Intrauterine deposition of calcium on copper-bearing intrauterine contraceptive devices

Extensive psammomatous calcification of the uterus and cervix associated with a uterine serous carcinoma

This report describes a uterine serous carcinoma with bilateral ovarian metastasis, which was associated with widespread extensive psammomatous calcification of the uterine leiomyomata, the myometrium, and the cervical stroma. These psammoma bodies were not associated with tumour or epithelial elements. This psammomatous calcification is rare, with no previous reports of similar cases. The presence of psammoma bodies is probably related to the serous carcinoma, raising the possibility that psammoma body formation in serous carcinomas is the result of a factor secreted locally by the tumour, rather than the widely held theory that their formation is secondary to necrosis, with subsequent dystrophic calcification within a papillary neoplasm.

Analysis of surface deposits on intrauterine contraceptive devices

Surface deposits on stainless steel contraceptive devices removed from the uterus after varying periods of insertion were examined and analyzed by means of scanning electron microscopy (SEM), X-ray energy dispersive analysis (XEDA), Augar electron spectroscopy (AES), X-ray photoelectron spectroscopy (XPS), transmission electron microscopy (TEM) and atomic absorption spectrophotometry for microquantitative analysis. The data obtained were compared with the data for copper-bearing IUDs (TCu200) obtained by the same method. The wire coils of stainless steel IUDs which had been in situ for 5 years showed no obvious changes, but copper wire coils showed varying degrees of erosion after the same period of time. Analysis clearly showed that the wire coils of both types of IUD were encrusted with deposits. Deposition began earlier on copper-bearing IUDs than on stainless steel IUDs (27 days and 3 months after insertion, respectively). This process began earlier than has previously been reported in the literature. The amount of deposit increased with duration of insertion, but there were large individual variations. The microanalysis showed that the principal component of the deposit on both types of IUD was calcium, which was present in the crystal form of calcium carbonate. The substances attaching to the crystals were similar to the nitrogenous organic compounds. We suggest that the mechanism regulating the deposited formation may be similar to that of calculus. The influence of these deposits on complications relating to IUD insertion, such as uterine bleeding and accidental pregnancy, is briefly discussed in this article. The subject should be studied in greater detail.

Microbial colonization of tailed and tailless intrauterine contraceptive devices: influence of the mode of insertion in the rabbit

An experimental rabbit model was developed to study the microbial colonization of intrauterine contraceptive devices. Tailed and tailless devices were surgically inserted into into the uterus by two different routes: surgically, directly into the uterine horn, thus avoiding contact with the vaginal and cervical microfloras, or via the vagina and cervix. After 1 to 8 weeks the devices were recovered and prepared for scanning electron microscopy. The surfaces of surgically inserted devices remained uncolonized all through the experiment whereas in those inserted via the cervix microorganisms colonized the core surface as early as 2 weeks after insertion. Our data suggest that in our experimental conditions the mode of insertion appears to be the major factor influencing the microbial colonization of intrauterine contraceptive devices and that the presence of a tail does not seem to play a significant role.

The Ljubljana IUDs: further observations on surface morphology

Twelve IUDs that had been worn from 8 years 10 months to 24 years were examined by SEM. Photomicrographs of selected samples are shown, and a discussion of the nature of the surface encrustations is provided. The authors are of the opinion that surface encrustations are generic to different types of IUDs and that their clinical significance is presently unknown.

Scanning electron microscopy, x-ray diffraction, and electron microprobe analysis of calcific deposits on intrauterine contraceptive devices

Deposits found intrauterine contraceptive devices (IUDs) were studied by scanning electron microscopy, x-ray diffraction, and energy dispersive x-ray microanalysis. All seven devices, including five plastic and two copper IUDs, were coated with a crust containing cellular, acellular, and fibrillar material. The cellular material was composed of erythrocytes, leukocytes, cells of epithelial origin, sperm, and bacteria. Some of the bacteria were filamentous, with acute-angle branching. The fibrillar material appeared to be fibrin. Most of the acellular material was amorphous; calcite was identified by x-ray diffraction, and x-ray microanalysis showed only calcium. Some of the acellular material, particularly that on the IUD side of the crust, was organized in spherulitic crystals and was identified as calcium phosphate by x-ray microanalysis. The crust was joined to the IUD surface by a layer of fibrillar and amorphous material. It is suggested that the initial event in the formation of calcific deposits on IUD surfaces is the deposition of an amorphous and fibrillar layer. Various types of cells present in the endometrial environment adhere to this layer and then calcify. Thus, the deposition of calcific material on the IUDs is a calcification phenomenon, not unlike the formation of plaque on teeth. Hum Pathol 16:732-738, 1985.

Group B-beta haemolytic streptococcal colonization in women using intrauterine contraceptive devices

Two-hundred-and-eighteen gynaecological patients were screened for group B-beta haemolytic streptococci (GBS) colonization of the vagina, cervix, urethra and rectum. The overall colonization rate was 17%. There is no relation between the rate of colonization and the patient's age or parity. The colonization rate among the intrauterine contraceptive device (IUCD) users (31%) is significantly higher than the non-users (14.5%). The IUCD does not cause GBS vaginal colonization. Nevertheless, its presence helps the microorganisms' vertical spread through the cervical canal. The short duration of IUCD use among the Saudi patients may have provided a protective mechanisms against the development of PID. All the four sites were colonized in the IUCD users and only in 8.1% of the non-users. The urethra was the most common site involved in both groups (83.8%). A higher incidence of GBS colonization was found among patients presenting with excessive vaginal discharge as the main complaint. The presence of excessive vaginal discharge is a significant factor towards the spread of the microorganism to the cervix and urethra. Therefore, an IUCD user with excessive vaginal discharge has a higher chance of getting cervical and urethral colonization.

Energy dispersive spectrophotometric and X-ray diffraction observations in IUDs

This paper describes preliminary observations of the surface deposits on Lippes Loop, Dalkon Shield, and Saf-T-Coil IUDs removed after periods of time up to 15 years. Rosettes of euhedral rhombic crystals with a columnar prismatic habit were observed on a Lippes Loop that had been in situ for 15 years. All mineral deposits were found to be calcium salts, but the degree of crystallization varied significantly, from almost totally amorphous to the perfect euhedral crystal form. The microenvironment alone or in combination with cyclic changes in the biochemical milieu surrounding the IUD may influence the deposition of specific mineral species.

Surface changes in intrauterine contraceptive devices after variable use

Four used intrauterine contraceptive devices and two new control devices were studied by scanning electron microscopy. All intrauterine contraceptive devices were found to have surface deposits that differed not only from site to site on a given device but between devices. A finding of this study not previously described in the literature was the observation of a euhedral crystal rosette of an apatite mineral group [Ca5(PO4)3(F,Cl,OH)] on the Lippes Loop that had been in situ for 15 years.

Fetal abnormalities in cystic fibrosis suggest a deficiency in proteolysis of cholecystokinin

Ultrastructural and microvillous enzyme (MVE) histochemical studies of fetuses with cystic fibrosis (CF) and trisomies 13 and 18 identified features in CF which differed from the abnormalities in trisomies 13 and 18. The principal abnormalities in CF were in the tight (occluding) junctions and intracellular organelles, particularly the golgi and mitochondria, of the epithelial cells of the pancreas, respiratory system, intestine, and gallbladder. Abnormalities of amniotic fluid MVE levels in CF and trisomy 13 occur because of disruption of the pathways by which the MVE reach the amniotic fluid. Trisomy 18 shows hypoplasia and deficiency of epithelial cell microvilli. It is postulated that the basic defect in CF is due to the deficiency of an enzyme that cleaves the Arg-Asp peptide bond in cholecystokinin to produce the active octapeptide CCK-8, which normally stimulates exocrine secretion, especially in pancreas, gallbladder, and intestine, and potentiates the action of other gastrointestinal hormones.

Degradation of the copper-releasing intrauterine contraceptive device and its significance

Measurements were made of the copper remaining on used Gravigard intrauterine contraceptive devices (IUCDs) that had been in utero for up to 40 months. The topography and composition of the surface deposits were analysed by scanning electron microscopy and energy-dispersive X-ray analysis. The rate of copper loss decreased exponentially from 0.42 mumol d-1 (26.7 micrograms d-1) upon insertion to 0.056 mumol d-1 (3.6 micrograms d-1) after 26 months of use; between 27 and 40 months of use a linear release of 0.32 mumol d-1 (20.3 micrograms d-1) was observed. There was no correlation between this changing rate of copper loss and the pregnancy rate with the device in situ. The changes in the rate of copper loss were probably due to the growth of a surface corrosion product which, due to internal stresses, fractured after about 2 years and exposed fresh copper; this results in a progressive increase in breakage of the copper wire after 3 years. It is recommended that a copper IUCD of this type be replaced after 3 years.

Corrosion of filamentous intra-uterine copper. The MLCu250 and the MLCu375

Although the effective life span of an IUD provided with filamentous copper is, calculated on the basis of the rate of dissolution of copper, several years, corrosion may lead to breakage of the wire after a shorter period of use. When copper wire with a diameter of 0.20 to 0.25 mm is used, the proportion of IUDs with broken wires increases with time after three years of use. It was not known whether this disadvantage could be reduced or eliminated by the use of a thicker wire. In this study the corrosion behaviour was observed in MLCu250 and MLCu375 devices, which have copper wire with a diameter of 0.30 and 0.40 mm, respectively. The earliest breakage was observed after 8 months of use for 0.30 mm wire and after 9 months of use for 0.40 mm wire. In IUDs with 0.30 mm wire the proportion with broken wires increased after 3 years of use. Since examples of the MLCu375 with 0.40 mm wire used for more than 3 years were few, it was impossible to make definite conclusions in this respect. In general, the corrosion behaviour in copper diameter range of 0.3 to 0.4 mm is the same as indicated in previous studies for diameter range of 0.2 to 0.25.

Corrosion of a new copper-gold or copper-platinum intrauterine device

It has been shown previously that supplementing plastic intrauterine devices (IUDs) with copper wire enhances the antifertility effect of the device. The use of copper intrauterine contraceptive devices, however, is currently limited to two to three years, mainly because of wire fragmentation, which was observed as early as after eight months of use. In the resulting search for a long-lasting device, two new systems of duplex wire, with gold and platinum cores electrolytically coated with copper, were devised and studied. Initially, duplex wires and controls were exposed to physiological solution. Copper dissolution rate and corrosion morphology were studied by weight-loss measurements and optical metallography. Similar systems were then surgically implanted in rat uteri for varying periods of up to 26 weeks. Electron microanalysis of corrosion products, in addition to weight-loss measurements and metallography, was performed. The results showed that a uniform and ductile copper coating is obtainable by electroplating on gold and platinum wires. Rate of copper dissolution is similar to that of solid copper wire. No dissolution of gold and platinum in the controls or coated wires was detected by weight loss, metallography, or atomic absorption measurements. Microanalysis of the deposits and corrosion products on the wires in the uteri environment showed sulfur, chlorine, and calcium, in addition to copper. The results of this study suggest that supplementing IUDs with copper-coated gold or platinum wires may result in significant prolongation of the life span of the device by preventing uncontrolled loss of copper caused by wire fragmentation.

Copper loss from the copper T model TCu22OC

The effect of mineral deposits on the copper dissolution rate of the Copper T Model TCu22OC was examined. 118 Copper T22OC devices removed from subjects for various medical and personal reasons after 12 to 72 months in utero were examined and graded based on the proportion of the total copper area covered with mineral deposits. The deposits increased in average size during the first three years of IUD use and then remained relatively constant. Seventeen percent of the devices were in situ for four or more years. Copper analysis was performed on 30 Copper T 22OC devices from selected periods of use : 12-14, 22-26, 36-39 and 48-72 months of use. The mean daily copper loss was 29.4 micrograms and the range, 7.3 to 62.1 micrograms. An inverse correlation between the amount of mineral deposit on the copper surface and the rate of copper loss was observed.

A copper-based intrauterine device with gold or platinum core: in vitro and in vivo studies

The use of copper intrauterine contraceptive devices is currently limited to 2-3 years, mainly due to wire fragmentation, which was observed as early as after 8 months of use. In the resulting search for a long-lasting device, two new systems of duplex wire, with gold and platinum cores electrolytically coated with copper, were devised and studied. Initially, duplex wires and controls were exposed to physiological solution. Copper dissolution rate, and corrosion morphology were studied by weight-loss measurements and optical metallography. Similar systems were then surgically implanted in rat uteri for varying periods up to 26 weeks. Electron microanalysis of corrosion products in addition to weight-loss measurements and metallography was performed. The results showed that a uniform and ductile copper coating is obtainable by electroplating on gold and platinum wires. The rate of copper dissolution is similar to that of solid copper wire. No dissolution of gold and platinum in the controls or coated wires was detected by weight loss, metallography or atomic absorption measurements. Microanalysis of the deposits and corrosion products on the wires in the uterine environment showed the presence of compounds containing sulphur, chlorine, calcium and copper. The results of this study suggest that supplementing IUDs with copper-coated gold or platinum wires may result in significant prolongation of the life-span of the device by preventing uncontrolled loss of copper caused by wire fragmentation.

Intrauterine devices: present and future

Although the mortality associated with the use of intrauterine contraception is low, its morbidity is probably higher than that associated with oral contraception. Much anxiety has been generated and whole programs prejudiced by lack of attention to detail during counseling, the fitting of intrauterine devices and follow-up. This paper draws attention to the shared etiology of many of the important adverse effects of the method, the fact that several become increasingly rare with increasing age of the user, and other factors that can assist in choosing the right device for the right woman. Likely future trends are also predicted.

Serum copper in long-term users of copper intrauterine devices

A study was undertaken to determine whether long-term use of a copper intrauterine device (IUD) was associated with any alteration in the serum copper levels and thereby whether absorption of copper from the device in utero could result in copper toxicity. Serial estimations in copper IUD wearers showed that there was no alteration in serum copper levels for a period of up to 24 months. The mean range and frequency distribution of serum copper levels in long-term copper IUD wearers was similar to that seen in the normal population. There was no difference in the mean 24-hour urinary copper excretion between the control group and the copper IUD wearers. Data suggest that the copper released from a copper IUD may not be readily absorbed from the uterine fluid. This hypothesis needs verification.

Scanning and transmission electron microscopy of material adherent to intrauterine contraceptive devices

The material adherent to intrauterine contraceptive devices (IUCDs) has been studied by transmission and by scanning microscopy coupled with X-ray microprobe analysis. Inert (Lippes Loop D, Saf-T-Coil and Dalkon shield) and medicated (Copper 7 and Progestasert) IUCDs were removed for examination from uteri immediately after hysterectomy. The cellular material identified on the surface of all inert IUCDs consisted mainly of macrophages with some polymorphonuclear leucocytes, erythrocytes, a few platelets and fibrin fibres. Polymorphonuclear leucocytes were the principle cells on the copper devices. Larger numbers of cells were evident on the inert arms than on the active part of the Progestasert device. All the devices examined exhibited varying amounts of surface calcium deposition. The IUCDs which had been in utero for longer periods showed the greatest amount of calcium deposition. Although a less rapid calcium deposition appeared to occur on the Progestasert device, this deposition may influence the release of medications from IUCDs which are retained in utero for longer periods than one year.

Corrosion of copper in utero

The influence of corrosion on the copper wire in the Copper T-200 intrauterine device (IUD) was studied in devices which had been in utero for 3 to 52 months. This was done mainly by examining cross-sections of the wires under a light microscope. Corrosion was normally localized to narrow areas and led to breakage and fragmentation of the copper wire. Neither deposits on the wire nor corrosion products prevented the dissolution of the copper. The progress of the corrosion over a given time was determined by comparing the depth of corrosion with the original dimension of the wire. The lifetime of the IUD was evaluated on the basis of the progress of corrosion, the calculated copper release, and the number of cases of wire breakage. It was found that the Copper T-200 could be left in place for up to 45 months.

Continuous intrauterine copper contraception for 3 years: comparison of replacement at 2 years with continuation of use

A total of 1245 women had a copper 7 intrauterine contraceptive device (IUD) inserted in 1971-3 were followed up for three years (22 761-5 women months of use). After 24 months 483 women elected to continue with the same copper 7 (continuation group), and 183 had their copper 7 replaced with a new one (replacement group). The subsequent pregnancy and expulsion rates were both significantly lower in the replacement group. The higher pregnancy rate among the women who continued to use their copper 7 device for a third year suggests that although the copper is still there, it is not available for contraceptive action. Replacing the device at 24 months did not seem to cause again the problems that usually occur in the first six months of IUD use.