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Intrauterine Devices

Daniel R. Mishell Jr, MD
JAMA. 1990;263(2):235-236. doi:10.1001/jama.1990.03440020069025.
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To the Editor.—  I read with interest the article on intrauterine devices (IUDs) in the Questions and Answers section of The Journal.1 In general, the article is very well written and the conclusions are valid. The portion of the article that I disagree with is the paragraph dealing with the mechanism of action of the copper-containing IUDs, which states that the foreign-body reaction reduces implantability and therefore fertility.1(p2128)There is a great body of evidence that indicates that the mechanism of action of IUDs in general, as well as the copper-bearing IUDs specifically, is to prevent fertilization by acting as a spermicide. Sagiroglu and Sagiroglu2 showed that sperm were being phagocytized by white blood cells within the uterine cavity in women wearing IUDs. The IUDs exert a foreign-body reaction, inducing migration of white blood cells in large numbers to the endometrial cavity. These leukocytes phagocytize sperm, and


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