Document Detail


A prospective New Zealand study of fertility after removal of copper intrauterine contraceptive devices for conception and because of complications: a four-year study.
MedLine Citation:
PMID:  2916624     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A prospective New Zealand study was started in 1982 to determine fertility rates and pregnancy outcomes after removal of copper intrauterine contraceptive devices to allow conception or because of complications. In a combined 4-year study, there were 887 removals to allow conception and 164 due to complications. Participants were 375 (35.7%) nulligravid and 676 (64.3%) gravid women. Within 48 months, 91.5% of the nulligravid and 95.7% of the gravid women had conceived. A 2-year combined study, with regard to longer use of intrauterine contraceptive devices (greater than 2 years), did not show any significant reduction in fertility or increase in ectopic gestation within 24 months. However, in gravid women of similar age distribution, there was a significant increase in the miscarriage rate, compared with use of intrauterine contraceptive devices for less than 2 years or compared with nulligravid women. In a 1-year study, removals because of complications did not cause a significant reduction in fertility or an increase in ectopic gestation, miscarriage, or preterm delivery rates within 12 months, compared with removals to allow conception.
85% of physicians in New Zealand who insert IUDs participated in a prospective study begun in 1982 to ascertain fertility and pregnancy outcome in nulligravid and gravid women after removal of IUDs to permit conception or because of complications. In the 4-year study period, there were 887 removals for purposes of conception and 164 due to complications. 64% of these removals involved gravid women, and 36% involved nulligravidae. At 36 months after removal of the IUD, 92% of women who underwent removal because of complications had conceived compared with 94% of women who had removals to become pregnant. There were no significant differences in conception rates according to the complication that led to removal--e.g., pain and bleeding, pelvic inflammatory disease, and vaginal discharge. The ectopic pregnancy rate was 0.7% among women who had their IUDs removed because of complications compared with 0.5% among those who underwent removal to achieve pregnancy. There were no significant differences between women who had used the IUD for less than 2 years and those who had the device in place for 2 or more years in terms of return to fertility or the ectopic pregnancy rate. However, there was a significant increase in the miscarriage rate among women who had used the IUD for 2 years or more (15.3% miscarriage rate) compared to those whose IUD use was under 2 year's duration (10.4%). Further analysis indicated that removals because of complications did not cause significant differences in preterm delivery rates compared with removals to allow conception. An important finding of this study was a high induced abortion rate (11%) after IUDs were removed because of complications, in part reflecting a mistaken assumption on the part of women who had their IUDs removed because of pelvic inflammatory disease that they were infertile. Overall, this prospective study suggests that a favorable return to fertility and a good pregnancy outcome can be expected after IUD use is discontinued.
Authors:
J C Wilson
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of obstetrics and gynecology     Volume:  160     ISSN:  0002-9378     ISO Abbreviation:  Am. J. Obstet. Gynecol.     Publication Date:  1989 Feb 
Date Detail:
Created Date:  1989-03-23     Completed Date:  1989-03-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370476     Medline TA:  Am J Obstet Gynecol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  391-6     Citation Subset:  AIM; IM; J    
Affiliation:
St. Helens Hospital, Auckland, New Zealand.
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MeSH Terms
Descriptor/Qualifier:
Abortion, Spontaneous / etiology
Female
Fertility*
Humans
Infertility, Female / etiology
Intrauterine Devices, Copper* / adverse effects
Middle Aged
Pregnancy
Pregnancy Outcome
Pregnancy, Ectopic / etiology
Prospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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