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Observational Study
. 2014 Mar;89(3):222-8.
doi: 10.1016/j.contraception.2013.11.010. Epub 2013 Nov 22.

Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates

David K Turok  1 , Janet C Jacobson  2 , Amna I Dermish  2 , Sara E Simonsen  3 , Shawn Gurtcheff  4 , Molly McFadden  5 , Patricia A Murphy  6
Affiliations
Observational Study

Emergency contraception with a copper IUD or oral levonorgestrel: an observational study of 1-year pregnancy rates

David K Turok et al. Contraception. 2014 Mar.

Abstract

Objective: We investigated the 1-year pregnancy rates for emergency contraception (EC) users who selected the copper T380 intrauterine device (IUD) or oral levonorgestrel (LNG) for EC.

Study design: This prospective study followed women for 1 year after choosing either the copper T380 IUD or oral LNG for EC. The study was powered to detect a 6% difference in pregnancy rates within the year after presenting for EC.

Results: Of the 542 women who presented for EC, agreed to participate in the trial and met the inclusion criteria, 215 (40%) chose the copper IUD and 327 (60%) chose oral LNG. In the IUD group, 127 (59%) were nulligravid. IUD insertion failed in 42 women (19%). The 1-year follow-up rate was 443/542 (82%); 64% of IUD users contacted at 1 year still had their IUDs in place. The 1-year cumulative pregnancy rate in women choosing the IUD was 6.5% vs. 12.2% in those choosing oral LNG [hazard ratio (HR) 0.53, 95% confidence interval (CI): 0.29-0.97, p=.041]. By type of EC method actually received, corresponding values were 5.2% for copper IUD users vs. 12.3% for oral LNG users (HR 0.42, 95% CI: 0.20-0.85, p=.017). A multivariable logistic regression model controlling for demographic variables demonstrates that women who chose the IUD for EC had fewer pregnancies in the following year than those who chose oral LNG (HR 0.50, 95% CI: 0.26-0.96, p=.037).

Conclusion: One year after presenting for EC, women choosing the copper IUD for EC were half as likely to have a pregnancy compared to those choosing oral LNG.

Implications: Compared to EC users who choose oral levonorgestrel, those who select the copper IUD have lower rates of pregnancy in the next year. Greater use of the copper IUD for EC may lower rates of unintended pregnancy in high-risk women.

Keywords: Emergency contraception; IUD; Oral levonrgestrel; Pregnancy.

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Figures

Fig. 1
Fig. 1
Study Flowchart * There were 44 IUD removals in total including 4 from participants who were LTFU after removal, 3 who withdrew from the study after removal and 37 who were followed to 12 months.
Figure 2
Figure 2
Cumulative IUD discontinuations over 1 year
Figure 3
Figure 3
The risk of pregnancy in the 12 months after presenting for EC based on the method of EC selected (participants who desired an IUD but were not able to have it inserted were analyzed in the IUD group) shows fewer pregnancies in the IUD group by Kaplan Meier curves (log rank X2 =4.18) hazard ratio 0.53 (95% CI: 0.29–0.97, p= 0.041).
Figure 4
Figure 4
The risk of pregnancy in the 12 months after presenting for EC based on the method of EC received (women who desired an IUD and were unable to have it inserted received oral LNG for EC and were analyzed in the oral LNG group) shows fewer pregnancies in the IUD group by Kaplan Meier curves HR 0.42 (95% CI: 0.20–0.85, X2 =5.73, p= 0.017).
Figure 5
Figure 5
Method of contraception at each follow up by initial EC choice
See this image and copyright information in PMC

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