Authors:
Doll H. Vessey M. Painter R.
Institution:
H. Doll, Health Services Research Unit, Department of Public Health, University of Oxford, Old Road, Headington, Oxford OX3 7LF; United Kingdom.
Title:
Return of fertility in nulliparous women after discontinuation of the intrauterine device: Comparison with women discontinuing other methods of contraception (2001).
Source:
British Journal of Obstetrics and Gynaecology. Vol 108(3) (pp04-314), 2001.
Abstract:
Objective. To clarify the effect of the using the intrauterine device on fertility in nulliparous women. Design. Prospective cohort study of two groups of nulliparous women, one recruited while using an intrauterine device and the other while using an oral contraceptive. Setting. Seventeen family planning clinics in England and Scotland. Sample. 1071 nulliparous, married women, aged 18-40 years, 558 of whom contributed information to the main objective of the study. Methods. The women were recruited between 1982 and 1985 and followed up annually to 1994. Dates and reasons for any contraceptive method changes (which were most frequently to barrier methods) were recorded, together with the outcome of any pregnancies, at each follow up. Main outcome measures. The number of nulliparous women giving birth at term after stopping contraception (oral contraceptive, intrauterine device or barrier method) in order to conceive.
Results:
Women who stopped using a barrier method to achieve a planned pregnancy conceived most quickly: 54% were delivered after one year vs 39% of intrauterine device and 32% of oral contraceptive users (log rank P = 0.002). There was no association between fertility and duration of oral contraceptive use: However, short term intrauterine device users (<42 months) showed a fertility pattern more favourable than seen in those discontinuing oral contraceptives, with increasing duration of intrauterine device use being associated with decreasing fertility (linear trend P = 0.005); the fertility of women who had used the intrauterine device for 78 + months was the most impaired (28% were delivered by 12 months vs 46% of short term users; at 36 months the corresponding figures were 79% vs 91%). This association remained after adjusting for potential confounding factors, including maternal age, husband's social class, and history of gynaecological illnesses, factors which themselves had independent associations with fertility. Conclusions. Long term intrauterine device use in nulliparous women appears to be associated with an increased risk of fertility impairment.
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- 1 What is infertility?
- 2 How prevalent are infertility problems?
- 3 What are the main causes of infertility?
- 4 What are the objectives of our infertility investigations?
- 5 Have there been any noticeable changes in fertility requirements in recent years?
- 6 What is the effect of our age on fertility?
- 7 I smoke cigarettes. Can this have an effect on my fertility?
- 8 Does my weight influence fertility?
- 8A Obesity! How can I lose weight?
- 9 I have fibroids. Could these reduce my fertility?
- 10 I have been told that my womb has an abnormal shape and that was the way that I was born. Could this reduce my fertility?
- 11 I have endometriosis. Could this reduce my fertility?
- 12 I have been told that I have cervicitis or a cervical ectopy (erosion). Could this impair my fertility?
- 13 My doctor tells me that my womb is retroverted (tilts backwards). Could this reduce my fertility?
- 14 I have had an ectopic pregnancy. Does this affect my future fertility?
- 15 We are worried that we may have a fertility problem. What should we do?
- 16 How will our doctor be able to identify the cause of our infertility?
- 17 How can we tell if I am releasing my eggs (ovulating)?
- 18 Investigations have shown that I have a problem releasing my eggs (anovulation). What could be the cause of this?
- 19 How important are my Fallopian tubes in fertility?
- 20 How can we tell if my Fallopian tubes are functioning?
- 21a What are the causes of male factor infertility?
- 21 How can we assess male fertility?
- 22 What is the purpose of a post-coital test (PCT)?
- 23 We have had our infertility investigations and our problem remains unexplained. How can this be?
- 24 What are our chances of achieving a pregnancy?
- 25 Where can I obtain more information?
- 26 Could we have some recommended infertility support groups?
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