I.U.D. Debate

How great are the risks?

Before crossing the deserts, Arabs centuries ago performed a curious rite. Using narrow tubes, they inserted pebbles into the wombs of their camels to keep the animals from becoming pregnant during the long journeys. That crude but successful measure may have been the first intrauterine device (I.U.D.), a contraceptive now employed by some 50 million women round the world, including about 2 million in the U.S. Yet, as effective as the I.U.D. is, preventing pregnancy for years at a time with no special effort by the woman, it has lately become a center of controversy. Some patients and physicians believe that I.U.D.s have been prescribed indiscriminately, with little regard for the risk of infection in the reproductive system or the danger of causing infertility.

Infection, of course, can occur whenever a microbe-laden foreign object is inserted into the body. Indeed, early I.U.D.s, made of a variety of materials ranging from glass, ivory, gold, or ebony to diamond-studded platinum and even silkworm gut, caused so many complications that they soon fell out of favor. But in the 1960s, with the availability of antibiotics and the development of new plastics that made insertion easier, I.U.D.s proliferated. That trend increased when unexpected side effects were discovered from the popular contraceptive pills.

The original camel pebble simply discouraged mating. Today's I.U.D.s are effective (up to 98%) for different reasons. Inserted into the uterus, they cause a minor inflammation of the uterine lining that prevents the fertilized egg from implanting in the uterine wall after its journey through the fallopian tube. Certain types of I.U.D.s also function by releasing copper or the hormone progesterone.

However well the devices work, they are not always trouble-free. Within the past decade, the incidence of pelvic infections, usually caused by bacteria, has reached epidemic proportions among women, and studies indicate that users of I.U.D.s seem from two to seven times more susceptible to such problems than women who do not employ them. This is a special concern for those who have never been pregnant. The warning signals include abdominal pain, fever, severe menstrual cramps, abnormal bleeding and vaginal discharges. Left unchecked, such infections can scar and block the fallopian tubes, where the union of egg and sperm takes place, and sometimes lead to a hysterectomy. The I.U.D., when it fails, has also been suspected of causing ectopic pregnancies, in which the fetus grows outside the uterus. But recent studies indicate that the devices actually seem to reduce that danger in users compared with women who employ no contraception at all.

The precise role of the I.U.D. in pelvic infections still puzzles doctors. One theory is that bacteria are able to ascend into the uterus via the threads that are attached to I.U.D.s to let women check on their proper position and make their removal easier. Another possibility: the I.U.D. somehow makes the uterus more hospitable, biochemically speaking, to invading bacteria. By contrast, birth control pills seem to have the opposite effect, suppressing infection.

Some doctors feel that the I.U.D.'s dangers are being exaggerated. They insist that pelvic infection, which now causes sterility in 80,000 women in the U.S. a year, is primarily linked to venereal disease and sexual activity with more than one partner. Says Dr. Bruce Stadel, coordinator of a $2 million federal study on gynecological complaints: "For women without serious problems the I.U.D. is probably a reasonable method of contraception and may sometimes be preferable to other methods." But until the issue is firmly decided, many physicians are declining to recommend the I.U.D. for young, sexually active women who have not borne children and are advising it mainly for those mothers who do not want any more babies.

This file is automatically generated by a robot program, so viewer discretion is required.