Intrauterine device use, sexually transmitted infections, and fertility: a prospective cohort study

Background In the 1970s, numerous medical reports, media coverage, and litigation around Dalkon Shield intrauterine device led to a perception that all devices cause upper genital tract infection infertility. Objective This study aimed assess association between use time conception. Study Design The Fertility After Contraceptive Termination is multicenter, prospective cohort of women stopping their contraceptive method attempt We recruited participants 2011 2017. Participants were convenience sample from academic centers in Philadelphia, PA; Los Angeles, CA; St. Louis, MO; Indianapolis, IN; Aurora, CO; Salt Lake City, UT. Women eligible if they stopped within past 120 days before enrollment, 18 35 years age, had no history infertility or sterilization, at least 6 months follow-up. Baseline data included demographic reproductive characteristics, use, nucleic acid amplification testing for sexually transmitted infections, serology with Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium. primary exposure was (ever); outcome All observed longitudinally up 24 months. used piecewise exponential proportional hazards models multiple imputation provide hazard ratios respective 95% confidence intervals. Results Of 461 participants, mean age 28.2 years, 178 (38.7%) Black, 157 (34.1%) considered as low socioeconomic status, 275 (59.7%) use. Without adjusting any covariates, median conception shorter who (5.1 months) than never an (7.5 months). controlling potential confounders, not statistically significant (adjusted ratio, 1.25; interval, 0.99–1.58). our multivariable model, nulligravidity, Black race, genitalium associated longer times (hazard 0.76; 0.58–0.99). Conception by 12 lower (68% vs 80% without infection; P=.019). Conclusion found impairment fertility ever device. Serologic evidence higher rates modifiable