IUD — three letters that send a chill down the spines of many American women.
The IUD, or intrauterine device, fell out of favor with American women when the contraceptive was linked to such side effects as bleeding, cramping, infection and infertility. The evidence against the device was so convincing that usage in the United States shrank from 10 percent of women using contraceptives 30 years ago to less than 1 percent today.
But some researchers say it's time to put aside the bad press the birth control received decades ago. They say today's IUD is not your mother's, and a new study supports their assertions.
The study, appearing in today's New England Journal of Medicine, looked at close to 2,000 women in Mexico City to establish the relationship between use of the IUD and infertility.
The study, led by epidemiologist David Hubacher, PhD, of the nonprofit research organization Family Health International, found no increased risk of infertility in women who have never given birth with previous use of the copper IUD, a small t-shaped device installed in the uterus that releases copper to prevent fertilization.
What the study did find was a greater incidence of the sexually transmitted disease chlamydia and infertility, suggesting the STD, not the IUD, is responsible for infertility.
"I think this is blockbuster," says Dr. David Grimes of the University of North Carolina, and a contraception expert at Family Health International. "Older studies were pointing fingers at the IUD, and not at STDs."
Bad Rap During 1970s
A lot of the bad IUD press was due to the Dalkon Shield, the plastic IUD that was removed from the market after deaths related to pelvic infection were reported in the mid 1970s. But experts say that IUD was a faulty and poorly designed product.
"A lot of the research conducted in the '70s and '80s lumped the Dalkon Shield together with other IUDs," explains Hubacher, "The point made to the medical community was that all IUDs are dangerous, and this is not true."
Still, Michael Ciresi, a Minneapolis attorney who won more than $40 million in settlements for clients against Dalkon Shield manufacturer A.H. Robbins in the 1980s, says that he's not convinced by just one study.
"There would have to be very, very good science, multiple studies and different investigators before you could ever convince me that women who have never had children should use an IUD, " says Ciresi who adds that the NEJM study omits such information as the type of copper IUD used.
Around the world, more than 100 million women are using IUDs, which exceeds the number using oral contraceptives. In some European countries, such as Norway and Sweden, it's the preferred birth control method for 40 percent of women.
"The paradox," says Grimes, "is the IUD has the worst reputation among all contraceptives in the U.S. The exception is among actual IUD users — they have the highest satisfaction rates."
IUD Mishaps Can Happen, But Unlikely
One IUD user who would not be among these satisfied users is Tonya Nieskes of Wisconsin. Tonya was using the copper IUD for two years before she became pregnant unexpectedly.
"I thought, 'How could this be?' I was promised that I wouldn't have to worry about pregnancy for 10 years," she says. Instead, she became one of the statistics cited in IUD pamphlets.
Within days of her diagnosis, she experienced painful symptoms such as cramping and backache that led her to the emergency room. Within hours she was being operated on for an ectopic pregnancy that burst her fallopian tube and resulted in the removal of one of her ovaries as well as the tube.
But many doctors say such experiences are rare. In fact, most researchers tout the extremely high efficacy of the IUD (1 percent failure rate as opposed to 5 percent with the pill) and point out that compliance is not an issue as it is with the pill. And as the device supplies birth control for up to 10 years, it's an excellent option for women in monogamous relationships with a low risk of STDs.
"We've long past the time to pardon the IUD; It's time for a renaissance," says Grimes.