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  • Title: Do insertion-related problems affect subsequent IUD performance?
    Author: Chi IC, Waszak CS, Wilkens LR.
    Journal: Contraception; 1986 Nov; 34(5):497-503. PubMed ID: 3816233.
    Abstract:
    This investigation compares the IUD performance of 372 women who had an insertion-related problem (most with moderate or severe pain) and 372 matched women who had no such problem; all women had interval insertion. A woman in the Problem Cohort and her matched counterpart in the Comparison Cohort were inserted with the same IUD type by the same insertor on the same day or on close dates. The six IUD types used by these women were Lippes Loop D, Copper-7, Copper T-200, Copper T-380 Ag, Multiload Copper 250 and Multiload Copper 375. Cumulative gross life-table rates of the pertinent events (accidental pregnancy, expulsion and medical removal for bleeding and pain), adjusted for age and parity, were calculated. Between the Problem Cohort and the Comparison Cohort, no differences were detected in the event rates that were of either statistical or practical significance. Results from this preliminary study suggest that the insertion-related problems usually encountered during interval insertion such as insertion pain, syncope and/or mild cervical laceration are not associated with an increased risk of IUD discontinuation due to pertinent events. This study, based on data compiled by Family Health International, examined IUD performance in terms of problems related to insertion. The subjects included 2415 women from 6 centers in 5 countries who had had a Lippes Loop D, Copper T-200, Copper T-380 Ag, or Multiload 375 IUD inserted in 1976-84. Of these women, 165 (6.8%) had at least 1 insertion-related problem, including moderate or severe pain in 115, cervical laceration in 30, and syncope or other vasovagal reactions in 20. 150 of these cases were able to be matched with controls of similar age and parity with no insertion-related problems with the same device. Cases and controls were then compared in terms of rates of accidental pregnancy, expulsions, and medical removal in the 6 months postinsertion. The pregnancy rate at 6 months was 2.5% in cases vs. 1.6% in controls. The expulsion rate was 4.4% in cases vs. 1.5% in controls, and the medical removal rate was 2.3% in cases vs. 6.1% in controls. None of these differences was statistically significant. This lack of difference may be due to the experienced personnel at the study centers. In addition, since virtually all subjects had had at least 1 child, the study population was a low-risk one in terms of insertion-related problems. Moreover, there may not have been real differences between cases and controls, i.e., cases may have exaggerated the degree of insertion pain as moderate or severe when it was in fact mild. Although these results suggest that insertion-related problems are not associated with an increased risk of IUD termination, further studies with larger samples are needed to confirm this finding.
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