Intrauterine device (IUD) associated pathology: a review of pathogenic mechanisms.

This paper summarizes our studies of IUD-related disease with those previously published by others. Our data are based upon 51 IUDs and 42 index cases of IUD-related disease demonstrating specific processes. Gross, dissecting microscope, scanning electron microscope and X-ray microanalysis examinations were made of selected IUDs and associated tissues. Tissue associated with the IUDs revealed inflammation in 59.4%, calcific material in 6.3% and no abnormality in 34.4%. IUD-associated tissue responses were accompanied by changes of the IUD; these changes involved deposition of substances upon the IUD surface and degradation of the IUD itself. Disintegration of the IUD, its string or both, has been repeatedly observed. The material deposited upon the surface of the IUD included proteins and calcium salts. The changes which involve the IUD and the host appear to be operative in the genesis of IUD-related disease. Inflammatory changes and infections are the most common IUD-related disease processes and are also the mechanisms commonly associated with the most serious complications of IUD use, reproductive failure and death. We propose that serious IUD-related disease is caused by or is a direct consequence of processes which alter the IUD and which potentiate inflammation and infection. A model amenable to testing is proposed.