Intrauterine contraceptive device failures in renal transplant patients

Abstract

Concern is voiced regarding sexually active renal transplant patients and their use of the IUD for contraception. Two patients of this type conceived while receiving immunosuppressive therapy. The possible mechanisms of the IUD in preventing conception are mentioned. Immunosuppression may significantly alter these actions, thus allowing fertilization and implantation to occur. Alternate means of contraception are suggested in place of IUDs for these patients.

PIP: 2 case studies are presented where patients with functioning renal transplants on immunosuppressive treatment conceived while using a copper IUD for contraception. Since ovulation recurs from between 1 and 12 months following return to normal renal function after renal transplant, the sexually active woman must utilize some form of contraception. For those women who opt for contraception of a nonpermanent nature, there are several problems. Oral contraceptives often cause a reversible elevation in blood pressure in these patients and they may also have some detrimental effects on the sodium and water balance. The diaphragm, foam, and condom may be used but without high motivation from the couple, unplanned and unwanted pregnancies often result. IUD use can open a renal patient to the risk of infection or, as in these case reports, to contraceptive failure due to a decrease in effectiveness in association with immunosuppressive therapy. In animal studies it was shown that the antifertility effect of the IUD was associated with the administration of Cytoxan and Leukeran (immunosuppressive agents) along with a decrease in IgG and IgM. Although IUD mechanism of action is not totally understood, it does seem that an intact immune system is required for effectiveness. Thus renal transplant patients should be informed about the use of other agents in order to avoid unwanted pregnancy.