QuestionQUESTION: I am 18 and have a 13month old son who was delivered via scheduled c-section. I was diagnosed with uterine didelphys 3years ago (complete uterine,cervical and vaginal septums). I have been on birth control (YAZ) for 11months now. My insurance runs out in about 3months when i turn 19 and i will not be able to afford the pills or Dr. visits to get the prescriptions. Also women in my family seem to have a high failure rate with birth control pills of any kind, sex is almost impossible for me because of my intense fear of the method failing and becoming pregnant again. I am highly allergic to latex and do not trust polyurethane as that is how i now have my son. I have done alot of research into IUD's and have found a few cases where it is possible and has been done with uterine anomalies such as mine (one is placed in each uterine horn). Despite my risk factors of an incompetent cervix, pregnancy and/or conception issues i have never had a miscarriage, my son was not breach nor did i encounter any pre-term labor which to me proves my cervix is strong and not likely to expel the IUD also that despite everything, my reproductive system seems to work normally. My question is do you think it is possible/recommended i pursue getting an IUD? I would like to gather as much info as possible before actually proposing the idea to my OB/GYN. Thank you so much in advance
ANSWER: Dear Patricia,
Here are the general contraindications to IUD placement:
- Pregnancy
- History or presence of acute PID in the past three months
- Patient (or partner) with multiple sexual partners
- Postpartum or postabortion endometritis in the past three months
- Uterine abnormalities resulting in anatomic distortion*
- Uterine or cervical malignancy, including unresolved, abnormal Pap smear
- Genital bleeding of unknown etiology (cause)
- Untreated vaginitis or cervicitis, including bacterial vaginosis
- Previously inserted IUD still in place
- Genital actinomycosis
- Conditions or treatments associated with increased susceptibility to infection with microorganisms (leukemia, type 1 diabetes mellitus, intravenous drug use, AIDS)
- Previous ectopic pregnancy
- STD
- Pelvic surgery
- Postpartum or postabortion incomplete involution of uterus
- Wilson's disease
- Known allergy to copper
- Uterus measuring <6cm or >10cm by ultrasound*
I have put an asterisk by the two contraindications which most specifically relate to you. I would suspect that your doctor will not consider an IUD in your case. You can inquire, but that would be my initial thought.
Because of your particular situation, you might want to ask your doctor about Implanon, which is an implant that goes beneath your skin. Not all doctors can perform the procedure, but I believe the Implanon website can assist in finding doctors who are qualified. It is considered to be effective for about three years. You also will need to become really educated about your cycles to help in minimizing your chances of pregnancy. If you have regular 28 day cycles, it will be fairly easy for you to be able to predict when you are about to ovulate each month and are therefore fertile. If you are regular but your cycle lengths are 29, 30, 34 days or whatever, you will need to calculate and keep track. Typically, a woman ovulates 14 days prior to the beginning of her next period starting. So, the week leading up to, day of, and day or two after suspected ovulation are the MOST fertile days of the cycle.
I hope this has helped you and answered your question. I wish you well.
Brenda
---------- FOLLOW-UP ----------
QUESTION: I am very aware that my anomaly is a contradiction to an IUD. The reason i asked is because as i said before, i found articles (from quite reparable sites) where it has been successfully done. Also i do know from ultrasounds that my uterus measures 8cm. Can the Implanon be compared to Norimplant? I know they took that off the market a few years ago. Thank you so much for your reply though, i will definitely look into the alternative you suggested.
AnswerDear Patricia,
If you feel the sites are reputable, then I would suggest printing out the information and taking it to your personal OB doctor to look over and research on his/her own. Again, it is all about what your own doctor, or others if you choose to seek other opinions, will feel comfortable doing. If an IUD would be placed in each uterine horn, then I would suspect the measurement of each horn would need to be > 6 cm. If the uterine measurement as a whole is 8 cm, I'd question whether the space in each uterine horn might be too small. But again - it would be about your doctor's judgement in the end, so that would be the person to convince. :-)
Implanon is similar to Norplant, but not the same. Norplant was a six-capsule system implanted under the skin containing a hormone (a progestin) called levonorgestrel that was effective for up to five years. Each capsule contained 36mg of the levonorgestrel. Implanon is a one-capsule implant containing 68mg of a progestin called etonogestrel that is effective for up to three years (approved by the U.S. FDA in July 2006). Also - it really is important to know that the majority of those Norplant lawsuits that settled out of court were about attorneys who claimed in the massive class action that women were not adequately informed of side effects such as headaches, irregular menstrual bleeding, nausea and depression (which would be possible with any hormonal therapy). In, I believe, 2002 a Federal judge actually threw out the remainder of the claims that had not already settled. It was actually the pharmaceutical company that manufactures Norplant who decided not to market in the U.S. any longer after 2002. I encourage you to research both Norplant and Implanon to confirm the information and come to your own conclusions.
I hope this has helped. Be well.
Brenda
