IUDs: a state of the art conference. Introduction.

A conference sponsored by the US Department of Health and Human Services and the National Institute of Child Health and Human Development, in cooperation with the American College of Obstetricians and Gynecologists and the American Society for Reproductive Medicine, sought to increase appreciation of the IUD as a safe, effective, and cost-beneficial contraceptive. The IUD is greatly underused in the US, selected by only 1% of contraception users. Lack of knowledge on the part of clinicians and patients about currently available devices and inadequate clinical training in IUD insertion are major obstacles to expanded utilization of this effective method. The vast majority of chief residents in obstetrics-gynecology have never inserted an IUD or have inserted too few to be considered proficient. Many concerns are related to the Dalkon Shield's adverse effects; which concerns are not generalizable to contemporary devices. Also limiting IUD use has been the perception that the device acts as an abortifacient. Current research suggests the device induces a local inflammatory response in the endometrium. The addition of copper further decreases the likelihood of sperm reaching the distal section of the fallopian tubes and diminishes fertilization capabilities. The copper-containing IUD in use today has a low expulsion rate (3%) and low rates of removal for pain and bleeding. Perforation rates remain steady at approximately 1 per 1000-2000 insertions. Return to fertility after removal is comparable to that associated with oral contraceptives and barrier methods.