Use of medication in the form of copper wire coiled around the vertical shaft of an inert plastic carrier was a major innovation in IUD technology. The copper medication enabled the IUD to be small yet as effective as larger nonmedicated devices. Small size permitted the IUDs to be used by women who had never been pregnant. This initial advance was not accompanied by an important improvement in effectiveness. Neither the TCu 200 nor the Copper 7, the first two copper devices, showed substantially lower pregnancy rates in the United States (Tietze and Lewit, 1972; Jain, 1975) or in developing countries (Sivin, 1976). When copper wire devices were introduced, a key question was how long they would remain effective, since their effectiveness stems from the action of copper slowly dissolving in the uterine environment. After prolonged use, some of the copper coils are shed and thereby, in theory, the device becomes less effective. At first, two years of use was thought to be the limit, but as experience accrued the TCu 200 was found to remain effective for three years (Jain and Sivin, 1977), and both the TCu 200 and the Copper 7 have been approved by the US Food and Drug Administration for three full years of use. Data presented in this paper indicate that the TCu 200 provides effective protection against pregnancy for four full years of use. Efforts to increase effectiveness and extend duration of protection have led to the development of two improved Copper T devices. In the TCu 380A, collars or cylinders of copper have been placed on the horizontal arm of the T, each collar providing 30 mm2 of copper surface. These collars fit tightly onto the plastic and can be eroded from one side only. Erosion may pit the surface of the collars but cannot fragment them. Thus the copper in the collars will be available for contraceptive effect for many years. A theoretical advantage of placing collars on the horizontal arms of the T is that the copper supply is brought closer to the fundus of the uterus. Because implantation tends to occur high in the uterus, fundal placement of copper is considered to enhance effectiveness. In addition to the 60 mm2 of copper collars on the horizontal arms, the TCu 380A has 320 mm 2 of thick copper wire on the vertical shaft of the T, a surface area achieved by using more or tighter turns of wire than used in the TCu 200 device. A sixyear lifetime is the minimum duration of effective protection predicted for this device. This prediction is based on the assumption of slow fragmentation of the wire, leaving only the 60 mm2 of copper in the collars available for contraceptive effect after the wire has severely fragmented. In the second new device, the TCu 220C, collars of copper are placed on both the vertical and horizontal arms of the T form. Wire was eliminated entirely. With a total copper surface area of 220 mm2 in the form of collars, an effective lifetime for this device is estimated to be 1015 years, as no fragmentation is to be expected.
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