The document provides an overview of intrauterine contraceptive devices (IUDs), detailing their history, types (first, second, and third generation), mechanisms of action, ideal candidates, insertion timings, and post-insertion advice. It highlights the advantages such as high success rates and reversibility, as well as disadvantages including potential menstrual changes and risk of pelvic infection. Overall, it serves as a comprehensive guide on the use, effectiveness, and considerations regarding IUDs in contraception.

1. INTRA UTERINE
CONTRACEPTIVE DEVICE
(IUCD)

2. Learning points
■ History
■ Introduction
■ Types of IUCD
■ Mechanism of Action
■ Ideal IUD Candidate
■ Contraindications
■ Time of Insertion
■ Advice after Insertion
■ Failure rate & restoration of fertility
■ Advantages & disadvantages

3. What is IUCD?
■ It is a small, flexible, plastic device that
contains either metal e.g. copper or hormones
e.g. progesterone, which when placed inside
the uterus, prevent the birth of the child.
■ Concept: Derived from Arabs – By controlling
conception in camels by introducing a small
spherical stone into each horn of the uterus.

4. History
■ 1929 = Grafenberg, German Gynecologist  Used a core of silkworm gut encircled by
German Silver ring successfully in preventing conception.
■ 1934 = Mr. Ota, Japan  Introduced a gold plated silver ring, with a disk in the center,
attached by three spokes (Ota ring)
■ 1959 = Oppenheimer (Israel) & Ishihama (Japan)  Published the excellent results of
IUDs, discovered by Grafenberg & Ota.
■ 1960 = Margulies spiral was launched, a plastic device, impregnated with barium sulfate, a
radioopaque substance.
■ 1960 = Dr Jack Lippe (USA)  Introduced Lippes Loop, very popular for two decades in
India
■ 1970 = It was modified by adding copper, have strong antifertility effect, widely used now a
days under NFWP.
■ 1990 = Further modified and improved by impregnating the IUDs with slow releasing
hormones.

5. Introduction
■ IUD is a small, stiff but flexible, nontoxic, polyethylene plastic frame,
incorporated with barium sulfate, to make it radiopaque and prevents
conception by acting as a foreign body when inserted into the uterus of
the women, through vagina.
■ Has two strings
– Made up of nylon
– Hang through the opening of the cervix into the vagina
– To check by the user to know whether it is in situ
– To remove it by pulling when pregnancy is desired

6. Types
of
IUCD

7. Types of IUCD
First
Generation
IUDs
• Non-medicated
• E.g., Lippes Loop
Second
Generation
IUDs
• Medicated
• Copper IUDs
Third
Generation
IUDs
• Medicated
• Hormonal IUDs

8. First Generation IUDs
■ Inert, non-medicated devices
■ E.g., Lippes Loop
■ Double S-shaped, serpentine device,
made up of polyethylene, non-toxic,
non-tissue reactive material,
incorporated with barium sulfate.
■ Two nylon transcervical threads –
attached to lower end of the loop.

9. First Generation IUDs
■ Four size – A, B, C, D
■ Latter being the largest, recommended for
multiparous women.
■ India = 2 sizes available – 27.5 and 30 mm.
■ To identify = Smaller one – black thread,
Bigger one – Yellow thread
■ Limitations = More side effects & higher
expulsion rate (19 per HWY)

10. Second Generation IUDs
■ 1970 = Metallic copper has
a strong antifertility effect.
■ Addition of copper to IUD =
Made it possible to develop
smaller and safer than
Lippes Loop.
■ Minimizing the side
effects & expulsion rate

11. Second Generation IUDs
Earlier Devices
• T Cu 200, T Cu 200 B, Copper 7, Sanghai-V-Cu-200
Newer Devices
• T Cu-220C, T Cu-380A, T Cu-380S (Slim Line), Cu Nova-T 200,
Cu Nova T 380
Multiload Device
• ML Cu-250, mL Cu-375

12. Second Generation IUDs
■ The number = Indicates the
surface area of the copper in sq.
mm on the device.
■ Nova T and Copper T 380 Ag =
Distinguished by a silver core
over which is wrapped the copper
wire.
■ All Cu T and Multiload devices =
Effective for at least 5 years
except Cu T 380A (10 year)

13. Third Generation IUDs
■ Also ‘T’ shaped device
■ Made up of permeable, polymer membrane incorporated with a slow releasing
progesterone hormone (Progestasert, Levonorgestrel 20g/day) – LNG20.
– Progestasert
■ Contains natural progesterone hormone
■ Released in uterus slowly over a period of 1 year @ 65 g daily
■ Regular replacement is necessary every year.
– Levonorgestrel 20 g/day
■ Contains potent synthetic hormone.
■ Releasing 20 g/day
■ Effective for 3-5 years.
■ Compared to Copper device, expulsion rate and side effects are low but more
expensive

15. Mechanis
m of
Action of
IUCD

16. Mechanism of Action
General
• Cause foreign body reaction,
results cellular and
biochemical changes, which
increased vascular
permeability, edema &
infiltration of leukocytes in
the endometrium of uterus
• The viability of the ovum is
impaired  reduce the
chances of fertilization
• Even if fertilization occur 
because of increased tubal
motility by the foreign body,
the fertilized ovum moves to
the uterus earlier and dies.
Cu T
• Copper ion released from Cu
T  have strong antifertility
effect by cellular &
biochemical changes as well
as affecting motility, viability
& capacity of sperms
• Cu T  Release
prostaglandin   the
contractility of uterus.
Hormone Releasing Device
• Progesterone hormone
increases the viscosity of
cervical mucus which
prevents the sperms from
entering the cervix
• Maintain high level of
progesterone in the
endometrium which make it
unfavourable for the
implantation of zygote

17. Insertion
of
IUCD

18. IUCD Insertion

19. Ideal IUD Candidate
■ Women in the reproductive age
■ Given birth to at least one child
■ Not having multiple sexual partners
■ No history of pelvic disease
■ Normal menstrual period
■ Willing to check IUD tail regularly
■ Has access to follow up

20. C/I for IUD
Absolute C/I
• STDs
• Previous Ectopic Pregnancy
• Any Pelvic Pathology
• Bleeding disorder
• Congenital defects in the uterus
• Cancer Cervix, Uterus or Adnexa
Relative C/I
• Multiple sexual partner
• Anaemia
• Wilson’s disease (For Cu T only)

21. Time of Insertion
■ Make sure the female is not pregnant
■ At any time during the menstrual cycle
■ Ideal time =
– After 5th
day and before the 10th
day of
menstrual period
– Called “Intermenstrual Insertion”
– After pregnancy - Chances of expulsion
and perforation are high within 1st
week
of pregnancy
– Convenient time 6-8 weeks after
pregnancy

22. Time of Insertion
■ Depending on the time of insertion it is classified as;
Postplacental Insertion
• Immediately following delivery of placenta
• Between 10 minutes and 48 hours after childbirth
• “Immediate Postpartum Insertion”
• Disadv. – High expulsion rate & high risk of infection & perforation of uterus
Postpartum Insertion
• 6-8 weeks after delivery
• “Postpuerperal Insertion”
• Expulsion rate – Half of postplacental insertion
Postabortum Insertion
• 12 weeks after the abortion
• Following spontaneous abortion, can be inserted after first MC
Post-CS Insertion
• 6-8 weeks after CS
• Risk of infection is high
Postcoital Insertion
• 3-5 days of unprotected or forced intercourse
• “Emergency Contraception”

23. Instruction after IUD insertion
■ Must feel for the thread in the vagina – every month
■ Must report if it is not felt or expelled out or cause any
problem
■ Must report for routine examination – 1 & 2 years after
insertion
■ Removal of IUD after its lifespan is over
■ If she became pregnant & if she desires the pregnancy
– Remove the IUD to avoid infection & spontaneous
abortion.
■ If she became pregnant & if she does not want the
pregnancy – MTP is done.

24. Failure Rate
• 2-3 / HWY
Restoration of Fertility after
Removal
• Fertility is not impaired
• 70% of IUD users conceive within 1 year of
removal

25. Advantages
Simple to insert &
safe to use
Visit to the clinic is
only once
High success rate
(97%)
High continuation
rate
Reversible method
Free from systemic,
metabolic side
effects like oral pills
Does not interfere
with sexual
intercourse
Does not interfere
with lactation
Also used as “Post-
coital emergency
contraceptives” (use
within 3-5 days)
Less risk of ectopic
pregnancy

26. Disadvantages (SE & Cx)
Menstrual
Changes
(Bleeding)
Pain
Pelvic
Infection
Uterine
Perforation
Expulsions
Ectopic
Pregnancy