterine cavity can be measured with the Wing Sound. IUCD complications are more frequent if the length of a device exceeds the effective length or the width of the uterine cavity. Devices must be designed to fit the uterine cavity and to conform to physiological changes in the shape of the organ.
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31
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Heikkilä M, Lähteenmäki P, Luukkainen T. Immediate postabortal insertion of a levonorgestrel-releasing IUD. Contraception 1982; 26:245-59. [PMID: 6816506 DOI: 10.1016/0010-7824(82)90073-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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32
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Abstract
In the UK the marketing and quality control of all intrauterine devices (IUCDs) is controlled by the Medicines Act (1968). Training is supervised by the Joint Committee of Contraception (JCC), and Trainers have to ensure that the trainee has acquired safe standards before the JCC certificate is granted. Patients must be adequately counselled and consent obtained. There is no unequivocal evidence of its mode of action in humans, which might limit its acceptability to certain individuals. There are a number of problem areas. How long should a copper-containing IUCD be retained when there is clinical evidence of continued effectiveness for more than the statutory 2 years? Perforation of the uterus and the resulting abnormal situation of an IUCD can be potentially dangerous. Sound technique minimizes its occurrence but if perforation occurs there must be defined and documented action. Because the IUCDs' primary intrauterine action is to prevent implantation, should pregnancy occur, there is an increased likelihood of ectopic gestation. Awareness of this, and appropriate early action, should prevent a disastrous outcome. There is clear evidence that ascent of organisms relates to the cervical thread. Perhaps tailless devices should be made available for women who are at risk of developing pelvic inflammatory disease? Other potential problem areas, where there might be legal liability involving practitioners, include the management of abnormal bleeding and difficult removals.
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Rosenfeld J, Williams WS, Sharma NK. SEM analysis of copper-containing intrauterine implants. JOURNAL OF BIOMEDICAL MATERIALS RESEARCH 1981; 15:605-10. [PMID: 7276026 DOI: 10.1002/jbm.820150414] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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34
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Makler A, Zinder O. The effect of copper on spermatozoal motility and viability evaluated objectively with the aid of the multiple-exposure photography method. Am J Obstet Gynecol 1980; 138:156-64. [PMID: 7191636 DOI: 10.1016/0002-9378(80)90027-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The antispermatozoal effect of the copper intrauterine contraceptive device (IUD) was investigated in an attempt to explain one aspect of its contraceptive mechanism. For this purpose, 42 specimens of normal semen were incubated in vitro with the metallic portion of two types of copper IUDs for 24 hours. Periodic determinations of sperm velocity and percentage of motility and viability were performed objectively with the aid of the multiple-exposure photography (MEP) method. No significant effect concerning these parameters was found when specimens were incubated continuously with either type of these IUDs at 23 degrees C. On the contrary, sperm velocity and percentage of motility dropped markedly, and the number of dead spermatozoa increased reciprocally when specimens were incubated with those IUDs at 37 degrees C for 4 hours. However, motility was almost unaffected in specimens that were incubated at 37 degrees C with amounts of copper that exist usually within uterine cavities bearing this sort of IUD. The conclusion was that a copper IUD does not seem to exert its contraceptive effect by inhibiting spermatozoal activity.
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35
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Gillett PG, Lee NH, Yuzpe AA, Cerskus I. A comparison of the efficacy and acceptability of the Copper-7 intrauterine device following immediate or delayed insertion after first-trimester therapeutic abortion. Fertil Steril 1980; 34:121-4. [PMID: 7409230 DOI: 10.1016/s0015-0282(16)44893-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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36
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Sobrevilla LA, Quintero AG, Bailey J. Postpartum and postabortion use of the TCu-220C and Lippes Loop: A comparative study. Int J Gynaecol Obstet 1980; 18:31-4. [PMID: 6106596 DOI: 10.1002/j.1879-3479.1980.tb00236.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The postinsertion experience of 274 women with the TCu-220C and 522 women with the Lippes Loop in a university hospital family planning program in Bogotá, Colombia, has been studied by a life-table method. Pregnancy and continuation rates are similar for both devices. Although the expulsion rate of the TCu-220C is significantly lower than that of the Loop up to 12 months, higher removal rates for the TCu-220C account for the similarity in overall continuation.
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37
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Randić L. Copper content in cervical mucus of women wearing plain and copper-bearing spring coils. Int J Gynaecol Obstet 1980; 17:444-9. [PMID: 6103837 DOI: 10.1002/j.1879-3479.1980.tb00183.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To test the hypothesis that the copper in copper-bearing intrauterine devices (IUDs) and its reaction with cervical mucus constitute the agent in preventing conception, the copper content of 300 samples of cervical mucus, 150 each from women wearing plain Spring Coil IUDs and those wearing Spring Coils containing 500 mg of copper, was determined at 3, 6 and 12 months after IUD insertion. Stoner and Dasler's modified spectrophotometric micromethod (Clin Chem 10:845, 1964) was used to quantify the copper content of the cervical mucus. Analysis showed no significant change in the copper content of the cervical mucus of women wearing plain Spring Coils compared to that of women not wearing IUDs; however, the amount of copper in the cervical mucus of women wearing copper-bearing Spring Coils was 5--6 times greater at midcycle 3, 6 and 12 months after insertion. Thus, we conclude that there is an important biologic basis for assuming that copper-bearing Spring Coils can inhibit sperm penetration through the cervical mucus and that they can initiate contraceptive activity at the cervical level.
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38
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Tuttle M, Baker R, Laufe L. Slow release aprotinin delivery for control of intrauterine-device-induced hemorrhage. J Memb Sci 1980. [DOI: 10.1016/s0376-7388(00)80478-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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39
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Fylling P, Svendsby T. Contraceptive practice before and after therapeutic abortion. II. Use-effectiveness of oral contraceptives and intrauterine devices. Fertil Steril 1979; 32:24-7. [PMID: 456627 DOI: 10.1016/s0015-0282(16)44110-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Of 180 women who underwent therapeutic abortion in a certain period in 1977, 71.7% were unmarried and 63.9% were unmarried primigravidas. At the first follow-up visit 3 to 6 weeks postabortion 55.0% of the unmarried primigravidas chose oral contraceptives and 43.2% chose intrauterine devices (IUDs). Of the unmarried women, 25.7% chose oral contraceptives and 65.7% chose IUDs. For unmarried primigravidas the 1-year continuation rates for oral contraceptives and IUDs were 83.6% and 93.8%, respectively. For married women the figures were 55.6% for oral contraceptives and 91.3% for IUDs. The differences between use of oral contraceptives and use of IUDs in the two groups of women was not statistically significant. We recorded no contraceptive failure, but three episodes of pelvic inflammatory disease occurred among unmarried primigravidas. The results indicate a high motivation for reliable methods and a high continuation rate following therapeutic abortion. The results may also indicate that oral contraceptives and IUDs represent equivalent methods for both parous and nulliparous women.
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40
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Baker RW, Tuttle ME, Lonsdale HK, Ayres JW. Development of an estriol-releasing intrauterine device. J Pharm Sci 1979; 68:20-6. [PMID: 758458 DOI: 10.1002/jps.2600680110] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Estriol-releasing intrauterine devices were developed for experimental use in animals and humans. The devices consist of a reservior containing the steroid surrounded by a rate-limiting polyurethane membrane. After an initial transient, the drug is released from the device at a constant rate for 1 year or more; devices with a much longer release period can be fabricated readily. A constant release rate is achieved by maintaining solid drug in the reservoir and good physical contact between the drug and the inside wall of the device. The methods used to fabricate the devices are described along with release rate and stability data.
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41
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Luukkainen T, Nielsen NC, Nygren KG, Pyörälä T, Kosonen A. Randomized comparison of clinical performance of two copper-releasing IUDs, Nova-T and Copper-T-200, in Denmark, Finland and Sweden. Contraception 1979; 19:1-9. [PMID: 428219 DOI: 10.1016/s0010-7824(79)80003-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A randomized study was conducted simultaneously in three countries to compare the clinical performance of two new IUDs, the Nova-T and Copper-T-200. Forty-four persons, midwives, general practitioners, residents and specialists in obstetrics and gynecology inserted 907 Nova-Ts and 936 Copper-Ts. The pregnancy rate of Nova-T (0.7 at one year) was significantly lower than that of Copper-T (2.2 at one year). No significant differences were observed in other termination rates. The continuation rates were 72.6 for Nova-T and 71.3 for Copper-T-200. The total experience was based on 18,035 woman months of use, with a lost to follow-up of less than 7 per cent for both IUDs.
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42
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Abdel Gawad AH, Toppozada HK, el-Sawi M, Saleh F, el-Sahwi S. Study of the uterine environment in association with intrauterine contraceptive devices. Contraception 1977; 16:469-85. [PMID: 590010 DOI: 10.1016/0010-7824(77)90071-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Garzón P, Aznar R, Olivera E, Gallegos AJ. Progesterone metabolism by human proliferative and secretory endometria. Contraception 1977; 16:79-87. [PMID: 913110 DOI: 10.1016/0010-7824(77)90132-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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44
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Larsson B, Hamberger L. The concentration of copper in human uterine secretion during four years after insertion of a copper-containing intrauterine device. Fertil Steril 1977; 28:624-6. [PMID: 862973 DOI: 10.1016/s0015-0282(16)42612-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The contraceptive action of a copper-containing intrauterine device (Cu IUD) is mainly associated with the copper ions released, thus its efficiency varies with the surface area of the copper wire. It is of considerable clinical interest to know the usful life-span of a Cu IUD. Therefore, the concentration of copper in the uterine secretion of women wearing a Cu-7 IUD (Gravigard) with a surface area of the copper wire of 200 sq mm was determined by atomic absorption spectroscopy. No decrease in the concentrations of copper was found in a series of women followed for 4 years after the insertion of a Cu IUD.
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45
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Wallach E, Tatum HJ. Clinical Aspects of Intrauterine Contraception: Circumspection 1976**Supported in part by Grant 1 P01 HD 0567-05 from the National Institutes of Health and by the International Committee for Contraception Research of The Population Council, New York. Fertil Steril 1977. [DOI: 10.1016/s0015-0282(16)42311-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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46
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The Effects of Prostaglandins on Sperm Motility**Presented at the Thirty-Second Annual Meeting of The American Fertility Society, April 5 to 9, 1976, Las Vegas, Nev.††American Cystoscope Makers, Inc., Urology Prize Essay of 1976. Fertil Steril 1977. [DOI: 10.1016/s0015-0282(16)42321-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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47
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Hasson HM, Berger GS, Edelman DA. Factors affecting intrauterine contraceptive device performance. I. Endometrial cavity length. Am J Obstet Gynecol 1976; 126:973-81. [PMID: 998687 DOI: 10.1016/0002-9378(76)90687-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Landesman R, Coutinho EM, Saxena BB. Detection of Human Chorionic Gonadotropin in Blood of Regularly Bleeding Women using Copper Intrauterine Contraceptive Devices**Supported by Grant GA-HS-7406 from The Rockefeller Foundation and Grant HD-09004 from the National Institutes of Health.††Presented at the Twenty-Third Annual Meeting of the Pacific Coast Fertility Society, October 15 to 19, 1975, Palm Springs, Calif. Fertil Steril 1976. [DOI: 10.1016/s0015-0282(16)42077-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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49
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González-Angulo A, Aznar-Ramos R. Ultrastructural studies on the endometrium of women wearing TCu-200 intrauterine devices by means of transmission and scanning electron microscopy and x-ray dispersive analysis. Am J Obstet Gynecol 1976; 125:170-9. [PMID: 1266897 DOI: 10.1016/0002-9378(76)90588-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Endometrial biopsies obtained from 12 young women wearing TCu-200 intrauterine contraceptive devices from six to 12 months were studied by means of transmission and scanning electron microscopes as well as with the use of rubeanic acid stains and x-ray dispersive analysis. Six biopsies were taken at Day 10 and six were taken at Day 20 of the menstrual cycle. The aim was to investigate epithelial and stromal changes possibly related to copper deposition. The main changes were located in the cell organelles at Day 10 of the cycle. The mitochondria disclosed vacuolization of the matrix and myelin figure formation in 70 to 80% of the epithelial cells. There were also increased numbers of lysosomes. There were similar alterations of secretory endometrium in only a few cases. Instead, there was an increased number of mitochondria, and most of them were dividing. Rubeanic acid stains as well as energy-dispersive x-ray analysis failed to reveal significant amounts of copper in the various cell organelles studied. The above observations seem to indicate that there is a definite alteration of the mitochondria of epithelial cells which may result in impairment of respiratory mechanisms and energy production, rendering the endometrial environment inhospitable to the fertilized egg. These changes are thought to be reversible. The absence of copper is explained on the basis of a rapid turnover of the endometrium or to a problem in sampling common to this methodology.
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50
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Van Eyck J, Lagasse A, Thiery M. Scanning electron microscopy of inert and copper-bearing intra-uterine devices. Contraception 1976; 13:65-77. [PMID: 1245118 DOI: 10.1016/0010-7824(76)90075-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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