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History of the IUD

Posted Apr 09 2009 7:14pm

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.

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