Intra Uterine Delivery Systems

Oral contraceptive pills lead to systemic contraceptive activities = Ideal method of fertility control IUD systems provide localized therapeutic activities in the uterine cavity for a prolonged period.

Mechanism of action of Non-medicated IUD

The foreign body inside the uterus irritates the lining and wall making it hard for an embryo to implant.

Medicated IUDs
Serve as carriers or vehicles for pharmacologicallly effective anti-fertility agents, such as The Copper bearing IUD (anti fertility) The progesterone releasing IUD In addition to anti-fertility agents, some anti-fibrinolytic agents such as aminocaproic acid and tranexamic acid were also incorporated in these systems to minimize the incidence of pain and bleeding.

 Copper IUDs work by impairing the mobility of sperm and preventing them from joining with an egg. Additionally, the foreign body inside the uterus irritates the lining and wall making it hard for an embryo to implant.

CU-IUD
CU-IUD develop a corrosion layer and encrustation layer over the surface of the copper wire. Corrosion layer composed of protein is imp in release of cupric ions Encrustation layer which is developed over corrosion layer predominantly made up of calcium retards release of copper ions. The formation of encrustation layer can be prevented or reduced by coating of copper wire with polymeric membrane such as collodion

Intrauterine Devices (IUDs) The most common adverse effects reported with the copper IUD are abnormal bleeding and pain. Some women may experience hormone-related effects, such as headaches, nausea, breast tenderness, depression, and cyst formation, with the levonorgestrel intrauterine system. Overall, complications with IUDs are uncommon and mainly include expulsion, method failure, and perforation. A pregnancy conceived with a levonorgestrel intrauterine system that is retained raises the theoretic concern of the effect of fetal exposure to hormones.

Conventional non medicated IUDs

Mechanical effect on the endometrium is responsible for the prevention of pregnancy by these devices. Dependant on the size and surface area of the IUD. The greater the contact area with endometrial surface more effective is the contraception. Drawback: Larger IUDs provoked bleeding, cramping and frequent expulsion due to irritation.

Medicated IUDs
Serve as carriers or vehicles for pharmacologicallly effective anti-fertility agents, such as The Copper bearing IUD (anti fertility) The progesterone releasing IUD In addition to anti-fertility agents, some antifibrinolytic agents such as aminocaproic acid and tranexamic acid were also incorporated in these systems to minimize the incidence of pain and bleeding.

 Ideal shape and size of IUDs = T Conforming to the shape and size of the endometrial cavity. Also T shape IUD caused nearly 1/5th the incidence of pain and bleeding compared to conventional Lippes loop D. Low incidence of expulsion due to restricted movement of T shaped device.

Copper- bearing IUDs

Copper possess cytotoxic activity if present in sufficiently high concentration. Enhances the spermatocidal as well as spermatodepressive action of non-medicated IUD. It is competitive inhibitor of steroidal hormone receptor interaction by

acting on receptor sites.

It is blastocystocidal. Lysosomes of the blastocyst incorporate the copper , releasing

lysosomal enzymes and causing cellular autolysis and eventually death.

 Combination of ionization and chelation Ensures continous release of copper from copper bearing IUD. Daily copper dose is 9.87 ug/day Shows constant release profile (Q vs t)

CU T-200 with surface area of 200cm2 produced maximum anti-fertility efficacy