Fertility after Intrauterine Device Removal: A Pilot Study

Abstract

Background Despite high efficacy, only 7.7% of women in the United States currently using contraception use an IUD. There is little published contemporary data about fertility rates after IUD use, especially in nulliparous women and women using the hormonal IUD.

Study Design We recruited sexually active women 18 to 35 years of age enrolled in the Contraceptive CHOICE Project who had discontinued a contraceptive method and desired pregnancy.

Results In this pilot project, we enrolled 69 former IUD users (19 copper and 50 levonorgestrel) and 42 former non-IUD users. Pregnancy rates at 12 months were similar between the two groups; 81% of IUD users became pregnant compared to 70% of non-IUD users (p = 0.18). In the Cox model, there was no difference in the time to pregnancy in IUD users compared to non-IUD users (HR_adj 1.19, 95% CI 0.74–1.92). African American race was the only variable associated with reduced fertility (HR_adj 0.40, 95% CI 0.24–0.67).

Conclusions We found no difference in 12-month pregnancy rates or time to pregnancy between former IUD users and users of other contraceptive methods. However, there was a clinically and statistically significant reduction in fertility in African American women.

Chinese Abstract

摘要：

背景：尽管宫内节育器有效性很高，在美国目前只有7.7%的女性使用宫内节育器避孕。关于当前宫内节育器使用后妊娠率的资料鲜有发表，尤其是有关未产妇和使用含激素宫内节育器的女性的相关资料。

研究设计：我们招募了18- 35岁的性活跃女性参加避孕选择项目，这些女性已经停止避孕，期望妊娠。

结果： 在这项初步研究里，我们招募了69名以前使用宫内节育器的女性（19名使用的是含铜节育器，50名使用的是含左炔诺孕酮节育器）和42名未使用宫内节育器的女性。两组女性12个月后的妊娠率是相似的；使用过宫内节育器的女性和未使用过宫内节育器的女性妊娠率分别为81%和70%（p=0.18）。在Cox模型中，使用过宫内节育器的女性和未使用过宫内节育器的女性妊娠时间没有差异（HR adj 1.19, 95% CI 0.74–1.92），非洲裔美国人是与生殖力下降相关的唯一变量。

结论：我们发现使用宫内节育器避孕的女性和使用其他避孕方法的女性12个月后的妊娠率及妊娠时间没有差异。然而，非洲裔美国人的生殖力临床上和统计学均显著的下降。

Keywords:

• Intrauterine device
• Fertility
• Contraception
• Race

Declaration of interest: Dr Peipert receives research funding from Bayer Healthcare Pharmaceuticals, Merck & Teva Pharmaceuticals, and serves on the advisory boards for Teva Pharmaceuticals, Bayer Healthcare Pharmaceuticals, and MicroCHIPS. Dr Madden serves on an advisory board for Bayer Healthcare Pharmaceuticals. Dr Allsworth receives research funding from Bayer Healthcare Pharmaceuticals.

This research was supported in part by: (1) the Society of Family Planning; (2) Award number K23HD070979 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD); and (3) Clinical and Translational Science Award (UL1RR024992), from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCRR, NICHD, or NIH. Information on NCRR is available at http://www.ncrr.nih.gov. Information on Re-engineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp