Time to conception after IUD removal: importance of duration of use, IUD type, pelvic inflammatory disease and age.

Some investigations of IUD use have demonstrated impaired ability to become pregnant after removal, while others have not. None of these studies, however, have adequately considered such potentially influencing variables as age and a history of pelvic inflammatory disease (PID). To study the effect of length of IUD use, IUD type and the modifying influences of age and PID history on time required to conceive, we followed women trying to become pregnant after removal of their IUD. Five hundred forty women in Ljubljana, Yugoslavia who were first fitted with an IUD between 1964 and 1972 and had their IUD removed in order to become pregnant were followed through 1980. We found no relationship between the duration of IUD use or type of IUD used, but increasing age and a history of PID each decreased the monthly probability of conception. These findings, along with other recent work, indicate that IUDs are a safe and efficacious contraceptive for women at low risk for sexually transmitted diseases.

PIP: Previous investigations of IUD use have demonstrated impaired ability to become pregnant after removal, while other studies have not. None of these studies, however, have adequately considered such potentially influencing variables as age and a history of pelvic inflammatory disease (PID). This investigation uses regression analysis to assess the influence of various factors individually on time to conceive. 540 women in Ljubljana, Yugoslavia, who were 1st fitted with an IUD between 1964 and 1972 and had their IUD removed to become pregnant, were followed through 1980. The COX regression model is used to assess simultaneously the influences of length of IUD use, device type (Lippes Loop), age at removal, parity, previous PID history, and duration of marriage on time to conception, thus controlling for the interrelationships between variables. This technique estimates the probability of conceiving at different times. Results indicate that duration of IUD use did not affect the time to conception. In addition, IUD type, duration of marriage or parity did not affect the time required to conceive. These findings demonstrate that the use of IUDs does not, in and of itself, lead to problems with subsequent fertility. However, these results underscore the importance of limiting IUDs to women who are not at high risk of sexually transmitted diseases.

IUD use after 40 years of age.

One hundred sixty-three IUD acceptors over the age of 34 at the time of insertion of the device were compared with 321 IUD acceptors under the age of 35 at the time of insertion. The older IUD acceptors were less educated, more likely to be married, and had more children and more induced abortions. At the time of last follow-up, 161 women were 40 years of age or older, and 323 were less than 40 years old. During 9 years of observations, there were fewer IUD removals and fewer side-effects during the last year of use in the older group of women. Questions relating to the risks of long-term IUD use and the use of hormone-releasing IUDs in this age group remain unanswered.

Pregnancy rate after longer use of two copper IUDs.

PIP: The life table method was used to analyze the longterm performance of 2 types of Copper IUDs in a study in Yugoslavia. Follow-up was carried out for 7 years in 93 Copper T 200 users and for 6 years in 165 Copper 7 users. The cumulative continuation rate for the Copper T 200 after 7 years was 46.2 and for the Copper 7 after 6 years was 42.9. Contrary to expectations, the pregnancy rate decreased with duration of use. Neither decreased coital frequency in higher ages nor the decreasing number of cases available for observation account for the lower pregnancy rate during the later years of follow-up. All data are tabulated and graphed. As a result of this study, it is concluded that Copper IUDs can be effective in preventing pregnancy for much longer than the recommended 3 years.^ieng

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.

Fertility survey in Slovenia, 1989.

PIP: Slovenia, an independent state since January 1992, conducted a KAP-type survey of 1117 male and female respondents aged 15-44 years between August 1989 and March 1990. The aim of the survey was to assess the social, medical, and demographic factors in low fertility and to identify fertility determinants. An explanation was needed for inadequate use of contraceptives, which were easy and inexpensive to obtain, and for reliance on abortion. The questionnaire included 180 questions on 16 topics; the same questions were asked of men and women with a few exceptions. There was a mean age of 30 years and 59% were married. 77% were employed and 59% had finished secondary school. The average number of children was 1.3; desired number of children was 2.4. 43% of women with children wished to stop childbearing. 13% desired an additional child; 32% wanted 2 or more children and 12% wanted 3 or more children. 62% believed that every woman should have a child. The ideal family of 2 children was reported by 60%. 31% favored 3 children. 58% considered a family size of 2 children appropriate for their own family. Over 75% reporting 2 children appropriate for their family size thought 2 children were ideal. 99% considered family planning as a mutual decision. 24% thought men's participation in decision making was inadequate, because men did not have sufficient opportunity to speak with a doctor. Women did not have confidence in men and wanted to make decisions alone. There were significant differences in attitudes by sex. 87% of men and 90% of women were sexually active. 41% reported that at the beginning of their sexual activity there was little discussion of contraception. Of those discussing contraception, 57% decided to use contraceptives of which 71% decided on regular use and 20% on use only during the fertile phase of the cycle. 33% of women who decided alone relied on regular use of withdrawal, and a larger number of joint decisions involved withdrawal as a method of choice. The greatest differences in subjective and objective knowledge were for condoms, diaphragm, and foam/jelly. Ever use of contraception was 85% for women and 56% for a reliable method. There were big differences between characteristics of women who used or did not use contraception. Traditional sexual behavior occurs for most Slovenians; family planning is not an accepted part of their lives.^ieng

IUDs and PID: a comparative trial of strings versus stringless devices.

An international multicentered clinical trial was designed to determine the possible role of intrauterine device (IUD) marker strings in the etiology of pelvic inflammatory disease (PID). A total of 1265 women were admitted and randomly allocated to receive either a standard TCu200 IUD or a TCu200 IUD without marker strings. These patients were followed-up through 12 months postinsertion. No statistically significant differences were found between the two groups of IUD users with respect to the incidence of PID or other types of infection or inflammation. The 12-month life table termination rates and overall continuation rates were also similar for users of the respective devices, with the exception of removal rates for bleeding/pain, which were significantly higher in the strings group than in the stringless group. However, the number of bleeding/pain complaints ever reported during the study were not statistically different in the two study groups. The study results indicate that the IUD string does not play an important role in the etiology of PID associated with the use of IUDs.