BACKGROUND AND PURPOSE:

• There still may be concerns regarding fertility and IUD use based on events that occurred several decades ago
• Peipert et al. (AJOG, 2021) assessed the association between IUD use and time to conception

METHODS:

• Multicenter, prospective cohort study
  • Fertility After Contraceptive Termination Study
• Participants
  • 18 to 35 years
  • Contraception discontinued (within past 120 days prior to enrollment) to attempt conception
  • No history of infertility or sterilization
  • ≥6 months follow-up
• Exposure
  • Ever IUD use
• Study design
  • Baseline data collected
    • Demographic and reproductive characteristics
    • Past contraceptive use
    • Nucleic acid amplification testing for sexually transmitted infections
    • Serology for past infection with Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium
  • Follow-up to 24 months
• Primary outcome
  • Time to conception

RESULTS:

• 461 participants
  • Mean age: 28.2 years
  • 38.7% Black | 34.1% low socioeconomic status
  • History of IUD use: 59.7%
• Without adjustment, the median time to conception was shorter for participants who had a history of IUD use
  • History of IUD use: median 5.1 months to conception
  • Never use: Median 7.5 months
• After controlling for confouders, the association of past IUD use with time to conception was not statistically significant
  • Adjusted HR 1.25 (95% CI, 0.99 to 1.58)
• Following factors associated with longer time to conception (P<.05)
  • Age | Nulligravidity | Black race | Low socioeconomic status
  • Past Mycoplasma genitalium infection (P=0.019)

CONCLUSION:

• A history of IUD use was not associated with reduced fertility and the direction of association was in the opposite direction (positive) although not statistically significant
• Other factors were associated with longer time to conception and infertility, including evidence of past Mycoplasma genitalium infection
• The authors state

Patients and providers should be reassured that contemporary IUDs have no impact on the ability to conceive

Learn More – Primary Sources:

Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study

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