Preventing infection related to insertion of an intrauterine device.

A study was undertaken to determine whether pelvic inflammatory disease (PID) resulting from the insertion of an intrauterine device (IUD) could be eliminated by inserting the IUD during ovulation and administering prophylactic antibiotics to cover insertion. IUDs, 95% of which were Progestaserts, were inserted within two days of probable ovulation in 288 patients. These study patients were compared with a matched control group of 288 patients not using IUDs. None of the 288 IUD patients (totaling 619 woman-years of IUD use) developed PID after insertion, and only 0.5% per 100 woman-years developed PID later. The incidence of PID seen in these patients was less than that observed in the control group. It was also less than that in the general population or that following legal induced abortion. The expulsion rate of 1% per 100 woman-years in our patients is the lowest ever reported. It probably is related to the low motility of the uterus and expansion of the cervix during ovulation; the latter facilitates insertion during ovulation.