BACKGROUND AND PURPOSE: 

• Schwarz et al. (Journal of General Internal Medicine, 2022) compare the effectiveness and safety of IUDs to laparoscopic tubal ligation for Medicaid clients

METHODS: 

• Retrospective cohort study
  • California database
  • Medicaid claims data
• Population
  • IUD placed or laparoscopic tubal ligation
  • Procedure performed between 2008 and 2014
• Exposures
  • IUD placement
  • Tubal ligation
• Study design
  • Study included stakeholder advisory board including patients and clinicians
  • Linear regression models used to test associations between contraceptive procedure and outcomes
  • Adjustments for sociodemographic variables and pre-procedure health status
• Primary outcome
  • Contraceptive failure
  • Complications
  • Pain in first year post-procedure

RESULTS: 

• Levonorgestrel IUD: 35,705 patients | Copper IUD: 23,628 patients | Tubal ligation: 23,965 patients
• In unadjusted analyses, rates of pregnancy within 1 year were similar among the groups
  • Levonorgestrel IUD: 2.40%
  • Copper IUD: 2.99%
  • Tubal ligation: 2.64%
• In adjusted analyses, compared to tubal ligation, pregnancy was less common following placement of
  • Levonorgestrel IUD
    • Adjusted incident rate ratio (aIRR) 0.72 (95% CI, 0.64 to 0.82)
  • Copper IUD
    • aIRR 0.92 (95% CI, 0.82 to 1.05)
• Procedural complications such as infection were significantly less common with IUD placement than tubal ligation
  • IUD placement: 0.35%
  • Tubal ligation: 2.91%
• Claims for pelvic and abdominal pain decreased in frequency over time regardless of contraceptive approach
• At 6 to 12 months post-procedure, pelvic pain claims were less common after
  • Levonorgestrel IUD placement
    • aIRR 0.69 (95% CI, 0.65 to 0.73)
  • Copper IUD placement
    • aIRR 0.70 (95% CI, 0.66 to 0.75)
• Results unchanged even after excluding patients at highest risk for post-procedure complications

CONCLUSION: 

• Among patients with medicaid insurance, placement of a levonorgestrel or copper IUD is at least as effective at preventing pregnancy as tubal ligation 1-year post-procedure
• Compared to tubal ligation, pregnancy within 1 year was
  • Lower than laparoscopic tubal ligation
  • Similar for copper IUD
• Pain and infection were less common in patients who received an IUD vs tubal ligation
• The authors state

As desire for reversal of tubal ligation is known to occur, it is important that all patients considering tubal ligation receive thorough counseling regarding the comparative safety and effectiveness of IUC prior to undergoing tubal ligation

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Learn More – Primary Sources: 

Comparative Effectiveness and Safety of Intrauterine Contraception and Tubal Ligation

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