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  • Title: The intrauterine device and ectopic pregnancy.
    Author: Edelman DA, Porter CW.
    Journal: Contraception; 1987 Jul; 36(1):85-96. PubMed ID: 3311627.
    Abstract:
    Based on data given by case-control and cohort studies the relationships between current and past IUD use, duration of IUD use and the type of IUD were evaluated to determine the risk of ectopic pregnancy among IUD users. The results of this review indicate that current and past IUD users do not have an increased risk of ectopic pregnancy. No relationship was found between the duration of IUD use, for either current or past IUD users, and the risk of ectopic pregnancy. Pooled data from clinical studies of different types of IUD showed that the lowest risk of ectopic pregnancy was for users of copper-bearing IUDs, and the highest risk was for users of progesterone-releasing IUDs. Further research is needed to evaluate the ectopic pregnancy risks to past IUD users, especially in view of recent studies which have shown that these women may be at a higher risk of infertility. A review of existing case-control and cohort studies on the association between IUD use and ectopic pregnancy suggests 3 conclusions: 1) neither current nor past use of an IUD is associated with any increased risk of ectopic pregnancy; 2) the incidence of ectopic pregnancy seems to be similar for current users of all types of IUDs, except for the Progestasert; and 3) the duration of IUD use does not increase the risk of ectopic pregnancy. Pooled data from clinical studies of various types of IUDs indicate that the lowest risk for ectopic pregnancy is found in users of copper-bearing IUDs, while the highest risk occurs in users of progesterone-releasing devices. Although the incidence of ectopic pregnancy increased throughout the 1970s, when IUD use was also on the rise, there is no basis for assuming a cause and effect relationship. It is more plausible that the increase in ectopic pregnancy is related to the increase in various sexually transmitted diseases and the effects they have on the female genital tract. However, there is a need for further evaluation of the interrelationships between contraceptive use and predisposing factors such as pelvic inflammatory disease to tubal infertility and ectopic pregnancy.
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