Study finds risk of pregnancy low prior to IUD placement following recent unprotected sex

The findings of a secondary analysis from a randomized trial of intrauterine devices (IUDs) for emergency contraception should bolster confidence about the low pregnancy risk when providers insert an IUD following a recent episode of unprotected intercourse.

Senior author David K. Turok, MD, MPH, chief in the division of family planning in obstetrics and gynecology at the University of Utah in Salt Lake City, said that providers have historically been hesitant to place IUDs immediately because of the theoretical risk of pregnancy in the current menstrual cycle. However, the best contraceptive care occurs when people receive what they want on the day that they present for care, he said.

“It doesn’t make sense to turn people away and tell them to come back next month, because as soon as they walk out the door they have lowered their chance of actually getting the method of birth control that they just decided upon,” Turok told Contemporary OB/GYN®.

Data indicate that for a negative urine pregnancy test at the time of IUD placement, the risk of pregnancy in that next month is low, regardless of when and how often the person has had sex without a prior contraceptive method.1

The trial assessed the copper T380A IUD and the levonorgestrel 52-mg intrauterine system for emergency contraception. At enrollment, all 655 female participants had at least 1 episode of unprotected intercourse in the last 5 days, along with a negative urine pregnancy test.

Only 1 patient became pregnant within 1 month after IUD placement, and that person reported a single episode of intercourse 48 hours before IUD placement.

Multiple unprotected intercourse episodes before IUD placement were reported by 43.7% of participants and 14.4% of participants reported at least 1 incidence of unprotected intercourse 6 to 14 days before IUD placement, none of which resulted in pregnancy.

“We suspected a low risk of pregnancy and that is what we found,” Turok said.

The frequency and timing of intercourse was very similar to a prior smaller study that Turok and his research team published in 2016 in the American Journal of Obstetrics and Gynecology.2

“I was surprised, though, that almost exactly the same proportion of IUD emergency contraception users in both studies reported multiple episodes of unprotected intercourse in the last 14 days,” Turok said.

With the present study, “we now have a higher level of confidence that 4 out of 10 people selecting an IUD for emergency contraception have had unprotected intercourse more than once in the last 14 days,” he said. “This supports the need to provide care for people at their initial visit.”

If providers followed the current guidelines from the Centers for Disease Control and Prevention (CDC), these patients would have been told to come back next month. “Would you turn away 100 people if you knew that pregnancy would occur for only none or 1 of them?” Turok posed. “If your main concern is undesired pregnancies, you will help people reduce their risk a lot more by providing those people with the method they want on that day and not getting trapped up into a theoretical concern of pregnancy in the current menstrual cycle.”
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Disclosure

Turok is a consultant to Sebela Pharmaceuticals.

References

  1. BakenRa A, Gero A, Sanders J, et al. Pregnancy risk by frequency and timing of unprotected intercourse before intrauterine device placement for emergency contraception. Obstet Gynecol. 2021; 138(1): 79–84. doi:10.1097/AOG.0000000000004433
  2. Sanders JN, Howell L, Saltzman HM, et al. Unprotected intercourse in the 2 weeks prior to requesting emergency intrauterine contraception. Am J Obstet Gynecol. 2016;215:592 e1- e5. doi:10.1016/j.ajog.2016.06.028