Pregnancy and IUDs

Pregnancy is possible with an IUD in place; it is also possible if the IUD has been expelled or has moved out of its proper position. The chance of conceiving with an IUD still in place decreases as the woman’s fertility declines. About 5% of the pregnancies which occur are ectopic, compared with 0.5% among pregnancies in non-IUD users. If the pregnancy is ectopic, then an immediate operation is necessary. Ectopic pregnancy can be a particular danger to an IUD user, as she may attribute the pain to her IUD and not get help quickly.

If the pregnancy has occurred with the IUD still in place, the IUD should be gently removed by the clinician, if possible within the first three months, if this is at all feasible. This removal will carry a 25-30% chance of precipitating a miscarriage (twice the normal rate in pregnancy). If the IUD cannot be removed and is left in place, there is a 50% chance of miscarrying the baby. Many of these miscarriages are likely to be ‘septic’ — associated with infection. Many of the deaths in IUD users are attributable to septic miscarriage or undiagnosed ectopic pregnancy. If the baby is carried to term safely, there is no evidence to suggest that it stands any more chance of being abnormal than babies of ordinary pregnancies.

Removal

IUDs may be removed for replacement, because the woman wants to get pregnant, or because she wishes to discontinue this method. Generally removal takes a few minutes, but occasionally there can be difficulties. Removal of the Copper-7 can be difficult because of its shape. Saf-T-Coils and Lippes Loops are generally removed fairly easily unless they have become embedded in the uterine wall. The pain on removal seems to be worse if the IUD has been in place for five years or more — it may have become embedded, or the cervical canal may have become narrower. Removal during a period is easiest as the cervix is more relaxed. Occasionally the doctor may need to anaesthetize the cervix and dilate it. IUDS containing copper should be replaced every 2-3 years, (apart from 5-year Novagen) the Progestasert-T every year, but the others can be left in place for much longer.

Other considerations

The return of fertility is an important area in relation to IUDS, especially as PID and ectopic pregnancies can lead to infertility. Roughly 85-90% of those discontinuing the IUD because they want to become pregnant do so within a year of removal. One advantage of the IUD is that it can be used during breastfeeding, as it has no effect on lactation. The safety record of the IUD outstrips that of the pill as the woman gets older, her fertility declines, and the risks of the pill become more dangerous. The IUD should always be removed after the menopause.

Health Problems With IUDs

Contraindications of IUDs

There are some conditions which will prevent a doctor from suggesting the IUD as a suitable method of birth control. These are:

  • Pregnancy (known or suspected).
  • Acute or chronic (long lasting) pelvic infection.
  • Known or suspected malignancy of the cervix or uterus If the woman wants to have children in the future (this is only true of some doctors).
  • Relative contraindications are those that the doctor considers may make an IUD inadvisable. These are:
  • Not having had children (not true of some doctors). Painful periods.
  • Heavy periods or irregular bleeding.
  • Abnormalities of the uterus, e.g. double uterus, large fibroids, very small uterus.
  • Lack of access to emergency treatment.
  • Multiple sexual partners (or history of).
  • History of pelvic infection.
  • Severe cervicitis.
  • Anaemia.
  • History of ectopic pregnancy
  • Some conditions such as renal disease, valvular heart disease, which would make an infection dangerous.
  • Being on anticoagulant therapy, or steroids.

Danger signs.

All women fitted with IUDS should be aware of the danger signs that can signal ND, pregnancy, miscarriage or an ectopic pregnancy. The initial letters spell out the mnemonic PAINS.

  • Period late or absent.
  • Abdominal pain.
  • Increased temperature, fever, chills.
  • Noticeable or foul discharge.
  • Spotting, bleeding, heavy periods, clots.

Reliability

The actual failure rate of the IUD is very close to the theoretical, as the woman has to do very little to continue using the method once the device is fitted. The theoretical failure rate is 1-3 per 100 woman/years (there is a slight variation among different styles of !up). The actual failure rate is 4-10 per 100 woman/years.

Conclusions

The IUD is a long-acting method of birth control which generally needs little attention from the user. It has a high success rate, is discreet to use, does not alter the body’s natural rhythms, and can be used by breastfeeding mothers. It is not suitable for all women, and is associated with several undesirable and a few fatal complications. Its chief drawback, however, which outweighs all other benefits and drawbacks, is that it generally acts by preventing implantation rather than preventing conception, which makes it morally unacceptable to those who believe that life begins at conception. For the exception to this method of action.