Advanced Slide Set, Slide #1

Copper-Bearing Intrauterine Devices (IUDs)

Advanced Slide Set

Copper T 380A

Advanced Slide Set, Slide #2

Copper IUDs:

Effectiveness

Source: Trussell, 2011.

Oral contraceptives

Percentage of women pregnant in first year of use

Pregnancy rate as commonly used

Pregnancy rate when used correctly and consistently

Female condom

Female sterilization

Implants

DMPA

Spermicides

Standard Days Method

Male condom

IUD (TCu-380A)

0 10 15 20 255 30

Male sterilization

Advanced Slide Set, Slide #3

IUDs Reduce Risk of Ectopic Pregnancy

6.5

1.51.2

0.6 0.4 0.2

0

1

2

3

4

5

6

7

No method Condom All IUDs Femalesterilization

OCs TCu 380A

Ectopic pregnancy rate per 1000 woman years

Source: Sivin, 1991.

Advanced Slide Set, Slide #4

10.7

0

2.7

14.7

8.8

0.4

0.8

4.9

8.6

14.8

2.0

10.0

0 5 10 15 20 25 30 35 40

Infection-relatedcomplications

PID

Pregnancies

IUD expulsion

IUD removal

Overallcomplications

Noninfected N=486HIV-infected N=150

IUDs: Safe for Women with HIV

Percentage of women in Kenyan study

Source: Morrison, 2001.

Little difference in complications between IUD users with and without HIV.

Advanced Slide Set, Slide #5

IUD Use Does Not Increase HIV Transmission

Theoretical concern: • Does IUD use by women with HIV increase

the risk of transmission to her partner?

Research found:• No post-insertion increase in cervical shedding • No increased risk of partner exposure to higher dose of virus

Source: Richardson, 1999.

Advanced Slide Set, Slide #6

Risk of PID Greatest in the First Few Weeks after IUD Insertion

Source: Farley, 1992.

0

0

1

2

3

4

5

6

7

8

1 2 3 4 5 6 7 8 9 10 11 12 2 3 4 5 6 7 8+

Time Since IUD Insertion

PID

Ra

te (

pe

r 1

,00

0 W

om

an

-Ye

ars

)

YearMonth (first year)

Advanced Slide Set, Slide #7

Infertility is Linked to STIs, Not to IUDs

IUD use in the past

Chlamydia antibodies

No Yes No Yes

Infertile women with tubal occlusion

93.6% 6.4% 61.7% 38.3%

Infertile women without tubal occlusion (controls)

94% 6% 64.6% 35.4%

Pregnant women (controls)

93.2% 6.8% 77.4% 22.6%

Source: Hubacher, 2001.

Advanced Slide Set, Slide #8

Expulsion Rates are Higher for Postpartum Insertion

Timing of Insertion Expulsion Rates

Interval(more than 6 weeks after delivery)

Low(3% for skilled provider)

Immediate postpartum(within 10 minutes)

Slightly higher

Early postpartum(between 10 minutes and 48 hours)

Moderately higher

Late Postpartum(48 hours to 4 weeks)

High – generally not recommended

Source: Chi, et al, 1985.