Abstract
Many of the major conclusions regarding IUD performance reached by the Cooperative Statistical Program (CSP) during 1963-68 continue to guide understanding of this contraceptive method. The CSP evaluation, based on more than 180,000 woman-months of observation, concluded: 1) the smaller the size of the IUD, the greater the pregnancy and expulsion rates; 2) the larger the IUD, the greater the probability of removal for bleeding; 3) pregnancy, expulsion, and removal rates are highest in the first year of use; 4) expulsion rates decrease with increasing age and parity; and 5) user removal rates decrease with increasing parity. Today's IUDs have evolved in conjunction with rigorous scientific standards and sophisticated methodologies. The era of the inert IUD ended with the withdrawal of the Dalkon Shield in 1974. At this time, the copper T380A is the most effective device. Although a progestin-containing IUD has been available since 1976, it has a higher failure rate than copper-releasing devices and must be replaced annually. Widespread use of the IUD among US women has been hindered by fear of litigation, limited training in IUD insertion, and misinterpretation of epidemiologic data concerning the association between IUDs and infection and infertility. Improvement in hormone-bearing IUDs is the most likely area for further IUD development in the US.
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