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Grand Rounds

Does a History of IUD Use Impact Time to Conception?

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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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Related ObG Topics:

Can Copper and Levonorgestrel IUD Use Be Safely Extended?
IUDs, Lower Cervical Cancer Rates and HPV – Is There a Connection?

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