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  • Title: Tubal infertility and the intrauterine device.
    Author: Cramer DW, Schiff I, Schoenbaum SC, Gibson M, Belisle S, Albrecht B, Stillman RJ, Berger MJ, Wilson E, Stadel BV.
    Journal: N Engl J Med; 1985 Apr 11; 312(15):941-7. PubMed ID: 3974684.
    Abstract:
    To study the association between intrauterine devices (IUDs) and pelvic inflammatory disease, we compared contraceptive histories in 4185 while women--283 nulliparous women with primary tubal infertility, 69 women with secondary tubal infertility, and 3833 women admitted for delivery at seven collaborating hospitals from 1981 to 1983. The relative risk of tubal infertility associated with IUD use was calculated by means of multivariate logistic regression to control for confounding factors, including region, year of menarche, religion, education, smoking, and reported number of sexual partners. The adjusted risk of primary tubal infertility associated with any IUD use before a first live birth was 2.0 (95 per cent confidence limits, 1.5 to 2.6) relative to nonuse. Users of the Dalkon Shield had an adjusted risk of 3.3 (1.7 to 6.1), users of the Lippes Loop or Saf-T-Coil had a risk of 2.9 (1.7 to 5.2), and users of copper IUDs had a risk of 1.6 (1.1 to 2.4). Women who reported having only one sexual partner had no increased risk of primary tubal infertility associated with IUD use. The adjusted risk of secondary tubal infertility associated with use of a copper IUD after a first live birth was not statistically significant (1.5; 95 per cent confidence limits, 0.8 to 3.0), whereas the risk from similar use of noncopper devices was significant (2.8; 1.3 to 5.9). We conclude that tubal infertility is associated with IUD use, but less so with copper IUDs. The association between prior use of an IUD and subsequent infertility due to tubal disease was investigated in a multicenter case-control study. The study population included 283 nulliparous white women with promary tubal infertility, 69 white women with secondary tubal infertility, and 3833 controls admitted for delivery at 7 collaborating hospitals in 1981-83. Cases with tubal disease tended to be older, less educated, more likely to be smokers, and to have had more sexual partners than controls. The relative risk of tubal infertility associated with IUD use was calculated by means of multivariate logistic regression to control for these factors as well as region, year of menarche, and religion. The adjusted risk of promary tubal infertility associated with any IUD use before a 1st live birth was 2.0 (95% confidence limits, 1.5-2.6) relative to non-use. Users of the Dalkon Shield had an adjusted risk of 3.3 (1.7-6.1), users of the Lippes Loop or Saf-T-Coil had a risk of 2.9 (1.7-5.2), and users of copper IUDs had a risk of 1.6 (1.1-2.4). IUD use on the part of women with history of genital or pelvic infection doubled the baseline risk of tubal infertility. Women who reported having only 1 sexual partner, however, had no increased risk of primary tubal infertility associated with IUD use. The adjusted risk of secondary tubal infertility associated with use of the copper IUD after a 1st live birth was not statistically significant (1.5; 95% confidence limits, 0.8-3.0); the risk from similar use of non-copper devices, on the other hand, was significant (2.8;1.3-5.9). These results confirm as assoiciation between past IUD use and subsequent tubal infection. On the basis of this study, it is estimated that the IUD accounts for tubal disease in 88,000 (16%) of the 550,000 cases of infertility-producing tubal disease in the US. It is recommended that, with the possible exception of women with a single partner at low risk for sexually transmitted diseases, the IUD should not be a contraceptive method of 1st choice for nulliparous women. For the woman who has 1 child, however, the use of copper devices may offer a relatively safe alternative to other methods.
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