Copper-containing Intrauterine Devices Research Articles

Primary tubal infertility in relation to the use of an intrauterine device.

Women who use an intrauterine device (IUD) are at increased risk of acute pelvic inflammatory disease, but the relation of the IUD to subsequent infertility is not established. We interviewed 159 nulligravid women with tubal infertility to determine their prior use of an IUD. Their responses were compared with those of a matched group who conceived their first child at the time the infertile women started trying to become pregnant. The risk of primary tubal infertility in women who had ever used an IUD was 2.6 times that in women who had never used one (95 per cent confidence interval, 1.3 to 5.2). The observed difference between cases and controls was not uniform for different types of IUD. The relative risk associated with use of a Dalkon Shield was 6.8 (1.8 to 25.2), and that associated with use of either a Lippes Loop or Saf-T Coil IUD was 3.2 (0.9 to 12.0). The smallest elevation in risk was found among users of copper-containing IUDs (relative risk, 1.9 [0.9 to 4.0] for all women who had ever used a copper-containing IUD). The relative risk for women who used only a copper-containing IUD was 1.3 (0.6 to 3.0). We conclude that use of the Dalkon Shield (and possibly of plastic IUDs other than those that contain copper) can lead to infertility in nulligravid women.

An invitation to experience health.

Abstract “Immunodeficiency in Female Sexual Partners of Men with the Acquired Immunodeficiency Syndrome,” CAROL HARRIS, et al. Because the current outbreak of acquired immunodeficiency syndrome (AIDS) among previously healthy adults may be caused by a transmissible biologic agent, and because it may be preceded by immunologic abnormalities with or without a prodromal illness, we studied seven female sexual partners of male patients with the syndrome. The male patients were all drug abusers. One of the seven women was found to have the full-blown syndrome, a second had an illness consistent with the prodrome of AIDS (generalized lymphadenopathy, lymphopenia, and a decreased ratio of helper to suppressor T cells), and four others had generalized lymphadenopathy or lymphopenia, with or without a decreased ratio of helper to suppressor T cells. Only one woman had no abnormalities. These findings suggest that AIDS may be transmitted between heterosexual men and women. (New England Journal of Medicine 1983;308:1181–4.) “The Effect of Different Types of Intrauterine Devices on the Risk of Pelvic Inflammatory Disease,” DAVID W. KAUFMAN, et al. A case-control study of 155 women with pelvic inflammatory disease (PID) and 305 controls with other conditions was carried out. Compared with other methods of contraception, the age-adjusted relative risk estimate for use of any intrauterine device (IUD) within one month of admission was 8.6 (95% confidence limits, 5.3 and 13.8); for past use, the estimate was 1.6 (confidence limits, 0.6 and 4.0). The estimated risk was highest for users of the Dalkon Shield (11 cases and two controls), lowest for users of copper-containing devices (40 cases and 34 controls), and intermediate for users of other IUDs, principally the Lippes Loop (32 cases and 23 controls). Compared with copper-containing IUDs, the relative risk estimate for the Dalkon Shield was 6.5 (confidence limits, 1.5 and 27.5). When the Dalkon Shield and copper-containing IUDs were compared, in turn, with the Lippes Loop, the estimated risk was increased for the former and reduced for the latter, but the differences were not statistically significant. Nine of the 11 cases using the Dalkon Shield (82%) had severe PID (diagnosed at surgery or because of purulent cervical discharge), compared with 12 of 40 copper device users (30%) and nine of 32 Lippes Loop users (28%). The risk of PID did not seem to be related to duration of use of any of the three IUDs. This study confirms that IUD use increases the risk of PID. It also suggests that the Dalkon Shield is more harmful than other devices. (Journal of the American Medical Association 1983;250:759–762.)

The Effect of Different Types of Intrauterine Devices on the Risk of Pelvic Inflammatory Disease

A case-control study of 155 women with pelvic inflammatory disease (PID) and 305 controls with other conditions was carried out. Compared with other methods of contraception, the age-adjusted relative risk estimate for use of any intrauterine device (IUD) within one month of admission was 8.6 (95% confidence limits, 5.3 and 13.8); for past use, the estimate was 1.6 (confidence limits, 0.6 and 4.0). The estimated risk was highest for users of the Dalkon Shield (11 cases and two controls), lowest for users of copper-containing devices (40 cases and 34 controls), and intermediate for users of other IUDs, principally the Lippes Loop (32 cases and 23 controls). Compared with copper-containing IUDs, the relative risk estimate for the Dalkon Shield was 6.5 (confidence limits, 1.5 and 27.5). When the Dalkon Shield and copper-containing IUDs were compared, in turn, with the Lippes Loop, the estimated risk was increased for the former and reduced for the latter, but the differences were not statistically significant. Nine of the 11 cases using the Dalkon Shield (82%) had severe PID (diagnosed at surgery or because of purulent cervical discharge), compared with 12 of 40 copper device users (30%) and nine of 32 Lippes Loop users (28%). The risk of PID did not seem to be related to duration of use of any of the three IUDs. This study confirms that IUD use increases the risk of PID. It also suggests that the Dalkon Shield is more harmful than other devices.

Post-coital contraception

What can be done to prevent pregnancy after unprotected intercourse? Two distinct groups of women may need help: those, such as rape victims, who have had intercourse once, repetition being unlikely; and those who would like a method which can be used repeatedly after unpremeditated acts of intercourse. The second group is likely to be small. Oestrogens are well established as post-coital contraceptives, progestagens and oestrogen-progestagen combinations have been tried; copper-containing intra-uterine contraceptive devices are also used.

The Concentration of Copper in Human Uterine Secretion During Four Years after Insertion of a Copper-Containing Intrauterine Device

The contraceptive action of a copper-containing intrauterine device (Cu IUD) is mainly associated with the copper ions released, thus its efficiency varies with the surface area of the copper wire. It is of considerable clinical interest to know the usful life-span of a Cu IUD. Therefore, the concentration of copper in the uterine secretion of women wearing a Cu-7 IUD (Gravigard) with a surface area of the copper wire of 200 sq mm was determined by atomic absorption spectroscopy. No decrease in the concentrations of copper was found in a series of women followed for 4 years after the insertion of a Cu IUD.

Endometrial morphology with copper-bearing intrauterine devices

Copper-containing intrauterine devices such as the endouterine Copper T (CuT) first developed by Zipper and Tatum appear to offer great promise. The clinical effectiveness of these devices and their low rate of associated side effects such as expulsion, bleeding, and cramping compare favorably with other devices. The antifertility effect of the CuT is believed to be related to the metallic copper covering. Experimental data suggest that a local, rather than a systemic, contraceptive mechanism is operative due either to direct spermatocidal action, the inhibition of implantation, or a combination of these. The present study was undertaken to extend the electron microscopic studies of CuT-IUCD-bearing endometria using both scanning and transmission electron microscopy and to examine copper distribution utilizing an energy dispersive X-ray analyzer.

Effect of a copper-containing intrauterine contraceptive device on Neisseria gonorrhoeae in vitro

The effects of a copper-containing intrauterine device on the growth of N. gonorrheae in vitro as determined on a typing medium developed by Kellogg et al are described. Plates were incubated for 24 or 48 hours in candle jars with an increased carbon dioxide atmosphere. N. gonorrheae were obtained from a patient with acute urethritis. The exudate was streaked on Thayer-Martin (VCN) medium. Copper wires .5 mm in diameter in 1-inch lengths copper plate cut into 1.5 cm discs and commercial copper-containing IUDs were placed on the typing medium which had been streaked with gonococci. All inhibited the growth of the organisms for 2 mm on each side. The solubilization of the copper has been estimated as 1 mcg of copper per day which is in the bactericidal range in vitro. Results suggest that copper-containing IUDs may play a useful role in preventing gonorrhea.

Scanning Electron Microscopy of Copper-Containing Intrauterine Devices: Long-Term Changes in Utero

The addition of metallic copper wire to a polyethylene intrauterine device dramatically increases the efficacy of that device. A series of copper-containing Tatum-T devices which had been carried in utero for 2 to 3 years was examined by scanning electron microscopy. Few of these devices showed evidence of corrosion or pitting of the copper, as had been reported previously. Almost all of the Ts showed a definite pattern of layering of fibrinoid deposits; intact cells, cellular debris, and crystalline structures were also seen. The micrographs show an extensive buildup of surface layers which, we believe, encase the copper in a semipermeable matrix. This matrix may retard the diffusion of copper compounds into the uterus sufficiently to compromise the contraceptive action of the copper.

Letter: Copper particles from intrauterine contraceptive device.

To the Editor.— Recently, in the process of evaluating the inflammatory response to different surface textures of plastic, our attention was drawn to the article by Dr. Barranco on eczematous dermatitis caused by internal exposure to copper published in theArchives(106:386, 1972). The results of our studies confirmed his observation that small amounts of copper could be released from the copper-containing intrauterine contraceptive device (IUCD) and could essentially be rubbed off the IUCD, as demonstrated by the copper particle apparent in the scanning electron micrograph of a polyethylene IUCD (Dalkon Shield) (Figure). The copper content of the particle was identified by energy dispersive x-ray analysis. The poorly bound copper and barium content of the polyethylene IUCD is Scanning electron micrograph of surface of a polyethylene IUCD revealing particle of copper, confirmed by energy dispersive x-ray analysis (original magnification × 1,500). not described in the package insert that accompanies the

Effect of copper-containing intrauterine contraceptive devices on human cells in culture.

Intrauterine devices containing copper were introduced into cultures of adult and fetal cells. The Dalkon shield had no apparent effect on cell growth. The Gravigard device caused inhibition of growth and an increase in copper concentration in the supranatant medium. When the latter device was transferred through a series of subcultures the rate of release of copper decreased and growth was no longer inhibited.

Gonococcicidal action of copper in vitro

Several copper and cupric ion sources have been shown to kill or inhibit the growth of Neisseria gonorrhoeae in vitro. Micromolar amounts of copper sulfate and copper chloride kill gonococci during relatively brief incubation while the organisms are in suspension. Inhibition of gonococcal or meningococcal growth is achieved by concentrations of cupric ion several-fold more dilute than is necessary to inhibit growth of E. coli. The sensitivity of gonococci to killing by copper may have application in relationship to the use of copper-containing intrauterine devices and prophylaxis against genital gonorrhea in women.

The influence of copper on the motility of human spermatozoa

The effect of metallic copper and copper salts on the motility of human spermatozoa was studied as part of an investigation of the mechanism of action of the copper-containing intrauterine device (IUD). Copper released from an IUD inhibited sperm motility in vitro and in vivo within three to four hours. Comparable concentrations of copper sulfate were less effective. Preliminary experiments in which sperm were incubated up to four hours within a Millipore chamber in the uterine cavity of a patient using a copper device indicate that copper has little effect on sperm motility in utero . The three to four hours-long latent period required for the inhibition of sperm motility by copper suggests that immediate immobilization of sperm is not a major mechanism of action of the copper IUD in the human.