DEVELOPMENT IN INTRAUTERINE DEVICES ( IUD )

1
DEVELOPMENT IN INTRAUTERINE DEVICES ( IUD )
Presented BY AHMAD NOOR, PHARM.D AHMED
ALTAYAR, PHARM.D
2
Lecture outlines

• What is the IUD ?how does it work ?
• The types of IUDs
• Advantages disadvantages
• History development of IUDs
• The most IUDs used today
• Insertion of the IUDs

3

• Introduction
• At the beginning as you know it is a happiness
  for every parents to have a baby , but in the
  same time it is very important to put in mind all
  other factors that may effect the family life
  either health , economical or even social
  problems ,which increase in cases of a large and
  uncontrolled number of family members , from this
  point of view the need for a way to control the
  number of birth was established , to improve the
  population life-style
• Our responsibility as pharmacists appear in
  development and searching for different
  techniques to control pregnancy ,and we will
  talk today about one of this ways and its
  development

4
What is an ( IUD ) ?

• It is a small, flexible, plastic device that
  contains either metal e.g. copper or hormones
  e.g. progesterone and is inserted into the uterus
  to prevent pregnancy.

5
How dose it work ?

• It may
• -Block sperm from reaching or fertilizing the egg
• -Make the lining of the uterus unsuitable for
  implantation .
• -interfere with the ovulation process
• We do not know which of these actions is most
  important for preventing pregnancy and most
  likely all of them work together.

6
(No Transcript)
7
Types of ( IUD ) There are two main categories
of IUDs

• 1. Medicated  These forms of IUD use hormones or
  metals to prevent conception. progesterone and
  Copper plated IUDs are considered medicated
  because they have abilities to hinder
  fertilization.
• 2. Non Medicated  This category includes all
  other forms of IUD no matter shape or size.

8
Advantages and the Disadvantages of ( IUD )

• Advantages
• - Once inserted , remain in place .
• - Remains effective while in place.
• - it prevents pregnancy for long period
• - does not interfere with sexual activity.
• Disadvantages
• - May cause bleeding and cramping .
• - Increased risk of octopic pregnancy.
• - Doesn't prevent sexual transmitted diseases.
• - it is not recommended for women who have heavy
  or long period

9
What is the history of (IUD) ?
- Camel riders in the Middle East are the first
recorded users of the IUD or Intrauterine
Device.  It was common knowledge that if you
placed small stones in the uterus of your camel,
it would not become pregnant even during its
periods of high sexual activity .
10
Hippocrates, the original Greek doctor, also
wrote small piece that could be put into the
uterus of a woman with the help of a small tube
can prevent pregnancy .In 1909 a German
physician named Richard Richter began to build
IUDs from small bronze rings and silk thread. 
Richter, as well as many other doctors versions
of the IUD was too large for widespread use and
caused painful infections.
11
In 1930, Ernest Grafenberg improved Richter's
idea  making the contraptions smaller, avoiding
most infections and making the device more
comfortable. By the early 1960s many other
forms/designs of IUD were invented and were
constructed of safer materials . - Since 1998
worldwide, several new intrauterine devices
(IUDs) are under development or in the early
marketing phase.
12

• These new devices contain various modifications
  designed to improve patient continuation and
  physician satisfaction. Modifications include
  those designed to facilitate easier insertion and
  removal, decrease the rates of accidental
  expulsion, and reduce complaints of pain or
  bleeding

13
a. Lippes-Loopb. Saf-T-Coilc. Dana-Super   
Dana cuprumd. Copper-Te. Copper-7 f.
Multiloadg. Progesterone IUD
14
(No Transcript)
15
(No Transcript)
16
What are the most cu ( IUD ) used today ?
Today two types of cu IUD are used mostly
Multiload (left) and cupper T (right)
17

• What is the hormonal (IUD) used today?
• Late last year the FDA approved the intrauterine
  device (IUD) Mirena. Mirena is a T-shaped that
  releases small amounts of the hormone
  (levonorgestrel) to block conception, Mirena only
  needs to be replaced once every five years. The
  others, in contrast, must be changed yearly.
• A new IUD available in Europe US uses a
  synthetic hormone to achieve a high rate of
  long-acting contraception.

18
(No Transcript)
19
WHAT ARE THE NEW DEVELOPMENT IN ( IUD ) ?

• Developers are designing devices to address the
  disadvantages issue by modifying IUD size, shape,
  and flexibility.
• At least six new devices are under development,
  or have recently been introduced, outside the US.
• These devices include

20
ICFD Gynefix Multiload mark 2 Soft-T Fincoid350 Cu safe 300
21

• CuSafe 300The CuSafe 300 is a T-shaped copper
  IUD with flexible, uniquely shaped arms.
• Both ends of the device's transverse arms curve
  inward to reduce uterine tissue irritation. In
  addition, its mono filament tail is welded into
  the shaft, instead of knotted, to reduce
  ectocervical abrasion
• device's flexible design facilitate easier ,less
  painful insertion and removal, aslo the curved
  "fundal-seeking" arms resist expulsion.
• carries a recommended life span of 5 years.
• Advantages in comparison to copper T 380A IUD
• the inserter is about one third smaller than that
  of the copper T 380A IUD.
• These improvements should make the CuSafe 300
  easy to insert and remove.
• pain and bleeding occurred significantly less
  frequently among CuSafe IUD users, also the
  CuSafe had low and statistically significant
  decrease rates of pregnancy and expulsion

22

• Fincoid-350
• The Fincoid-350, devised in Finland, is also
  designed to resist accidental expulsion.
• The IUD has a plastic skeleton comprised of two
  parts curved horizontal arms, and a copper
  coated vertical stem. The resultant movable joint
  easily constricts and expands with uterine
  contractions, adjusting to variations in uterine
  size and shape. The Fincoid-350 comes in two
  sizes standard and short.

23

• Sof-T
• The Sof-T, manufactured and approved for use only
  in Switzerland, is a copper IUD with a unique
  shape to enhance effectiveness. The device has
  soft, flexible knobs, or occlusion bodies, on
  each end of its flexible transverse arms. These
  knobs theoretically block the entrances into the
  fallopian tubes.Two dimensional ultrasound must
  be used for insertion , however, to ensure exact
  placement of the device. The device's potential
  ability to occlude the fallopian tubes could, in
  theory, reduce the incidence of tubal infection
  and ectopic pregnancy.On the other hand, the
  knobs may incompletely block the fallopian tubes
  and result in higher rates of ectopic
  pregnancy.About 1,200 women currently wear the
  device. Limited data indicate that the annual
  expulsion rate ranges between 0.3 and 3.5,
  removals for pain or bleeding range from 0 to
  1.4

24

• Multiload Mark II
• The Multiload Mark II is an updated version of
  the original Multiload 375 (ML 375).
• The original device has a record of
  dependability, with low patient cessation rates
  due to pregnancy, expulsion or bleeding and pain.
  The ML 375 has been associated with problematic
  insertions, however, because its arms do not fit
  into the inserter the arms are open during
  insertion, making placement more difficult.the
  new inserter's diameter is smaller than the
  original model.
• In addition, the inserter has three other
  improvements its design prevents the IUD from
  getting pushed beyond the inserter it can
  function as a uterine sound and it has a one
  handed expulsion action.
• These innovations may help limit the risk of
  uterine perforation.

25

• GyneFix
• The GyneFix, a "frameless" IUD, consists of six 5
  mm copper sleeves. This device was originally
  called the Cu-Fix 390, then later the FlexiGard
  330.
• The device has undergone 10 years of testing and
  several modifications to its inserter and
  anchoring mechanisms. The upper and lower copper
  sleeves are crimped onto the suture thread to
  prevent slippage.
• The proximal end of the suture contains a knot
  that is pierced 1 cm into the fundal myometrium
  to anchor the device into the uterine muscle.
• Variations of the device for postpartum use
  include a larger knot and a cone shaped
  biodegradable tip that help anchor it securely.

26

• Due to its frameless design, flexibility, and
  minimal presence in the uterine cavity, the
  GyneFix is associated with few expulsions. In
  addition, the device has a high continuation rate
  at 1 year (90) due to few removals for
  complaints of bleeding or pain.Effectiveness
  depends upon proper insertion technique because
  the device must be securely anchored into the
  uterine myometrium or it will be expelled.In
  addition, the device has very low expulsion rates
  among nulliparous women.

27

• Intracervical Fixing Device (ICFD)
• The intracervical fixing device differs
  substantially in both construction and placement
  from other IUDs.
• The device consists of a rod shaped, copper
  coated polyethylene frame that is about 4 cm long
  with a 5 mm projection at the distal end. Through
  this projection, the ICFD is anchored (fixed) to
  the inner cervical wall using a modified
  tenaculum. Investigators believe the ICFD's
  anchoring mechanism could be improved.
• Better anchoring mechanisms could help to prevent
  expulsions. One potential advantage of the device
  is that the insertion procedure is not blind. In
  addition, because of the intracervical location,
  the device will likely be associated with less
  spotting, bleeding and pain.

28

• Conclusion
• Developers are designing new IUDs with
  modifications to help enhance patient and
  physician acceptance.
• Modifications to the devices aim to decrease
  removals due to pain and bleeding, make insertion
  and removal easier, and limit the risk of
  expulsion and prolong the life span of the device
  .

29
HOW TO INSERT ( IUD )?
30

• THANKS FOR YOUR ATTENTION!!

• Presented by
• AHMAD NOOR, PHARM.D
• AHMED ALTAYAR, PHARM.D