History of IUD Development

Used by almost 160 million women worldwide, the intrauterine device or IUD is the most commonly used reversible method of birth control in the world. An IUD is a plastic device that is placed in the uterus via insertion through the vagina and the cervix, and a string is attached to it that hangs down in the vagina for ease of removal. The first recorded report of an IUD was in 1909 by a German scientist, Richard Richter, who described a ring made of silkworm gut and how to insert it. Ernst Gräfenberg (the man for whom the G-spot, or Gräfenberg spot, was named in honor of his research on women’s genitals and sexual physiology) was the first scientist to successfully test the effectiveness of the IUD in 1929 with a 3 percent rate of pregnancies among 1,100 women who used the IUD. He then improved on the design and effectiveness of the IUD the next year, almost cutting the pregnancy rate in half, to 1.6 percent among 600 women, by wrapping the ring in silver wire. The silver used in the IUD by Gräfenberg just happened to contain copper, the material that 40 years later turned out to be the reason for the increased effectiveness of the IUD.

In 1934, a Japanese doctor named Tenrei Ota modified the ring by adding a central disc that reduced the chances that an IUD would pop out of the uterus. Although a significant improvement, more work was needed to make devices with lower rates of infections. However, World War II prevented this knowledge from spreading to the rest of the world until after the war. The next big development in IUD research came in 1958 with the creation of a plastic IUD that would reshape itself after insertion, made by U.S. doctor Lazar Margulies. However, the Margulies coil came with the side effects of cramps and bleeding due to its large size. In addition, the plastic tail that remained in the vagina could result in pain for sexual partners.

Progress on new modifications continued in 1962 with another U.S. doctor named Jack Lippes who created an IUD with a single strand of thread for a tail, the Lippes Loop, which became quite popular in the U.S. in the 1970s. Then in 1968, the well-known plastic T-shaped IUD was created by U.S. doctor Howard Tatum and simultaneously a Chilean doctor named Jamie Zipper announced the idea of including copper to increase the efficacy. The devices that used copper could be made smaller, were still effective, and would cause less side effects. T-shaped devices fit better in the uterus and were less likely to be expelled by the uterus. An IUD that releases progesterone to reduce cramping and blood loss was developed at approximately the same time as the copper IUD.   
 
Worldwide IUD Usage

Worldwide it was estimated in 2005 that 13 percent of married women between the ages of 15 and 49 who used contraception chose IUDs over all other options. Worldwide estimates of contraceptive use are calculated among married women because some countries ONLY ask married women of reproductive age about birth control. Married Chinese women lead the world in number of IUDs users, and make up more than half of all married users (60 percent). The rest of Asia (12 percent), Eastern Europe and Central Asia (11 percent), the Near East and North Africa (7 percent), Latin America and the Caribbean (5 percent), developed countries (5 percent), Sub-Saharan Africa (0.4 percent), and Oceania (0.01 percent) comprise the rest of the married IUD users. According to the 2002 National Survey of Family Growth, 1 percent of contraceptives used to prevent pregnancy by women in the U.S. are IUDs. What happened in the U.S. that has led to such a low prevalence of use of the IUD now?

What Happened in the United States?

In 1973, 8 percent of women in the U.S. were using an IUD as their method of contraception. In the early 1970s, almost 3 million of the women in the U.S. were using the Dalkon Shield as their IUD of choice. However, the Dalkon Shield had a major design flaw: the string that hangs down into the vagina was made of several filaments instead of just one. This was a problem because the multiple filaments could become a breeding ground for bacteria that could cause pelvic infections when they went from the unsterile vaginal environment into the sterile uterus. The Dalkon Shield was taken off the market in 1974 due to the fairly regular occurrence of septic abortions; that is, abortions that become more complicated due to the presence of a pelvic infection at the same time.

After the removal of the device from the market, other research came out saying that the Dalkon Shield was also to blame for many hysterectomies, miscarriages, ectopic pregnancies, and infertility, bankrupting A.H. Robins, who produced the product. Once the Dalkon Shield was pulled from the market, other IUDs were believed to be dangerous as well. IUDs, in fact, actually have a very low risk of infection and infertility. IUDs do not increase the chances of an ectopic pregnancy—they prevent all pregnancies. Due to the debacle with the Dalkon Shield, by the 1980s IUD use completely dropped in the U.S. and they were no longer made here. Many physicians steered women away from IUDs fearing infections. Even today, many physicians are reluctant to recommend IUDs to women who have not yet had children. IUDs have made a small comeback in the U.S., although the Dalkon Shield incident has seriously tainted the frequency of their use in the U.S. It is unfortunate that most women in the U.S. do not consider the IUD as a contraceptive option as it has a failure rate of less than 1 percent.

Types of IUDs

There are 2 types of IUDs: hormonal and non-hormonal. Non-hormonal IUDs, or copper IUDs, were first created inadvertently in 1929 and have been in regular use since 1968. Paragard is the only type of copper IUD available for purchase in the U.S. today. The copper IUD can be used for up to 12 years without complications. Hormonal IUDs were first developed in 1976; they released progesterone to reduce bleeding and prevent fertilization and were produced until 2001. In 1990, hormonal IUDs using levonorgestrel, a synthetic progesterone, were developed and Mirena is currently the only hormonal IUD available in the U.S. today. The hormonal IUD is usable for up to five years at a time.

How IUDs Work

The main method of IUD function is to prevent fertilization. Having the IUD in the uterus makes it more difficult for the sperm to reach the egg. The copper released from the non-hormonal IUDs is believed to damage the sperm and help prevent sperm from fertilizing any eggs. The hormonal IUD decreases how often ovulation occurs. Both types of IUD cause changes to the tissues lining the uterus and the fallopian tubes. Having an IUD in the uterus causes the tissue to release white blood cells and a certain type of hormones called prostaglandins, which make the uterus an unpleasant place for eggs and sperm. This change in the uterine environment affects how the eggs and sperm move through a woman’s reproductive system so that fertilization (joining of the egg and sperm) does not occur. IUDs do not destroy fertilized eggs, or act as an abortifacient (a substance that causes abortions). Copper IUDs can also be used as emergency contraception if they are put in place within five days of unprotected sex. They can then remain in place in the uterus and be used as regular contraception.

Insertion of an IUD

IUD insertion generally takes place during or immediately following a woman’s period because the cervix is partially open (making the insertion easier) and the chances of pregnancy are low. The insertion process takes about 5-15 minutes, and the majority of women feel cramping during and after. Insertion does carry a slightly increased risk for pelvic inflammatory disease (PID) within the first three weeks after the IUD is inserted, which normally has a very low risk of occurrence at 0.15 percent. PID was six times more likely to occur during the three weeks after insertion of an IUD than compared with any other time during IUD use. Because of this increased risk of PID, IUDs should be left in place for as long as possible and not changed earlier unless there is a problem. Women who have recently given birth, have cancer of the reproductive organs, have any STIs including HIV (because this will increase the risk of PID), are pregnant, have unexplained vaginal bleeding or any PID should not get an IUD.

Complications with IUDs

Both types of IUD run the risk of being expelled from the uterus and both types of IUD could puncture the uterine wall, but this happens only rarely. Women should check to make sure that the string is in place after each period. Copper IUDs can cause heavy bleeding and longer periods that may also be more painful. The blood loss may cause anemia, and there may also be spotting but this is not a sign of a problem. These side effects are less common with the hormonal IUD. However hormonal IUDs have other risks, amenorrhea (when period bleeding stops altogether), ovarian cysts, as well as weight gain, headaches, increased blood pressure, acne, depression, and lessening of sex drive. The period usually returns when the IUD is taken out. Some women or their partners may notice the string which hangs just inside the vagina for removal. If this becomes a problem, women should ask their doctor to trim the string a little shorter.

Don’t Give Up on the IUD!