Direct relationship between IUCD removal and ectopic pregnancy.Myth or fact?

Firstly for those of you who are not familiar with what IUCD's are please click here

*********Let it be known IUCD's are not recommended for women who have not yet had children, or are likely to want children in the future.*******


Online there seems to be two schools of thought on this subject. Predominantly the concern is for women who currently have an IUCD and are worried about the increased risk of having an ectopic pregnancy. Some professionals argue that if you have an IUCD then you have a 5% chance of it becoming ectopic, as opposed to 1-2% if you do not. Other professionals are adamant that women are not at a higher risk of having an ectopic pregnancy with an IUCD because the chances of falling pregnant are so low.

What I am concerned about is the overwhelming amount of women who have had there IUCD removed for the purpose of trying to conceive and are falling pregnant within a few months and having an ectopic pregnancy. This is what happened to me and I have been researching whether or not there is a correlation. It turns out there are a lot of conflicting results and once again Im left to my own devices.

 There are articles online that say this is not the case, including a study done in New Zealand in 1982 to determine fertility rates and complications after having a copper IUCD removed.You can read it here. In the article it states, in the 4 year study "The ectopic pregnancy rate was 0.7% among women who had their IUDs removed because of complications compared with 0.5% among those who underwent removal to achieve pregnancy." They also state that "overall, this prospective study suggests that a favorable return to fertility and a good pregnancy outcome can be expected after IUD use is discontinued."

Mind you they did say "good" pregnancy outcome...not brilliant!

I have come across a lot of women in forums across the globe, who have had their IUCD's taken out to conceive and have fallen pregnant very quickly only to miscarry or worse have an ectopic pregnancy.There is a midwife called Paula Greer who when asked what causes ectopic pregnancy she answers:
When the blastocyst implants anywhere outside the uterine cavity the result is an ectopic pregnancy. The incidence is about 1 percent of all pregnancies and is increased in women over age 35 and in women of color. Over the last decade the incidence is on the rise which may be attributed to the increase in sexually transmitted diseases and the use of antibiotics. Factors which increase the risk of ectopic pregnancy: blockage in the tubes from scarring from previous pelvic infections, abnormalities of the reproductive tract, and IUD users.

 The risk in IUD users seems to be the greatest in the several months after IUD removal so it is wise to practice other methods of birth control several months after an IUD is removed before attempting pregnancy.


Another article I found was a woman trying for medical malpractice legal advice her story is simple:

Hi,
I had the Mirena IUD inserted about 2 1/2 years ago.
My husband I and were very cautious about getting any form of birth control because of the side effects. After doing intensive research we decided to get the Mirena IUD. We already had two children that were 15 months apart so, we wanted to wait a couple of years before our 3rd child.

To our surprise, after the removal of the IUD we became pregnant 3 months later. 2 days after we took the pregnancy test I noticed I was bleeding. I called my OBGYN and they immediately started taking test, come to fine out I was have an Ectopic Pregnancy.

We were devistated because we trusted the research that was done on the Mirena IUD. Nowhere did it ever state that after the removal of the IUD that it can cause an Ectopic Pregnancy. We have two other children that were anticipating another sibling. 

The lawyers response was disgusting to say the least:

Ectopic pregnancies occur for a variety of reasons. One of the reasons is a disruption of the normal process such as an IUD or scar tissue as a result of an IUD. The second could be infection or scar tissue from an infection.Endometriosis and fibroid tumors can cause an ectopic pregnancy as well.

An ectopic pregnancy from the use of an IUD is a known risk although it is relatively low. Your risk of a subsequent ectopic pregnancy doubles once you have the first.

Very truly yours,

Paul D. Friedman, M.A., Ph.D., J.D.

Why thanks Paul, have you completely missed the question?She is not talking about whilst it was inserted, she is talking about AFTER it has been taken out! Yes the risks are well known when its IN but its not well documented about the effects when its taken OUT!

There was a follow up comment which I found particularly interesting which you can read here..

There is another site which has some ladies with interesting experiences with miscarriages and ectopic pregnancies after having an IUCD removed.You can read them here.

Jury is still out on this one if you ask me. Please let me know If you have come here because you have experienced an ectopic pregnancy after having an IUCD removed or you know of someone that has please let me know!

Thank you

Janey.

Side serving of Ectopic Pregnancy awareness anyone?

Im not a health professional, but I know a lot about my body. Im not going to be naive enough to say I know everything, but when you go through something like I have, you begin to understand that you can not trust in every health professional that comes your way either. I read these notes and articles and it scares me. It scares me a lot, because where is the awareness? They all mention a need for an increase in awareness for ectopic pregnancy with general practitioners, but what about the general public, what about every woman of child bearing age? How many women find themselves in an emergency department hours away from death only to be sent home with a diagnosis of gastroenteritis. The only reason I am alive today is because I grabbed my nurses arm, I looked her in the eye and I said, "This doesn't feel like a miscarriage okay, it feels like my bowel is twisted and I am about to explode!" I saw the light bulb switch on in her head and she then and only then called for the doctor. Its all here in black and white, mostly in general practitioner blogs, journals, articles and fundraiser forums but how many young girls who have just started having unprotected sex read these? How many women who have had abdominal surgery, or c sections or  treated for chlamydia are told that now they have an increase chance of ectopic pregnancy? 

 Ectopic pregnancy is about baby loss and it is horribly sad but I cant help but think that we aren't informed of just how deadly it is. It seems to be dealt with under the baby loss umbrella, which is not allowing women to identify with the mortality risk associated with this event.Don't get me wrong, I mourn for my baby that I lost but I also think about how close I came to losing everything and it didn't necessarily have to be that way, if I had been  informed and if the health practitioners who treated me had been properly educated in ectopic pregnancy it may have been a very different story.

Here are a few facts that every woman should know.
"Ectopic pregnancy is still the most common cause of first trimester maternal deaths, accounting for 73% of early pregnancy mortalities."

"Ectopic pregnancy was the fourth most common cause of maternal death in the most recent Confidential Enquiry into Maternal Deaths (CEMD) the United Kingdom 2000–2002; accounting for 11 out of 15 (73%) early pregnancy deaths.

In the last triennial report, the mortality rate for deaths from ectopic pregnancies had not declined since the previous triennial report, and was still an increase on the rates described 10 years ago. Two-thirds of women who died from ectopic pregnancy were misdiagnosed in primary care or ED settings."

Drife J, Lewis G. eds. Why mothers die. Triennial report 2000–2002.Confidential enquiries into maternal deaths. UK: RCOG, 2004.

Im sorry what? Two thirds of these women who died were misdiagnosed once they were treated by their health practitioners? They didn't faint on their couch, alone not knowing they were pregnant and bleeding out..blaming last nights vindaloo.... none the wiser....they were within the health system....right there amongst the thick of it...with all the resources needed to save their lives and the health system failed them!

"Performing qualitative urine dipstick testing for human chorionic gonadotrophin (hCG) with appropriate use of transvaginal ultrasound scan (TVS) on all women with unexplained abdominal pain certainly has cost implications, however this is one simple way to decrease death rates from ectopic pregnancy."

Drife J, Lewis G. eds. Why mothers die. Triennial report 2000–2002.
Confidential enquiries into maternal deaths. UK: RCOG, 2004.

Cost implications, I wonder how much it costs? In comparison to how much of our tax dollars go towards fixing "preventable" illnesses. A pregnancy test is surely a pitance I bought 40 sensitive tests off ebay for $8.00 (AU)!! I doubt if the results are negative that any patients would be followed up on with a transvaginal ultrasound anyway.This is where it would be getting costly.

Like I say if you have a positive pregnancy test result....

"Dont be suicidal, Get a transvaginal!"

"The IUCD is the only contraceptive method associated with increased risk after discontinuation of use."

Mol BW, Ankum WM, Bossuyt PM, Van der Veen F. Contraception and the risk of ectopic pregnancy. Contraception 1995;52:337–41.

13% of women in the world opt for an Intrauterine contraceptive device, how many of these women are screened for the likelihood of ectopic pregnancy prior to insertion. Without the knowledge that their chances increase whether or not they still have the device in when they fall pregnant??????

I could go on forever,the list is astounding. The only reason I have this knowledge, is because I trusted my health practitioners with my life and they nearly lost it so now I research and research and research.

 How many women and girls for that matter will lose their lives this year because they were not aware of the risk factors of an ectopic pregnancy, or will present at hospital with lower abdominal pain only to be sent home diagnosed with a stomach upset.

 I find it hard to sleep at night knowing this is happening all the time. I wonder how many women die and are pronounced dead via heart failure or organ failure with everyone neglecting to notice a foetus in their tubes. uhh........too scary!!

Please take the time to read this full article by George Condous.

We can not rely solely on the health system to stop women dying from this, we need to increase ectopic pregnancy awareness. The UK has a trust and an association and the US has a foundation, what does Australia have?


Think Pink

Janey

Did I have an ectopic pregnancy because of stress?

My husband and I held off from trying for a baby after we were married because  we had just done the noble thing for our family and decided to invest in our future well being. We got private health insurance. WOO HOO  Thats not true really, the main incentive for getting private health insurance is because we wanted to have a baby, but when I had spoken to all the new mums at our tiny mothers group on the island they all warned me against the maternity ward at the public hospital. DONT DO IT was the main consensus so I planned not to. AH...the luxury of planning!
We hadnt exactly planned our son, he was a lovely...surprise!
It was the summer of 2007, I was studying at university, living on 2 minute noodles and poached eggs and working at a local mens day spa as a remedial massage therapist. I was a heavy smoker and a sociable drinker when I could afford it that is.I had just split with my then boyfriend, I was hoping to feel free and ready to conquer the world, but instead I had constant stomach upset, bad bad bad crying bouts that lasted for hours, major mood swings (hence the breaking up in the first place) and chronic period pain with no period. Hmmm....had to fork out food money, $9.99 on a pregnancy stick that I knew was a waste when.....ah.....okay 2 red lines. That means Im not pregnant right?     right?? 
Then theres the whole frantic search for the box on the floor and the cup full of my own piss falls off the rim of the toilet onto my pants and the floor and a roommate bangs on the door wanting to use the toilet blahdy blahdy blahhhhh......freakin nightmare!

I was lucky I had a boyfriend who could understand that the pregnancy had made me go a little..I dont know...NUTS!

Three months after he was born, I had a copper IUD put in which was great to start with. No chemical contraception whilst breast feeding, and not having to stress about pregnancy! Bliss! 3 days after the wedding, I had my IUD yanked out, I say yanked because the doctor had to just about put her feet in stirrups and use her whole body weight to get this thing out. It hurt...like Alleluia I can see the white light a comin..hurt. My sister had warned me that it feels like a swift kick to the guts but it goes in a few seconds. Well...thanks for the heads up sis!  I actually screamed the "f" word...twice, I shook like a banshee and squeezed the nurses hand like I was popping out triplets in unison. Afterwards I had to do the walk of shame, back out to the reception desk and through the waiting room which was full of curious staring eyes. Im sure they were looking to see if I had just had a limb torn off or something. I gave the sweet lady behind the counter money and slowly hobbled out to the car where my husband and son greeted me in the carpark. Needless to say I wasnt feeling like the perky sexy newly wedded bride that I thought I would but oh well...now we could make babies....no wait hang on....private health doesnt cover obstetrics for 12 months!!!....so we had to wait 3 months before we could try. Ouch.....

So...newly married and back to using condoms!? YAY!! So unfair...so in three months I think we had sex twice!!
Then the date came up and it was all systems go....except as always..things popped up.  Everywhere, like a fungus. A mushroom farm of problems. Nothing major just little crops of them popping up on everything like mushrooms do.

My husband offered me a job, for 3 weeks with decent pay but there was a catch. I had to do 2 weeks training with the accountant and this guy is like a tall Kim Jong-il. Even looks like him a bit too. Two words sum him up....Nut Job!

 During this 5 weeks needed a baby sitter for my son, and it was also his 4th birthday so we invited both of his grandmothers up to stay.The overlap of them staying was his birthday party, so both mothers were in the house for 3 nights.

What was I thinking?

Super stressful environment, crazy stressful well...for an Australian anyway. This is when I fell pregnant, which has made me question if conceiving whilst stressed out results in more ectopic pregnancies.

Well....according to a study done in the United States at a hospital they observed pregnant resident doctors who worked in excess of 40 hours a week and compared them to their colleagues pregnant wives and there was no evidence that being stressed leads to any more complications in pregnancy. Amazing....and here I was blaming the stress.

I made the best cake for my son though, because all of our groceries travel such a long distance the supermarkets substitute items if what you order is out of stock. I ordered vanilla icing and received "royal icing" which I had never used before.What a rigmarole! But I think it looked great!!!

Think pink

Janey