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Intrauterine DevicesAshley Krohn
Megan LeveranzMonicka Souksavong
Small object inserted through the cervix into the uterus
Protects against pregnancy Does not protect against HIV/AIDs & STDs
2000: approved in the U.S 2 types in the U.S
◦ ParaGard: copper wire◦ Mirena: releases hormones
What is an Intrauterine Device?
Made of tiny copper wire wrapped around plastic◦ Approved by FDA in 1984◦ Became available for use in 1988
Lasts up to 10-12 years Is the only copper IUD approved for use in the US
◦ In 2002 used by 1.3% of women Is about the size of a penny
◦ 1 ¼’’ across the top Copper is toxic to sperm, killing it May be used as emergency contraception if inserted
within 72 hrs 99% effective Copper IUD can inhibit expression of LIF, causing inhibition
of implantation stage (crucial stage)
ParaGard
Releases small amounts of progesterone Lasts up to 5 yrs Causes a subtle change in the endometrial
environment that impairs the implantation of egg in the uterine wall
Hormones (Progesterone &/or Progestin) reduce menstrual bleeding and cramps
Mirena
Mechanism of action◦ Not known
Prevent a developing human, already fertilized in the fallopian tube, from attaching to the endometrium of the uterus
Progesterone slowly releases that interferes with development of endometrium=no implantation
Levonorgetrel IUDs also prevent implantation Changes the lining of the uterus & fallopian tubes, affecting
movement of eggs=no fertilization Causes the mucus to become thicker=sperm cannot enter
the uterus
Uses
1902:precursors of IUD 1920: a ‘ring’ made of
surgical silk then switched to wire.◦ smaller than an inch in
diameter◦ Needed to dilate the cervix
for insertion with the wire-not the silk
1934: Japanese variation lowered the expulsion rate◦ Major problem: 1 in 10
expelled the IUD
History
Various forms of Intrauterine devices that have been used in the past
Fact: ◦ 25-30% of European women used the copper IUD and
less than 1% of Americans do◦ Dalkon Shield had over 10,000 lawsuits filed because it
allowed bacteria to travel from the vagina to the uterus causing PID due to the multifilament string- now changed to a monofilament string (similar to fishing wire)
More History
o1958: the first plastic IUD came outo1970’s: invention of the stainless steel ring and second generation Copper T-IUD
Uterus with a Dalkon shield inserted
Most cost-effective, reversible method of contraception today
Family Planning centers are usually cheaper than public clinics
Medicare and Insurance may cover some of the cost
Planned Parenthood◦ $175-$500 includes medical exam, insertion of IUD, and
follow-up visits Mirena Healthplan Coverage
◦ $585.89
Cost
Most widely used method of Reversible birth control◦ 160 million women use◦ Over 2/3rds are Chinese were it’s the most common mode
surpassing sterilization Usage measured by married women of reproductive age
◦ 1990 IUD usage 1.5% United States 18% Scandinavia 33% Russia and China 40% Kazakhstan
◦ 2008 IUD usage 0.7% North America 6.0% United Kingdom 33.1% Russia 36.4% China 36.7% Egypt 51.8% Uzbekistan
Prevalence
Worldwide IUDs are much more common Wider variety of brands are available
◦ In 2008 ten brands were available in the UK
World Views
Requires no daily attention Immediately effective after inserted 99.2-99.9% effective Allows sexual spontaneity Long-lasting Reduce menstrual
◦ Cramping◦ Bleeding
Advantages
Expulsion rate is 10% during the first year of use & higher in younger women or who have never given birth
If you become pregnant with it in, there is a 55% chance of a miscarriage
Women who have used if for 3+ years are 2 times as likely to have a tubal pregnancy than women who never used an IUD
Mirena causes ovarian cysts, and similar symptoms as the pill
Disadvantages
Insertion & removal must be done by a physician
May come out without realizing… chances are you notice too late
An individual should not use an IUD for specific reasons such as◦ Unexplained vaginal bleeding◦ PID◦ HIV/AIDs◦ Etc.
More Disadvantages
Major post fertilization effect: destruction of an early embryo in the fallopian tube
Most common contraception for its REVERSIBILITY Noxa, accumulates in the uterine lumen affects
the function and viability of gametes, decreasing rate of fertilization & lowering chances of survival of any embryo, before reaching the uterus
Ethical issues
oMany believe ‘contraception’ means to PREVENT fertilizationfrom occurringo1960s: redefined term as a method which prevents pregnancy
Federal Title X Program: Workers are taxed to help fund prevention clinics ◦ Example:
Right of confidentiality by the physician can cause harm to a minor◦ 16 yr. old girl came to Dr. Willkie’s clinic
after the clinic where she got the IUD simply told her “take an aspirin and rest”
◦ He immediate removed the device because she was experiencing “fatal blood poisoning” as a result of an infection
◦ Not able to inform her parents that she may be infertile now
Economic Issues
Federal Title X Program gives rise to societal issues
Conservatives fear that funding promotes premarital sex and decreases abstinence
IUD commercials such as Mirena are frequently aired on networks that are viewed by young adults◦ ABC◦ TLC◦ E!◦ Oxygen◦ MTV
Societal issues
IUDs have made major strides in the past century Are 99.2-99.9% effective Popular in many countries around the world IUDs have raised many concerns
◦ Ethical◦ Moral◦ Economic◦ Societal
Is the most common REVERSIBLE mode of contraception◦ Allows fertilization but then inhibits the implantation into
the uterine wall
Conclusion
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