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Original Research Gynecology| Volume 225, ISSUE 2, P157.e1-157.e9, August 2021

Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study

Published:March 11, 2021DOI:https://doi.org/10.1016/j.ajog.2021.03.011
Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study
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      Background

      In the 1970s, numerous medical reports, media coverage, and litigation around the Dalkon Shield intrauterine device led to a perception that all intrauterine devices cause upper genital tract infection and infertility.

      Objective

      This study aimed to assess the association between intrauterine device use and time to conception.

      Study Design

      The Fertility After Contraceptive Termination Study is a multicenter, prospective cohort study of women stopping their contraceptive method to attempt conception. We recruited participants between 2011 and 2017. Participants were a convenience sample of women recruited from academic centers in Philadelphia, PA; Los Angeles, CA; St. Louis, MO; Indianapolis, IN; Aurora, CO; and Salt Lake City, UT. Women were eligible if they stopped their contraceptive method within the past 120 days before enrollment, were between 18 and 35 years of age, had no history of infertility or sterilization, and had at least 6 months of follow-up. Baseline data included demographic and reproductive characteristics, past contraceptive use, nucleic acid amplification testing for sexually transmitted infections, and serology for past infection with Chlamydia trachomatis, Trichomonas vaginalis, and Mycoplasma genitalium. The primary exposure was intrauterine device use (ever); the primary outcome was time to conception. All participants were observed longitudinally for up to 24 months. We used piecewise exponential proportional hazards models with multiple imputation to provide hazard ratios and their respective 95% confidence intervals.

      Results

      Of the 461 participants, mean age was 28.2 years, 178 (38.7%) were Black, 157 (34.1%) were considered as low socioeconomic status, and 275 (59.7%) had a history of intrauterine device use. Without adjusting for any covariates, the median time to conception was shorter for participants who had a history of intrauterine device use (5.1 months) than participants who never used an intrauterine device (7.5 months). After controlling for potential confounders, the association of past intrauterine device use with time to conception was not statistically significant (adjusted hazard ratio, 1.25; 95% confidence interval, 0.99–1.58). In our multivariable model, age, nulligravidity, Black race, low socioeconomic status, and past Mycoplasma genitalium infection were associated with longer times to conception (hazard ratio, 0.76; 95% confidence interval, 0.58–0.99). Conception by 12 months was lower in participants with past Mycoplasma genitalium infection (68% vs 80% without past infection; P=.019).

      Conclusion

      We found no impairment of fertility with ever use of an intrauterine device. Serologic evidence of past Mycoplasma genitalium infection was associated with longer times to conception and higher rates of infertility. Mycoplasma genitalium infection is a potential modifiable cause of infertility.

      Key words

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      Article info

      Publication history

      Published online: March 11, 2021
      Accepted: March 8, 2021
      Received in revised form: March 5, 2021
      Received: February 17, 2021

      Footnotes

      J.F.P. serves on Advisory Boards for Bayer and CooperSurgical. He has received research support from CooperSurgical, Merck, and Bayer. C.A.S., The University of Pennsylvania has received research funding from Bayer Healthcare, Sebela, Medicines360 and NIH. S.T., The University of Colorado Department of Obstetrics and Gynecology has received research funding from Bayer Healthcare, Sebela, Agile Therapeutics, Merck & Co, and Medicines360. S.T. has served on a scientific advisory board for Bayer Healthcare and a data safety and monitoring board for a product marketed by Merck & Co. D.K.T. serves as a consultant for Sebela Pharmaceuticals, Inc. The University of Utah, Division of Family Planning, receives research funding from Bayer Women’s Health Care; Merck & Co, Inc; CooperSurgical; Bioceptive; Sebela Pharmaceuticals; and Medicines360. M.N. serves as a consultant for the Foundation Consumer Healthcare.

      Funding for the Fertility After Contraceptive Termination Study was provided by the Society for Family Planning, CooperSurgical, and Bayer. Funding from all sponsors supported staff salaries for the enrollment and follow-up of all participants. Study design, protocol, procedures, statistical analysis, and so on, were all under the direction of the investigators and independent of the funders.

      Cite this article as: Peipert JF, Zhao Q, Schreiber CA, et al. Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study. Am J Obstet Gynecol 2021;225:157.e1-9.

      Identification

      DOI: https://doi.org/10.1016/j.ajog.2021.03.011

      Copyright

      © 2021 Elsevier Inc. All rights reserved.

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