History of the IUD

Speaking of Dr. Ernst Gräfenberg, let’s talk about intrauterine devices (IUDs) since Dr. G is recognized as the first developer of the modern IUD.  IUDs, in a crude sense, have existed for an untold number of years.  Women and men have inserted various implements into human and animal uteri to prevent pregnancy for many years.  Forerunners to the modern IUD emerged in the beginning of the twentieth century with inventions such as the stem pessary.

The first true modern IUD was invented in the late 1920s by Dr. Gräfenberg when he was still practicing gynecology in Germany.  The IUD that Dr. G invented was, instead of the familiar t-shaped device, actually a circle-shaped device:  the Gräfenberg ring.  These rings were silk threads covered with fine silver wire.  The metal of this device caused an inflammatory response in the uterus thus creating hostile conditions for sperm.  He later found that some copper mixed with the silver aided in the contraceptive ability of the device.  (Of course, for a number of uteri in which these were inserted the inflammation was so great as to cause complications, though these were rarely severe.)  By the end of the 1930s, the Gräfenberg ring fell out of use mostly because of the eugenic policies implemented by Nazi Germany (in which all contraception was outlawed, as it was in Japan as well).  Gräfenberg himself left Germany in 1937 to escape persecution because of his Jewish heritage.

The modern plastic-based IUD began to take shape in the United States in the 1950s.  Lazar C. Margulies, an obstetrician in New York, is generally credited for pioneering plastic IUDs to help reduce the danger associated with previous IUDs.  In 1958 he introduced his version of the IUD, though it was not greatly successful because of its large size.  In 1962, Jack Lippes, a gynecologist also in New York, developed a smaller, plastic IUD that became more popular.  In the late 1960s, Howard Tatum, another New York obstetrician, developed a plastic-cased, cooper-based IUD that could be dramatically reduced in size without sacrifcing its effectiveness.  During the 1970s, in an effort to help cheaply curb reproduction and enforce the “one-child policy,” Chinese physicians developed the stainless-steel IUD, but banned them by early 1990s because of a 10% pregnancy rate due to steel’s lowered contraceptive capability.

The second generation of plastic-copper IUDs came around in the 1970s.  These IUDs increased the surface area of the devices and increased their effectiveness above 99%.  Today, in the United States, this type of IUD and one other type are available.  The copper IUD available in the United States is called ParaGuard and is effective for twelve years.  The other type of IUD available in the United States is a hormone-based IUD, called Mirena, that functions in a few ways.  This IUD first creates a hostile environment for sperm, much like copper-IUDs by thinning the uterine lining making it highly unlikely a fertilized egg could implant in the uterus.  Second, the hormones involved create a thicker cervical plug making it less likely that sperm will enter the uterus to begin with.  Finally, the hormone-IUD in some instances stops the ovary from releasing an egg, though this is less likely than the other two functions.  Hormone-based IUDs were developed in the 1970s, but have not been popular in the United States until recently because of ad campaigns for Mirena (though they remain relatively very unpopular compared to condoms and the pill).

This is all a sort of background to understanding the IUD.  Hopefully, in a later entry we can better address the scientific and medical aspects of IUDs in their modern form.  Do you have something to say about IUDs?  Or anything else?  I yield the floor.


5 thoughts on “History of the IUD

  1. I think one of the reasons that Mirena is less popular than the pill or condom is because you have to meet certain criteria in order to be able to get Mirena. You have to be in a marriage or long term committed relationship to one person and have at least one child. The doctors at the OB/GYN office I go to will refuse a patient for not meeting one or both of the criteria. The only reason they’ll let you have Mirena without having a child is if you are over 35.

    An important thing to note for moms is that Mirena is great contraceptive while breastfeeding. Breastfeeding alone is not a good contraceptive. Mirena does not affect the milk supply or harm the baby and is actually recommended by kellymom.com. Copper based IUDs like ParaGuard are not recommended to breastfeeding moms as one of the possible side effects is copper poisoning, a condition that can be passed on to the child through milk.

  2. My OB/GYN is actually pushing for me to have an IUD inserted but I refuse. It just doesn’t sound like something for me…and the fact that she told me that her practice has had IUD perforate a patient’s uterus. EEK!

  3. Thank you for this post; it is very interesting and informative. Could you cite where you get your information from? I would like to know more.

  4. I have Mirena and love it. I made an attempt to get an IUD a few years ago and was refused because I wasn’t married and didn’t have a child. A year later, however, I tried with another doctor and she gladly allowed it. It has honestly changed my life-I don’t want to have kids now, and I’m not entirely sure that I ever want to have them, so having the IUD has freed me from worrying about getting pregnant. It has also lightened and shortened my periods in the process. I would really recommend it to anyone who has a hard time with condoms or the pill-it’s a fantastic alternative. Thanks for this post–I wanted to know about the origin of the IUD and now I do!

  5. In reality research shows the Mirena to be safe for women who haven’t had children yet and who are not monogamous, and the American Congress of Obstetricians and Gynecologists is now recommending it even for teens. It just took a while for the data to come in, and so the original approval was conservative. Bayer now sells a slightly smaller version of Mirena called Skyla that they got approved for women without babies, but the Mirena itself is better because it lasts for 7 years (FDA approval for 5) while the Skyla only lasts for 3. Also, the Mirena reduces period cramps and bleeding by on average 90% by the end of the first year. The Bayer rep told me that they will never go back to the FDA to get it approved for young women without babies or for the 7 years that it actually works simply because there is no economic incentive for them to do so. A generic competitor will be out in 2014 or 2015 that will have that stamp of approval from the FDA.

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