Hair copper in intrauterine copper device users

The antifertility effect of copper-bearing IUDs is based on continuous release of copper, which is a result of the reaction between the metal and the uterine secretions. Released cupric ions collect in the endometrium and in the uterine fluid but significant accumulation has not been found in the bloodstream or elsewhere. Following Laker's suggestion that hair be used for monitoring essential trace elements, e.g., copper, we checked the copper content of the hair of women wearing copper-bearing IUDs. Samples of untreated pubic hair removed by clipping before diagnostic curettage were obtained from 10 young (24-34 years old), white caucasian females who until then had been wearing an MLCu250 IUD for more than 1 year. Pubes from 10 comparable (sex, age, race) subjects who had never used a Cu-containing device served as controls. The unwashed material was submitted to the toxicology laboratory, where the copper content was assessed by flameless atomic absorption, a technique whose lower limit of measurement lies at a concentration of 0.05 mcg Cu/ml fluid (50 ppb). Hair samples were washed to remove extraneous traces of metal according to the prescriptions of the International Atomic Energy Agency, weighed, and mineralized, after which a small volume (10 mcl) of the diluted fluid was fed into the graphite furnace. Each sample (75-150 mg) was analyzed 4 times, both before and after washing. Since the cleaning procedure reduces the weight of the sample (mainly by the removal of fat, dust, etc.) this explains why the percentage copper content of washed hair is higher than that of unwashed hair belonging to the same subject. The results indicate that there was no significant difference (Mann-Whitney U test) between the mean copper levels of both unwashed and washed pubes from women who were using or had never used an MLCu250 IUD. We therefore conclude that the use of this copper-containing device is not associated with significant accumulation of copper in (pubic) hair.

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.

Influence of age on the clinical performance of IUD in nulliparous and parous women: an analysis of 1144 insertions

The influence of age on clinical performance of a new IUD, the Fincoid, was evaluated in 1144 nulliparous and parous women separately, with a follow-up of 12 months and with 11,859 woman-months of use. Of the individual terminations, the rates for pregnancies, expulsions, and removals for pain decreased with age, whereas removals for bleeding increased with age. This applies to both parous and nulliparous women. The IUD is not a 1st choice method of contraception for young nulliparous and parous women (under age 24). Patient materials should be analogous for age and parity to obtain comparable performances for different IUDs.

Normoprolactinemic galactorrhea in a fertile woman with a copper intra-uterine device (copper IUD)

We report a case of galactorrhea in a normoprolactinemic fertile woman (30 years old) wearing a copper intra-uterine device (Gravigard). The Gravigard was first inserted in July 1977. In February 1979 our patient noted spontaneous galactorrhea, mainly on the left, but it was also present on the right, after breast pressure. X-ray film of the sella turcica, visual-field examination, thyroid function and basal prolactin levels were all within normal limits. In May 1979 the Gravigard was withdrawn and milk loss stopped finally in December 1979. In March 1980 the IUD was replaced; after only 3 days, mild spontaneous lactation again ensued, on the right side. The patient never took drugs which might have occasioned a prolactin rise. Possible explanations for this unusual phenomenon are discussed.

A comparative study of the nylon T and copper T 200

The nylon T IUD is identical to the copper T 200 except for the composition of nylon/copper. A study conducted at the Family Planning Institute in Ljubljana, Yugoslavia compared the nylon T with the copper T. Devices were randomly administered to women who had not been pregnant during the month prior to insertion. The pregnancy rate for the nylon T group was 13.0 at 12 months, significantly higher (Por= 0.01) than the rate of 0.0 for the copper T group. Effectiveness of copper devices is related to the copper itself, rather than being an effect of the increased surface area alone.

Randomized comparison of multiload standard and short devices

A randomized study was conducted to compare the clinical performance of the ML Cu 25-standard and the ML Cu 250-short devices. 375 insertions were performed postmenstrually to mainly parous women 16-43 years of age. Over 90% of the women in both IUD groups had uterine sound lengths from 7-9 cm. The rates are based on the total of 4273 woman months of use. The lost-to-follow-up rates at 12 months were 6.7 and 4.6% for standard and short ML series, respectively. The ML Cu 250-standard had a lower pregnancy rate and a lower removal rate for bleeding and/or pain, but a higher expulsion rate that the short model. However, these differences were not statistically significant. The shortening of the vertical arm of the Multiload device has no remarkable effect on its clinical performance.

Effects of non-medicated and copper IUDs on sperm migration

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

Predictive value of serum ferritin in anemia development after insertion of T Cu 220 intrauterine device

A one-year follow-up study in 30 healthy women was undertaken to study serum ferritin as well as other hematological parameters prior, six and twelve months after insertion of an intrauterine device, T Cu 220. Women were allocated into one of two groups according to the baseline ferritin serum levels; Group I abnormal ferritin and Group II normal ferritin levels. Other hematological parameters were normal and no iron supplement was given throughout the study. A direct relationship between low ferritin serum values (Group I), and anemia development was found. Seven out of 15 developed anemia, whereas only 2 out of 15 had anemia at twelve months in Group II with normal ferritin values. The overall data suggested that measurement of serum ferritin levels could be a useful tool to anticipate anemia development in women with intrauterine devices.

Two years' experience with two levonorgestrel-releasing intrauterine devices and one copper-releasing intrauterine device: a randomized comparative performance study

A randomized comparative performance study of two levonorgestrel intrauterine devices (IUDs) and a copper (Nova-T) IUD (Leiras, Turku, Finland) was performed at two clinics in Finland and one in Brazil. The 24-month cumulative event rates per 100 women are reported. Six thousand woman-months of use were recorded with the levonorgestrel IUD and 3000 with the Nova-T device. Pregnancy rates at 2 years of use were 0.6 and 0 with the two levonorgestrel IUDs and 3.3 with the Nova-T IUD. Removal rates because of bleeding and/or pain were low with all three IUDs: 7.5, 7.6, and 7.1, respectively, at 24 months. Recordings of the number of days of bleeding showed significantly fewer days of bleeding during use of the levonorgestrel IUDs than the Nova-T IUD from the second month of use onward, until the end of the second year. No infections were recorded in association with use of the levonorgestrel IUDs, and only one termination because of infection was recorded for the Nova-T IUD. The continuation rates of use at 24 months were 66.6, 60.7, and 71.9 for the two levonorgestrel IUDs and the Nova-T IUD, respectively; the differences were not statistically significant.

The peritoneal reaction to the translocated copper intrauterine device in women and female rats

The observation of a very severe peritoneal reaction to translocated copper-bearing devices in five women necessitated operative removal. Three Copper-T (Ortho Gyne-T, Ortho, Saunderton, High Wycombe, England) and two Copper-7 (Gravigard, Searle, High Wycombe, England) devices were involved. Similarly severe peritoneal reactions were noted in 90% of female rats who had small-sized modified copper devices inserted into their peritoneal cavities. In a control group of rats with the same device but without a copper wire, mild adhesions were observed in the majority (85%), and none had a severe peritoneal reaction. It seems evident that the severe peritoneal reaction is induced by the copper wire in both women and female rats.

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.

Fincoid--a new copper IUD: a preliminary report

Fincoid, a new copper IUD, was tested on a single clinic basis in a preliminary series of 956 1st insertions and 10,015 woman-months of use with an individual follow-up of 12 months. 458 (48%) of the women were nulliparous and 498 (52%) were parous. About 1/3 of the women had previously discontinued the use of other types of IUDs (mostly copper) because of side effects. The 1st segment of net cumulative rates for the whole series were: pregnancy 1.1, expulsion 4.7, removal for bleeding and/or pain 7.6 and removal for infection 0.8. The continuation rate was 78.9 and the percentage lost to follow-up was 2.8%. The parous group had a higher continuation rate (81) than the nulliparous group (76). Rates for pregnancy, expulsion, and infection in the nulliparous group were about 2-fold the corresponding rates of the parous group. There was no difference in the removal rate for bleeding and/or pain between the 2 parity groups. The results of the study show that the Fincoid is a valid method of intrauterine contraception.

Clinical performance of a new levonorgestrel-releasing intrauterine device. A randomized comparison with a nova-T-copper device

The clinical performance of two levonorgestrel-releasing intrauterine devices (IUDs) with different release rates was studied and compared with a copper-releasing Nova-T device in a randomized partly double-blind multiclinical trial. Special attention was given to patterns of bleeding, hormonal side-effects, blood pressure and body weight. The clinical acceptability of the levonorgestrel IUDs was as good as that of the copper-releasing IUD. A highly significant decrease in the amount of menstrual blood loss was seen with the levonorgestrel-IUDs, the users of which experienced fewer days of bleeding than prior to insertion. Patients suffering from dysmenorrhea experienced relief from this symptom after insertion of a levonorgestrel-IUD. Some side-effects, usually referred to as hormonal, increased during the levonorgestrel-IUD use, but did not result in higher termination rates than with the Nova-T device. No changes in body weight were recorded for the levonorgestrel-IUDs and a slight decrease in both systolic and diastolic blood pressure was found after one year of use. No infections were recorded.

Malonaldehyde production around copper IUDs

Specimens of cervical mucus from 7 women fitted with copper IUDs were placed immediately after collection in liquid nitrogen. These specimens were shown by electron paramagnetic resonance measurements to contain statistically significantly higher concentrations of free radicals than similar specimens from 6 women fitted with plastic Lippes loops. Cervical mucus, collected from women immediately prior to elective removal of an IUD, was placed in 2M hydrochloricacid and later analyzed for malonaldehyde using a newly developed polarographic method. Positive results were obtained for 8 of 19 women fitted with copper IUDs, but for none of 21 women fitted with plastic devices. Cervical mucus was similarly collected from 10 women fitted with copper IUDs, 9 women fitted with plastic IUDs, and an additional 9 using other methods of contraception. Mucus was collected 3 times (early, middle, and late cycle). No malonaldehyde was detected in mucus from women with plastic IUDs, or other contraceptive methods. Positive results were obtained in 13 of 29 mucus specimens from those using copper IUDs. Stage of menstrual cycle did not influence the percentage of positive results. Malonaldehyde was detected in vitro in solutions of arachidonate or prostaglandin F2alpha in buffered saline incubated with sterile copper IUD, but not with the plastic. Rate of malonaldehyde production was markedly influenced by pH, temperature, agitation, substrate concentration, and size of gas-liquid interface. the rates of malonaldehyde production around the copper IUD in utero are unknown. The possible increased risk of carcinogenicity associated with the copper IUD is discussed.

Iron-deficiency anemia and long-term use of copper-bearing IUDs

The increase in menstrual blood loss (MBL) caused by IUDs may result in iron deficiency anemia. 60 women completing 2 years of Cu-IUD use were investigated for this risk, using hemoglobin concentration serum iron indices. No significant differences were found compared to a control group of women requesting interval Cu-IUD insertion. A decrease in the MBL increment with time following insertion, self-selection of the study population, and increased dietary iron absorption are suggested explanations for these results. 15.4% of patients suffered from iron deficiency anemia. Measurement of serum ferritin is advocated to identify these women for treatment, in order to enhance maternal health.

Management of uterine adhesions with 'Massouras Duck's Foot' and 'Butterfly' IUDs

The Massouras Duck's Foot (MDF) IUD and the Butterfly IUD have been clinically evaluated. The MDF, which is Y-shaped, has 2 or 3 horizontal arms on a vertical stem and 2 triangular wings, in between the 'V'. When inserted after curettage, it prevents intrauterine or intracervical adhesions. The fan-shaped Butterfly IUD has 2 overlapping wings, thereby facilitating adjustment of the IUD to variable uterine cavities. Its wing span occupies the entire uterine cavity when inserted according to the instructions. Both IUDs are made of polyethylene plastic with barium sulfate. Several substitutions for barium sulfate are suggested, e.g., copper, silver, hormones, biodegradable polymers. The high antifertility action of these IUDs is due primarily to their occupancy of the entire uterine cavity.

Concentrations of copper in human secretions and weight of the copper wire during the 4 to 7 years after insertion of a Cu-IUD (intrauterine device)

The useful life span of the two most commonly used copper intrauterine devices (Cu-IUDs) (Gravigard and Cu-T) was investigated in a long-term study up to 90 months after insertion. Minor differences between the two types of devices were found that, however, probably do not contribute to a diverging contraceptive efficacy with time. To be able to ensure maximal contraceptive effect, the authors suggest on the basis of the present data that the time of use not exceed 5 to 6 years.

Intrauterine contraception with Nova-T and copper-T-200 during three years

A randomized comparative trial on the clinical performance of two copper-releasing IUDs (Nova-T and Copper-T-200) was performed simultaneously in Denmark, Finland and Sweden. After three years the cumulative pregnancy rate was 1.9 for Nova-T and 5.0 for Copper-T. This difference in efficacy was statistically significant (p less than 0.001). Copper-T had a lower expulsion rate (p less than 0.05) in the total series but not in postmenstrual insertions. Differences between the two devices in other termination rates were not statistically significant. Analysis according to age and parity demonstrated that the pregnancy rate of Nova-T was lower than that of Copper-T in every age and parity group. The pregnancy rate of Nova-T was not effected by age or parity whereas the pregnancy rate and the expulsion rate of Copper-T decreased with increasing age and parity. The removal rate because of infection decreased markedly after the first year of use for both devices. The cumulative rate of removals for infection during the three years of use was not significantly correlated to age and there was no correlation to parity. The continuation rates increased with age and parity. The continuation rates of nulli- and primiparous women were almost identical with both devices and lower than continuation rates of women with 2 or three or more children. Only 11% of the women were lost to follow-up during 36 months. Nova-T had superior effectiveness in preventing undesired pregnancies when compared with Copper-T. The performance of Nova-T is less affected by age and parity then the performance of Copper-T. The silver core in copper wire gives a prolongation of the life-span for Nova-T. For these reasons, Nova-T appears to meet the requirements for an ideal IUD.

Postplacental manual insertion of the Multiload Copper 250 IUD

A Multiload (ML) Cu 250 IUD was inserted manually immediately after childbirth in 200 volunteer women. The patients were followed up at 1, 3, 6, 12, and 24 months. There were no undesirable side effects and no serious complications occurred. No noteworthy bleeding occurred either in the postpartum period or subsequently. Maternal lactation was not affected. During the 2 years, 6 devices were removed for medical reasons and the IUD was expelled spontaneously in only 2 patients. 2 pregnancies occurred among the women who were followed up. Postpartum manual insertion of the ML Cu 250 is a very good method of postpartum contraception because there are no significant complications, the rate of expulsion is minimal, and the efficacy is quite high.