Controversies in family planning: timing of ovulation after abortion and the conundrum of postabortion intrauterine device insertion

Abstract

Questions: When does ovulation occur after an induced abortion? Is it different with regard to medical versus surgical abortion? Does ovulation occur at a different time point if the woman had a first versus second trimester abortion? If one is unable to provide an immediate post- abortion intrauterine device (IUD), when is the ideal time to insert the IUD and be sure your patient is not pregnant? What if the patient reports an act of unprotected intercourse between the abortion and her return for IUD insertion? Can one be certain she has not just conceived if her return for the IUD is 7 days post-abortion? What if it was 10 versus 14 or more days post- abortion? Respondent #1: Most data support three weeks for ovulation, therefore insertion within two weeks with no bridge method is fine. That said, about a third of women will not come back so some method right away might be a good idea. Respondent #2: I used to do one week for first trimester patients and two weeks for second trimester patients before we could do immediate insertion. We are currently working on an analysis of nearly 200 women who got IUDs at two weeks after first trimester abortion and there were no complications. These women received the IUD at two weeks, not before. There were no pregnancies with IUD in place. Most women reported they were abstinent or used condoms. Our expulsion rate was low at about 2.5% at 6 months. Respondent #3: Our beliefs that ovulation occurs one to two weeks earlier post-abortion than after delivery are based on some older studies. I think the best time for a post-abortion visit is within one week because that is when the problems occur. One study showed higher IUD expulsion at two weeks than right after first trimester abortion, so one week might be better. The date of post-abortion visit return for contraception is sometimes determined by how long after the abortion insurance will pay. It used to be we had to wait two weeks for post-abortion IUD insertion where I work but now it is as soon as the patient is not pregnant, which means now we can insert IUDs immediately. Respondent #4: I would keep in mind the range, not just the average date of ovulation after abortion. Some papers show ovulation occurring as early as six days post-abortion.