Our experience of the use of the No Gravid device as an intrauterine contraceptive.
Over a 2 year period, 755 No Gravid IUDs were inserted in women aged 18-55 years. 115 of the women were nulliparae and 637 were pluriparae. All but 4 insertions took place during the menstrual period, usually on the 3rd or 4th day. 2 sizes of the device were utilized according to parity; No Gravid No. 1 was used with 105 pluriparae, No Gravid No. 2 with 12 nulliparae. In 26 cases, cervical dilation using Hegar was necessary for insertion. Follow-up results are available for 635 women after 1 month, 205 women after 4-6 months, and 54 women after 1 year. After the 1st month, no menstrual alterations were observed in 234 women; 308 women reported their menstrual periods were longer, 192 reported spotting. Leukorrhea appeared or increased in 90 cases. 112 women reported pain in the 1st 2 days following insertion which, in all but 1 case, diminished. The 1 case required removal of the device. In subsequent follow-up checks, no particular changes were noted. The decrease in the number of women returning for a 2nd and 3rd check is taken as an indicator of a sound degree of tolerability and lack of pathology associated with the device. Other results noted that in 2 cases, regularization of oliogomenorrheic cycles was reported; in 13 women preexisting dysmenorrhea disappeared, in 1 case it was decreased. A total of 6 expulsions were reported, .79% of the total insertions; 9 devices were partially expelled, 1.19%; and 15 devices or 1.98% were removed. 4 pregnancies occurred for a Pearl Index of .54%, which is lower than rates reported for all other IUDs, the possible exception being the continuous progestin emission IUDs with which the authors lacked experience. Lower pregnancy rates are achieved only by combined estrogen-progestins and deposit injections of medroxyprogestrone acetate. Infections contracted included 20 cases of metritis, 21 cases of adnexitis and 1 woman had pelviperitonitis. 40 cases required estrogen and/or progestin therapy. Antiphlogistic therapy was required in 28 cases in conjunction with antibiotic therapy in 14 cases. Topical vulvovaginal therapy was necessary in 46 cases. The authors' conclusions that No Gravid IUDs are one of the most innocuous means of effective contraception is in part based on the low incidence of serious (only 1 case which involved penetration through the myometrium during pregnancy) and minor complications and side effects. In addition there are few absolute contraindications to IUD use, in this assessment contraindications were limited to rare cases of uterine malformation and 8 cases of hypoplasia of the uterus. Other conditions can be remedied prior to insertion. An advantage of the IUD is the immediate manifestation of problems which can be eliminated by removal.