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Presenters at a family planning conference told a tale of Arab traders inserting small stones into the uteruses of their camels to prevent pregnancy. Although the story has been repeated as truth, it has no basis in history and was meant only for entertainment purposes.
Precursors to IUDs were first marketed in 1902. Developed from stem pessaries (where the stem held the pessary in place over the cervix), the 'stem' on these devices actually extended into the uterus itself. Also known as interuterine devices (because they occupied both the vagina and the uterus), they had high rates of infection and were condemned by the medical community.
The first intrauterine device (contained entirely in the uterus) was described in a German publication in 1909, although the author appears to have never marketed his product.
In 1929, Dr. Ernst Gra"fenberg of Germany published a report on an IUD made of silk suture. He had found a 3% pregnancy rate among 1,100 women using his ring. In 1930, Dr. Gra"fenberg reported a lower pregnancy rate of 1.6% among 600 women using an improved ring wrapped in silver wire. Unbeknownst to Dr. Gra"fenberg, the silver wire was contaminated with 26% copper. Copper's role in increasing IUD efficacy would not be recognized until nearly 40 years later.
In 1934, Japanese physician Tenrei Ota developed a variation of the Gra"fenberg ring that contained a supportive structure in the center. The addition of this central disc lowered the IUD's expulsion rate. These devices still had high rates of infection, and their use and development was further stifled by World War II politics: contraception was forbidden in both Nazi Germany and Axis-allied Japan. The Western world did not learn of the work by Gra"fenberg and Ota until well after the war ended.
The first plastic IUD, the Marguiles Coil or Marguiles Spiral, was introduced in 1958. This device was somewhat large, causing discomfort to a large proportion of women users, and had a hard plastic tail, causing discomfort to their male partners. The Lippes Loop, a slightly smaller device with a monofilament tail, was introduced in 1962 and gained in popularity over the Marguiles device.
The stainless steel single-ring IUD was developed in the 1970s and widely used in China because of low manufacturing costs. The Chinese government banned production of steel IUDs in 1993 due to high failure rates (up to 10% per year).
Dr Howard Tatum, in the USA, conceived the plastic T-shaped IUD in 1968. Shortly thereafter Dr Jaime Zipper, in Chile, introduced the idea of adding copper to the devices to improve their contraceptive effectiveness. It was found that copper-containing devices could be made in smaller sizes without compromising effectivesness, resulting in fewer side effects such as pain and bleeding. T-shaped devices had lower rates of expulsion due to their greater similarity to the shape of the uterus.
The Dalkon Shield (which had a multi-filiment string) was introduced in the United States in 1970. It was banned after being linked to 200,000 PID infections, more than 250 septic abortions, infertility, emergency hysterectomies, and 33 deaths.
Second-generation copper-T IUDs were also introduced in the 1970s. These devices had higher surface areas of copper, and for the first time consistently achieved effectiveness rates of greater than 99%. Worldwide today, with the exception of the new GyneFix, this is the only type of IUD available.
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