Here's a very informative slide show on IUDs from the Baylor College of Medicine.
nulliparous is a term used to describe women who have not had any children.
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Research indicates that the return of fertility after removal of an intrauterine contraceptive device (IUD) is rapid and occurs at a rate similar to that of barrier methods. To clarify the effect of the IUD on fertility in nulliparous women, Doll et al. conducted a prospective cohort study of two groups of nulliparous women (N=558) from 17 family planning clinics in England and Scotland. One group was comprised of current users of an IUD and the other was comprised of oral contraceptive users. The dates and reasons for any change in contraceptive method (most frequently to a barrier method) were recorded, together with the outcome of any pregnancies, at each follow-up.
Women who stopped using a barrier method to achieve a planned pregnancy conceived most quickly: 54% delivered after one year as opposed to 39% of IUD users and 32% of oral contraceptive users (log rank P=0.002). There was no association between fertility and duration of oral contraceptive use. Short-term users (<42 months) of an IUD showed a fertility pattern more favorable than that seen in women who discontinued use of oral contraceptives, with prolonged IUD use being associated with a slower return to fertility (linear trend P=0.005). Women who had used an IUD for >78 months had the most impaired fertility; 28% of the prolonged users had delivered by 12 months as opposed to 46% of short-term users. At 36 months, the corresponding figures were 79% for long-term users versus 91% of short-term users. This association persisted after adjustment for potential confounding factors, including maternal age, husband's social class, and history of gynecological illnesses, factors that have independent associations with fertility. The investigators of the study concluded that long-term IUD use in nulliparous women appears to be associated with an increased risk of impaired fertility.
In 2001, Hubacher et al. conducted a case-control study of 1,895 women with primary tubal infertility; several control groups were used to minimize bias. Previous use of a copper-releasing IUD was not found to be associated with an increased risk of infertility.
Clearly, there are conflicting data regarding whether IUD use is associated with infertility among nulliparous women.
According to the Medical Eligibility Criteria for Contraceptive Use developed by the World Health Organization, nulliparity is a condition for which the advantages of using intrauterine contraception generally outweigh the theoretical or proven risks (risk category 2).
Jan 14, 08
