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Intrauterine Devices

Intrauterine Devices. Ashley Krohn Megan Leveranz Monicka Souksavong. What is an Intrauterine Device?. Small object inserted through the cervix into the uterus Protects against pregnancy Does not protect against HIV/AIDs & STDs 2000: approved in the U.S 2 types in the U.S

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Intrauterine Devices

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  1. Intrauterine Devices Ashley Krohn Megan Leveranz MonickaSouksavong

  2. What is an Intrauterine Device? • Small object inserted through the cervix into the uterus • Protects against pregnancy • Does not protect against HIV/AIDs & STDs • 2000: approved in the U.S • 2 types in the U.S • ParaGard: copper wire • Mirena: releases hormones

  3. ParaGard • Made of tiny copper wire wrapped around plastic • Approved by FDA in 1984 • Became available for use in 1988 • Lasts up to 10-12 years • Is the only copper IUD approved for use in the US • In 2002 used by 1.3% of women • Is about the size of a penny • 1 ¼’’ across the top • Copper is toxic to sperm, killing it • May be used as emergency contraception if inserted within 72 hrs • 99% effective • Copper IUD can inhibit expression of LIF, causing inhibition of implantation stage (crucial stage)

  4. Mirena • Releases small amounts of progesterone • Lasts up to 5 yrs • Causes a subtle change in the endometrial environment that impairs the implantation of egg in the uterine wall • Hormones (Progesterone &/or Progestin) reduce menstrual bleeding and cramps

  5. Uses • Mechanism of action • Not known • Prevent a developing human, already fertilized in the fallopian tube, from attaching to the endometrium of the uterus • Progesterone slowly releases that interferes with development of endometrium=no implantation • Levonorgetrel IUDs also prevent implantation • Changes the lining of the uterus & fallopian tubes, affecting movement of eggs=no fertilization • Causes the mucus to become thicker=sperm cannot enter the uterus

  6. History • 1902:precursors of IUD • 1920: a ‘ring’ made of surgical silk then switched to wire. • smaller than an inch in diameter • Needed to dilate the cervix for insertion with the wire-not the silk • 1934: Japanese variation lowered the expulsion rate • Major problem: 1 in 10 expelled the IUD Various forms of Intrauterine devices that have been used in the past

  7. More History • Fact: • 25-30% of European women used the copper IUD and less than 1% of Americans do • Dalkon Shield had over 10,000 lawsuits filed because it allowed bacteria to travel from the vagina to the uterus causing PID due to the multifilament string- now changed to a monofilament string (similar to fishing wire) • 1958: the first plastic IUD came out • 1970’s: invention of the stainless steel ring and second generation Copper T-IUD Uterus with a Dalkon shield inserted

  8. Cost • Most cost-effective, reversible method of contraception today • Family Planning centers are usually cheaper than public clinics • Medicare and Insurance may cover some of the cost • Planned Parenthood • $175-$500 includes medical exam, insertion of IUD, and follow-up visits • MirenaHealthplan Coverage • $585.89

  9. Prevalence • Most widely used method of Reversible birth control • 160 million women use • Over 2/3rds are Chinese were it’s the most common mode surpassing sterilization • Usage measured by married women of reproductive age • 1990 IUD usage • 1.5% United States • 18% Scandinavia • 33% Russia and China • 40% Kazakhstan • 2008 IUD usage • 0.7% North America • 6.0% United Kingdom • 33.1% Russia • 36.4% China • 36.7% Egypt • 51.8% Uzbekistan

  10. World Views • Worldwide IUDs are much more common • Wider variety of brands are available • In 2008 ten brands were available in the UK

  11. Advantages • Requires no daily attention • Immediately effective after inserted • 99.2-99.9% effective • Allows sexual spontaneity • Long-lasting • Reduce menstrual • Cramping • Bleeding

  12. Disadvantages • Expulsion rate is 10% during the first year of use & higher in younger women or who have never given birth • If you become pregnant with it in, there is a 55% chance of a miscarriage • Women who have used if for 3+ years are 2 times as likely to have a tubal pregnancy than women who never used an IUD • Mirena causes ovarian cysts, and similar symptoms as the pill

  13. More Disadvantages • Insertion & removal must be done by a physician • May come out without realizing… chances are you notice too late • An individual should not use an IUD for specific reasons such as • Unexplained vaginal bleeding • PID • HIV/AIDs • Etc.

  14. Ethical issues • Major post fertilization effect: destruction of an early embryo in the fallopian tube • Most common contraception for its REVERSIBILITY • Noxa, accumulates in the uterine lumen affects the function and viability of gametes, decreasing rate of fertilization & lowering chances of survival of any embryo, before reaching the uterus • Many believe ‘contraception’ means to PREVENT fertilization from occurring • 1960s: redefined term as a method which prevents pregnancy

  15. Economic Issues • Federal Title X Program: Workers are taxed to help fund prevention clinics • Example: • Right of confidentiality by the physician can cause harm to a minor • 16 yr. old girl came to Dr. Willkie’s clinic after the clinic where she got the IUD simply told her “take an aspirin and rest” • He immediate removed the device because she was experiencing “fatal blood poisoning” as a result of an infection • Not able to inform her parents that she may be infertile now

  16. Societal issues • Federal Title X Program gives rise to societal issues • Conservatives fear that funding promotes premarital sex and decreases abstinence • IUD commercials such as Mirena are frequently aired on networks that are viewed by young adults • ABC • TLC • E! • Oxygen • MTV

  17. Conclusion • IUDs have made major strides in the past century • Are 99.2-99.9% effective • Popular in many countries around the world • IUDs have raised many concerns • Ethical • Moral • Economic • Societal • Is the most common REVERSIBLE mode of contraception • Allows fertilization but then inhibits the implantation into the uterine wall

  18. Works Cited • Barrett, Jennifer, and Cynthia Buckley. "Constrained Contraceptive Choice: IUD Prevalence in Uzbekistan." International Family Planning Perspectives 33 (2007). • Guney, M., B. Oral, N. Karahan, and T. Mungan. "Expression of leukaemia inhibitory factor (LIF) during the window of implantation in copper T380A intrauterine device users." European Journal of Contraception and Reproductive Health Care 12 (2007): 212-19. Winona State University. Pubmed. Darrell L. Krueger, Winona. • Hughes, Mary Elizabeth, Frank E. Furstenberg, and Julien O. Teitler. "The impact of an increase in family planning services on the teenage population of philadelphia." Family Planning Perspectives 27 (1995): 60-68. • "Intra-Uterine Device (IUD)." Birth Control: Chemical Methods. Physicians for Life. 16 Nov. 2008 <http://www.physiciansforlife.org/content/view/182/36/>. • "Intrauterine Device (IUD)." July 2008. Cedar River Clinics. 16 Nov. 2008 <http://www.cedarriverclinics.org/index.html>. • "Intrauterine Device (IUD)." Procedures and Tests. 10 Mar. 2003. MedicineNet.com We Bring Doctors' Knowledge to You. 16 Nov. 2008 <http://www.medicinenet.com/iud/page2.htm>. • "Intra-Uterine Devices: A New Era in Birth Control?" Time 31 July 1964. Time in partnership with CNN. 16 Nov. 2008 <http://www.time.com/time/printout/0,8816,873995,00.html>. • "Intrauterine Devices." Contraceptive Methods. 2005. RHO Archives. 16 Nov. 2008 <http://www.rho.org/html/cont-iuds.htm>. • "Intrauterine Devices." New Contraceptive Choices. Information & Knowledge for Optimal Health (INFO) Project. 16 Nov. 2008 <http://infoforhealth.org/pr/m19/m19chap9.shtml>. • "IUD." IUD. 2 Oct. 2008. Planned Parenthood. 16 Nov. 2008 <http://www.plannedparenthood.org/health-topics/birth-control/iud-4245.htm>. • Jones, Kirtly. "Intrauterine Device (IUD) for birth control." Birth Control Health Center. 22 May 2008. WebMD Better information. Better health. 16 Nov. 2008 <http://www.webmd.com/sex/birth-control>. • Ortiz, ME, and HB Croxatto. "Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action." Contraception 16-30 75 (2007). Winona State University. Pubmed. Darrell L. Krueger, Winona. • Oruc, S., HS Vatansever, O. Karaer, F. Eskicioglu, and B. Narlikuyu. "Changes in distribution patterns of integrins in endometrium in copper T380 intrauterine device users." ActaHistochemica 107 (2005): 95-103. Winona State University. Pubmed. Darrell L. Krueger, Winona. • "The Progestogen IUD (Mirena)." Sex Matters: Factsheet. 10 Oct. 2008. Family Planning NSW. 16 Nov. 2008 <http://www.fpnsw.org.au/sex-matters/factsheets/56.html>. • Sonfield, Adam. "Popularity Disparity: Attitudes About the IUD in Europe and the United States." Guttmacher Policy Review 10 (2007). • Willke, JC. Abortifacients. 2008. Life Issues Institute. 17 Nov. 2008 <http://www.lifeissues.org/abortifacients/iud.html>.

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