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A History: the IUD

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The history of the IUD is a tumultuous one. Before the 20th Century there is no clear evidence of the insertion of foreign objects into the human uterus to act as contraception. There is, however, evidence that centuries ago traders in the Middle East used to prevent pregnancy in camels by inserting pebbles into their uteri before making long treks across the desert.1

The first documentation of this idea for humans was in 1909, when Dr. Richard Richter reported on his insertions of a ring made of silkworm gut into the uterus. He cut off the two ends at the level of the outside of the cervix in order make checking and removal easier.2

A few years later in the mid-1920’s, Karl Prust and Ernest Graefenberg both introduced similar versions, but with no mention of Richter’s paper. Prust recommended a silkworm placed in the uterus with a stiff cervical extension of a tightly wound thread and a glass button to cover the cervix. In Germany, Graefenberg made a similar model, but took the extensions off of the silkworm ring because of concerns over infections. In order to be able to identify the position of the ring in the uterus by x-ray, he attached a silver wire to it. The pregnancy rate of this device was reported to be 3%.3

Later, Dr. Graefenberg wrapped pure silver completely around the ring. Unexpectedly, the silver was absorbed and women’s gums turned bluish-black (gingival argyrosis). He then tried using, “German Silver” wire, made from an alloy of a mix of metals (including copper, which will later come into play).3 The pregnancy rate dropped to 1.6%. The ring was widely used in England and all British Empire countries, but not in continental Europe or the United States.2

The duration of WWII was a time of slowed research and development of contraception. In fact, both Germany and Japan forbade the use of any contraception in their populations during the war. In 1949, however, Dr. Mary Halton was back at work describing the use of silkworm gut. She would wrap it around her finger and then press the ring into a gelatin capsule. She then inserted this into the uterus where the gelatin liquefied and the thread spread out. The pregnancy rate was it’s lowest ever, 1.1%.2

For several years, different doctors all over the world wrote about their success using variations of intrauterine devices. Because of the earlier concerns that “tails” on IUDs led to higher rates of pelvic infection, most devices had no tails. This made it difficult to tell whether the device was still in the uterus or not and difficult to remove. At this point in time the new device was in the shape of a coil, made of polyethylene by Dr. Lazar Margulies in 1960. This concern was resolved by having the end of the device protrude through the cervix. Dr. Margulies first patient was his wife and he presented the inserter tube, the coil, and a copy of his wife’s hysterogram to reviewers Dr. Alan Guttmacher, Dr. Aqviles Sobrero and Dr. Christopher Tietze.2

In 1962, Dr. Jack Lippes developed and inserted the first of what be came known as the Lippes Loop. It was a simple plastic device, which was pushed through an inserter tube just like the Coil and eventually came in different sizes, depending on if and how many times a woman had been pregnant. A string was once again attached which facilitated detection and removal. The Loop was so easy to insert, remove, and inexpensive, it’s use took off and it quickly became the most popular and most copied IUD in the world. Within a few years there were all different kinds of IUDs – some successful and others having severe complications.6

1969 was a big year for IUDs. In an attempt to decrease the increased cramps and bleeding many women were reporting, Dr. Howard Tatum tried to decrease the size of the IUD. He devised a simple plastic T, which was well tolerated but had a pregnancy rate of 18%. That same year Dr. Jaime Zipper in Chile discovered that putting a copper wire in one horn of the uterus of a rabbit protected that somewhat isolated horn from pregnancy while it did not protect the other horn. Thus, the contraceptive effect of intrauterine copper was discovered, revolutionizing IUD effectiveness.6

In 1970, Dr. Antonio Scommegna devised a T shaped device with progesterone in a semi permeable capsule in the lower section. It was approved by the FDA for use for one year and was on the market until the early 2000’s.6

In 1971, A.H. Robins Company put an IUD called the Dalkon Shield on the market. It was aggressively (and prematurely) marketed as a highly effective, moderately priced means of preventing pregnancy. Just 3 years later however, it was pulled from the market because of an ill-designed removal string that funneled bacteria into the uterus because it wasn’t sealed on either end. This facilitated Pelvic Inflammatory Disease, sepsis, and eventually infertility. More than 300,000 lawsuits were filed against A.H. Robins, forcing the company to file for bankruptcy.6

Subsequently, IUD usage dropped significantly in the late 1970’s and early 1980’s and many IUDs were taken off the market. Only the progesterone T remained on the American market5.

In 1988 a new IUD appeared, the Copper T 380A (ParaGard). At first the FDA only approved its’ use for 4 years, but as data accumulated the effectiveness was eventually moved to up to 10 years. The levonorgestrel-releasing intrauterine system (Mirena) was made available for use in the U.S. in 20014.

Most recently, on January 9, 2013 a new low-dose hormone IUD, Skyla by Bayer, was approved by the FDA – the first new IUD in 12 years. The device is designed to prevent pregnancy for 3 years and targeted to women who have not had children. It will launch in February, 20138.

These days, the IUD is a safe, effective, low-risk form of birth control.  According to a 2012 study by the Guttmacher Institute, the proportion of women using long-acting, reversible contraceptive methods (such as the IUD) has risen from 2.0% in 2002 to 7.7% in 2009. One can hope these numbers keep climbing as more women become informed about their contraceptive options and have increased access to the best birth control for them.8

 

This post was written by Megan Corbett, RN. Megan is an intern at the Reproductive Health Access Project.

 

References:

1. http://www.time.com/time/magazine/article/0,9171,951492,00.html

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1749527/?page=3

3. http://en.muvs.org/topic/ernst-graefenberg-1881-1957-en/

4. http://www.nursingcenter.com/prodev/ce_article.asp?tid=1139964#P15

5.http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm#3

6. www.nyc.gov/html/hhc/downloads/ppt/2008-10-02-gentile.ppt

7. http://www.huffingtonpost.com/2013/01/09/skyla-iud-intrauterine-device-_n_2442434.html

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