History of the IUD

Dr. Ernst Grafenberg is widely recognized as the initial developer of the modern IUD, although crude variations of the IUD have been used for centuries, as women inserted various implements into the female uterus in an attempt to prevent pregnancy. The IUD invented by Dr. Grafenberg was a circle-shaped device rather than the now-familiar t-shaped IUD. The rings developed by Dr. Grafenberg were silk threads covered with a very fine silver wire which was theorized to cause inflammation in the uterus making a hostile environment for the sperm. He would find later that adding copper to the device increased its effectiveness. Nazi Germany soon outlawed all contraceptives and Grafenberg was forced to leave Germany in 1937 in order to escape persecution due to his Jewish heritage.

The 1950's brought the more modern plastic-based IUD, although initially these plastic IUD's were very large, therefore not so successful among women. Jack Lippes, an American gynecologist developed one of the first safe IUDs, called the Lippes Loop, using a double loop with a thread extension hanging from it for easier extraction. (the thread was later died blue in order to be able to find it more easily. Unfortunately, development of the IUD during the 1960's and early 70's was tainted by U.S. drug companies who did not thoroughly test their version of the IUD before releasing it. Women who used this product, known as the Dalkon Shield, felt severe pain during insertion and developed infections from the device. A large amount of lawsuits from the use of the Dalkon Shield almost stopped distribution of IUDs in America.

Chinese Contribution

Chinese physicians were searching for a way to cheaply enforce the China's one-child policy which led to the development of a stainless steel IUD in the 1970's. This IUD was banned in the early 1990's, because it had a pregnancy rate of approximately 10%. Meanwhile, the United States had been working on perfecting the IUD, and introduced a plastic/copper IUD in the 1970's which were considered to be about 99% effective. Few changes have been made to the IUD since that time other than hormones being added to the Mirena IUD. The Mirena IUD is considered to be effective for approximately five years, while the Paragard, which is a copper IUD without hormones, can be effective for 10-12 years.

Both Paragard and Mirena work by creating a hostile environment for sperm, as well as thinning the uterine lining which prevents a fertilized egg from implanting into the uterus. The hormones in the Mirena also create a thicker cervical plug, making it much less likely that sperm will make it into the uterus at all. The Mirena can also completely stop the ovaries from releasing an egg, although this is not as common. Although the IUD is a very effective means of birth control, it is still relatively unpopular when compared to condoms and the pill. Gynecologists tend not to recommend the IUD very often to their patients-some feel this comes from a lack of information regarding the IUD. Some gynecologists are uncomfortable providing IUD's to their patients from fear of litigation. While manufacturers sell IUDs, they spend few advertising dollars promoting the devices so as not to compete with their more lucrative birth control products.

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