Gynecology: Intra-Uterine Devices: A New Era in Birth Control?

It has been known for a century that a foreign body in the uterus can prevent conception — at least in animals. But how could such a process work and be put to safe human use? Even though modern medical men have no sure answers, the cautious and respectable Planned Parenthood Federation of America announced last week that its medical advisers are now giving "strong, though preliminary" approval to the newest form of birth control. Information accumulated from more than 10,000 women during 90,000 woman-months of observation, said P.P.F.'s medical committee, "indicates that the modern intrauterine contraceptive devices are both safe and effective."

Said P.P.F.'s president, Dr. Alan Guttmacher: "Intra-uterine devices are being subjected to as much scientific testing as the birth control pills." And it appears that they are almost equally effective. If their sponsors' hopes are fulfilled, IUCDS, as they are called, may soon be the most useful and prevalent contraceptive. They cost only pennies to manufacture; the cost of insertion is no more than a doctor chooses to charge, which may be nothing at a health station in India or the fee for an office visit and examination in the U.S. A woman who wants another child can usually become pregnant within a cou ple of months after the IUCD'S removal. Most important, IUCDS can be left in place for months or years without thought or attention.

Silk to Silver. The man who did most to demonstrate the effectiveness of IUCDS did not live to see the dawn of the new age that he pioneered. German Gynecologist Ernst Gräfenberg, born in 1881, began inserting rings in the wombs of his patients in the 1920s. He first used rings made of surgical silk, but soon switched to silver wire. The insertion of wire required dilatation of the cervix, but Dr. Gräfenberg reported few complications and fewer unwanted pregnancies. Yet when other doctors decided to follow his example, there were many complaints—mainly excessive bleeding and inflammation in the pelvis. The rings fell into disrepute. After Dr. Grafenberg settled in the U.S. in 1940, he gave up the use of IUCDS.

Research went on elsewhere. The late Dr. Willi Oppenheimer of Shaare Zedek Hospital in Jerusalem, who began working on the devices in 1930, thought that something like the gut used in surgical sutures would be less likely than metal to cause bad reactions. He went back to Gräfenberg's rings made from the surgical silk. His 329 patients had a few unwanted pregnancies, but no miscarriages and no malformed babies. There were no cases of permanent sterility, and no diseases, including cancer, that could be attributed to the ring. In Yokohama, Dr. Atsumi Ishihama recorded a total of 19,000 women fitted with IUCDS; his choice was a ring made from a spiral of metal or plastic, and with a disk in the center suspended from three points.