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Contraceptive Device Evaluation
Maryam Rezvani, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Abbreviations

          • Intrauterine device (IUD)
          • Intrauterine contraceptive device (IUCD)
          • Bilateral tubal ligation (BTL)
          • Levonorgestrel-releasing intrauterine system (LNG-IUS)
        • Definitions

          • IUD
            • Device inserted into endometrial cavity to prevent pregnancy
            • T-shaped polyethylene frame with polyethylene monofilament string
            • 2 types of IUDs in United States
              • Copper-containing (Paragard, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ)
                • Copper wire wrapped around stem
                • Works for up to 10 years
              • Levonorgestrel-releasing (Mirena, Shering, AG Pharmaceutical, Germany)
                • Levonorgestrel-containing collar around stem
                • Works up to 5 years
            • Other IUDs
              • Plastic IUDs and Lippes loop IUD (older)
              • Round IUD of stainless steel ring in fundus with straight shaft in lower endometrium (commonly used in China)
            • Mechanism of action: Primarily prevents fertilization
              • Induce endometrial and fallopian tube chronic inflammatory change
                • Spermicidal effects
                • Inhibits fertilization
                • Inhospitable environment for implantation
              • Partially inhibit ovulation (Mirena only)
              • Copper devices ↑ copper levels → change in cervical mucus, affecting sperm motility and irritating endometrium
          • Transcervical tubal occlusion device
            • Device/material inserted hysteroscopically into fallopian tubes for permanent sterilization
            • Essure (Conceptus Inc., Mountain View, CA)
              • 2 overlapping coils each with radiopaque end markers
                • Outer coil made of nitinol (nickel and titanium alloy)
                • Inner coil made of stainless steel wrapped in polyethylene terephthalate (PET) fibers
                • Outer coil expands upon release and conforms to tube wall
                • 4 cm in length
                • 1.5-2 mm expanded diameter
              • PET fibers elicit benign tissue ingrowth around and into device
                • Anchors device in place
                • Permanently obstructs fallopian tubes
            • Adiana (Hologic, Bedford, MA)
              • Hysteroscopic focal radiofrequency thermocoagulation of fallopian tube isthmus followed by intraluminal insertion of silicon elastomer matrix

        IMAGING

        • General Features

          • Imaging Recommendations

            DIFFERENTIAL DIAGNOSIS

              CLINICAL ISSUES

              • Presentation

                • Demographics

                  • Natural History & Prognosis

                    • Treatment

                      DIAGNOSTIC CHECKLIST

                      • Image Interpretation Pearls

                        Selected References

                        1. Dean G et al: Intrauterine contraception (IUD): Overview: UpToDate. http://www.uptodate.com/contents/intrauterine-contraception-iud-overview. Updated July 14, 2014. Accessed August 15, 2014
                        2. Boortz HE et al: Migration of intrauterine devices: radiologic findings and implications for patient care. Radiographics. 32(2):335-52, 2012
                        3. Guelfguat M et al: Imaging of mechanical tubal occlusion devices and potential complications. Radiographics. 32(6):1659-73, 2012
                        4. Barber M et al: Uterine perforation and migration of an intrauterine contraceptive device in a 24-year-old patient seeking care for abdominal pain. J Chiropr Med. 10(2):126-9, 2011
                        5. Moschos E et al: Does the type of intrauterine device affect conspicuity on 2D and 3D ultrasound? AJR Am J Roentgenol. 196(6):1439-43, 2011
                        6. Benacerraf BR et al: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol. 34(1):110-5, 2009
                        7. Peri N et al: Imaging of intrauterine contraceptive devices. J Ultrasound Med. 26(10):1389-401, 2007
                        8. Muhler M et al: [How safe is magnetic resonance imaging in patients with contraceptive implants?] Radiologe. 46(7):574-8, 2006
                        9. Valsky DV et al: The shadow of the intrauterine device. J Ultrasound Med. 25(5):613-6, 2006
                        10. Letti Muller AL et al: Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception. 72(3):192-5, 2005
                        11. Morales-Rosello J: Spontaneous upward movement of lowly placed T-shaped IUDs. Contraception. 72(6):430-1, 2005
                        12. Schiesser M et al: Lost intrauterine devices during pregnancy: maternal and fetal outcome after ultrasound-guided extraction. An analysis of 82 cases. Ultrasound Obstet Gynecol. 23(5):486-9, 2004
                        13. Caliskan E et al: Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care. 8(3):150-5, 2003
                        14. Hubacher D et al: Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv. 57(2):120-8, 2002
                        15. Stanford JB et al: Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol. 187(6):1699-708, 2002
                        16. Thonneau P et al: Risk factors for intrauterine device failure: a review. Contraception. 64(1):33-7, 2001
                        17. Tatum HJ et al: Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device. Am J Obstet Gynecol. 126(7):869-79, 1976
                        Related Anatomy
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                        Related Differential Diagnoses
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            • Top Differential Diagnoses

                              TERMINOLOGY

                              • Abbreviations

                                • Intrauterine device (IUD)
                                • Intrauterine contraceptive device (IUCD)
                                • Bilateral tubal ligation (BTL)
                                • Levonorgestrel-releasing intrauterine system (LNG-IUS)
                              • Definitions

                                • IUD
                                  • Device inserted into endometrial cavity to prevent pregnancy
                                  • T-shaped polyethylene frame with polyethylene monofilament string
                                  • 2 types of IUDs in United States
                                    • Copper-containing (Paragard, Ortho-McNeil Pharmaceutical, Inc., Raritan, NJ)
                                      • Copper wire wrapped around stem
                                      • Works for up to 10 years
                                    • Levonorgestrel-releasing (Mirena, Shering, AG Pharmaceutical, Germany)
                                      • Levonorgestrel-containing collar around stem
                                      • Works up to 5 years
                                  • Other IUDs
                                    • Plastic IUDs and Lippes loop IUD (older)
                                    • Round IUD of stainless steel ring in fundus with straight shaft in lower endometrium (commonly used in China)
                                  • Mechanism of action: Primarily prevents fertilization
                                    • Induce endometrial and fallopian tube chronic inflammatory change
                                      • Spermicidal effects
                                      • Inhibits fertilization
                                      • Inhospitable environment for implantation
                                    • Partially inhibit ovulation (Mirena only)
                                    • Copper devices ↑ copper levels → change in cervical mucus, affecting sperm motility and irritating endometrium
                                • Transcervical tubal occlusion device
                                  • Device/material inserted hysteroscopically into fallopian tubes for permanent sterilization
                                  • Essure (Conceptus Inc., Mountain View, CA)
                                    • 2 overlapping coils each with radiopaque end markers
                                      • Outer coil made of nitinol (nickel and titanium alloy)
                                      • Inner coil made of stainless steel wrapped in polyethylene terephthalate (PET) fibers
                                      • Outer coil expands upon release and conforms to tube wall
                                      • 4 cm in length
                                      • 1.5-2 mm expanded diameter
                                    • PET fibers elicit benign tissue ingrowth around and into device
                                      • Anchors device in place
                                      • Permanently obstructs fallopian tubes
                                  • Adiana (Hologic, Bedford, MA)
                                    • Hysteroscopic focal radiofrequency thermocoagulation of fallopian tube isthmus followed by intraluminal insertion of silicon elastomer matrix

                              IMAGING

                              • General Features

                                • Imaging Recommendations

                                  DIFFERENTIAL DIAGNOSIS

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Image Interpretation Pearls

                                              Selected References

                                              1. Dean G et al: Intrauterine contraception (IUD): Overview: UpToDate. http://www.uptodate.com/contents/intrauterine-contraception-iud-overview. Updated July 14, 2014. Accessed August 15, 2014
                                              2. Boortz HE et al: Migration of intrauterine devices: radiologic findings and implications for patient care. Radiographics. 32(2):335-52, 2012
                                              3. Guelfguat M et al: Imaging of mechanical tubal occlusion devices and potential complications. Radiographics. 32(6):1659-73, 2012
                                              4. Barber M et al: Uterine perforation and migration of an intrauterine contraceptive device in a 24-year-old patient seeking care for abdominal pain. J Chiropr Med. 10(2):126-9, 2011
                                              5. Moschos E et al: Does the type of intrauterine device affect conspicuity on 2D and 3D ultrasound? AJR Am J Roentgenol. 196(6):1439-43, 2011
                                              6. Benacerraf BR et al: Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol. 34(1):110-5, 2009
                                              7. Peri N et al: Imaging of intrauterine contraceptive devices. J Ultrasound Med. 26(10):1389-401, 2007
                                              8. Muhler M et al: [How safe is magnetic resonance imaging in patients with contraceptive implants?] Radiologe. 46(7):574-8, 2006
                                              9. Valsky DV et al: The shadow of the intrauterine device. J Ultrasound Med. 25(5):613-6, 2006
                                              10. Letti Muller AL et al: Transvaginal ultrasonographic assessment of the expulsion rate of intrauterine devices inserted in the immediate postpartum period: a pilot study. Contraception. 72(3):192-5, 2005
                                              11. Morales-Rosello J: Spontaneous upward movement of lowly placed T-shaped IUDs. Contraception. 72(6):430-1, 2005
                                              12. Schiesser M et al: Lost intrauterine devices during pregnancy: maternal and fetal outcome after ultrasound-guided extraction. An analysis of 82 cases. Ultrasound Obstet Gynecol. 23(5):486-9, 2004
                                              13. Caliskan E et al: Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care. 8(3):150-5, 2003
                                              14. Hubacher D et al: Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet Gynecol Surv. 57(2):120-8, 2002
                                              15. Stanford JB et al: Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol. 187(6):1699-708, 2002
                                              16. Thonneau P et al: Risk factors for intrauterine device failure: a review. Contraception. 64(1):33-7, 2001
                                              17. Tatum HJ et al: Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device. Am J Obstet Gynecol. 126(7):869-79, 1976