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 lUDs (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 lUDs other than those that contain copper) can lead to infertility in nulligravid women. (N Engl J Med 1985; 312:937–41.) USERS of an intrauterine device (IUD) are at a greater risk than nonusers for the development of acute pelvic inflammatory disease, most cases of which represent the clinical manifestation of acute salpingitis. 1 2 3 4 5 6 7 In turn, acute salpingitis may predispose to the occurrence of infertility, most likely from occlusion or restriction of the fallopian tubes by postinflammatory fibrosis. 8 9 10 11 For example, among 415 women with laparoscopically verified salpingitis, 21.2 per cent were infertile through 9.5 years of follow-up, 9 in contrast to only 3 of 100 salpingitis-free controls. Also, of 52 infertile women whose tubes were abnormal in appearance, 50 per cent had a . . .