Residues of pelvic inflammatory disease in intrauterine device users: a result of the intrauterine device or Chlamydia trachomatis infection?

Abstract

It is currently believed that intrauterine devices cause pelvic inflammatory disease and tubal infertility. To investigate this concept further, we evaluated 245 infertile patients for inflammatory residues by laparoscopy or laparotomy; 176 patients had not used an intrauterine device and 69 had used one. Chlamydial antibody titers were performed on all patients. Although users had a higher overall prevalence of inflammatory residues than nonusers, there was no difference in residue prevalence for either group at the same titer level. No specific type of device appeared to be associated with either an increased or decreased residue frequency. "Silent" chlamydial infections occurred with equal frequency in both users and nonusers. We conclude that inflammatory residues and tubal infertility in intrauterine device users are not caused by the intrauterine device but by both overt and silent chlamydial infections.

PIP: The association between IUD use, pelvic inflammatory disease, and subsequent tubal infertility was investigated in 245 infertile patients. Chlamydial antibody titer determinations were performed, and either laparoscopy or laparotomy was used for direct visualization of pelvic organs. 90 (51%) of the 176 patients who had never used an IUD were noted to have tubo-ovarian inflammatory residues compared to 49 (71%) of the 69 patients who had been IUD users, a statistically significant difference. However, when subjects were grouped according to antibody titer level, no significant difference in residue prevalence was noted between IUD users and nonusers. The greater overall frequency of residues in IUD users in this study parallels the increased frequency of both positive chlamydial antibody titers and a history of sexually transmitted diseases in this population. 49 (71%) IUD users had a positive titer compared to 84 (48%) nonusers. Similarly, 46 (67%) users had a history of sexually transmitted diseases compared to 53 (30%) nonusers. No association was detected between type of IUD and residue frequency. "Silent" chlamydial infections occurred with equal frequency in IUD users and nonusers. It is concluded that inflammatory residues and tubal infertility in IUD users are not the result of the IUD; rather, they are caused by both silent and overt chlamydial infections. It is recommended that future studies dealing with IUD-related acute salpingitis, ectopic pregnancy, tubal infertility, and postinflammatory residues should address evidence regarding current or prior chlamydial infection.