Post-coital intrauterine device insertion - a further evaluation

Abstract

A total of 191 patients have undergone post-coital insertion of an intrauterine contraceptive device up to ten days post-coitus. The majority of patients were nulliparous and underwent insertion of a standard Gravigard [Copper 7] device. The subsequent expulsion and medical removal rates were normal for this group of patients but the non-medical removal rates were higher. There was one possible post-coital contraceptive failure (0.6%) and one pregnancy at six months due to the device exhibiting a failure to conventional contraceptive action.

PIP: A total of 191 women who chose to use an IUD for post-coital contraception were recruited. The majority of patients were nulliparous and underwent insertion of a standard Gravigard (Copper 7) IUD. Post-coital IUD insertion was performed from day 0 to 10 days after unprotected coitus. 175 women underwent insertion within 5 days and the remainder between 5 and 10 days post-coital. There were no major complications during the insertion. The discontinuation rate was higher than that normally associated with IUD use. This was because of the relatively high non-medical removal rates, i.e., patients who wanted to use the IUD solely as a 'morning after' contraceptive rather than as a method in its own right. Termination of IUD use was recorded for the 1st followup visit 4-6 weeks after insertion and 1 month later at the 2nd followup visit. There were 19 terminations of use for all reasons at the 1st followup and another 20 terminations at the 2nd followup. The expulsion rate of 2% and the medical removal rate for pain and bleeding of 7% were in keeping with event rates obtained from larger and more detailed studies. The non-medical removal rate was higher at the 2nd followup visit. There was 1 possible post-coital contraceptive failure (0.6%) and 1 pregnancy at 6 months due to the device exhibiting a failure of conventional contraceptive action. Due to the fact that the mechanism of action of the IUD is unclear, it is uncertain if the insertion of a post-coital device is effective only before the implantation occurs or whether there is some effect after early implantation has occurred.