Editing Copper IUD (section)

== History ==
Precursors to IUDs were first reported in the early 1900s. Developed from stem or wishbone [[pessary|pessaries]], which were made of firm rubber or metal and had an anchor in the cervix, the stem on these devices extended into the uterine cavity. They were associated with high rates of genital tract infection, especially [[gonorrhea]], and were not widely adopted.<ref name=":5">{{cite journal | vauthors = Margulies L | title = History of intrauterine devices | journal = Bulletin of the New York Academy of Medicine | volume = 51 | issue = 5 | pages = 662–667 | date = May 1975 | pmid = 1093589 | pmc = 1749527 }}</ref>

The first intrauterine device to be contained entirely within the uterus was described in a [[Germany|German]] publication in 1909 by Richard Richter, who reported a ring-shaped device made of silk sutures with two ends protruding from the [[Cervical canal|external os]] of the cervix for removal. A similar design was reported by Karl Pust, who wound the free ends of the suture tightly and attached them to a glass disc, which covered the external os. Ersatz versions were made using silk suture wrapped into a ring and embedded in a gelatin capsule, which was inserted into the uterus, where the gelatin dissolved.<ref name=":5" />

In 1929, [[Ernst Gräfenberg]] of Germany published a report on an IUD made of silk sutures ([[Gräfenberg's ring]]), initially with a small amount of silver wire attached for visualization on x-ray, and then completely covered in silver wire. Because the silver was absorbed systemically and deposited in other tissues, causing a discoloration known as [[argyria]], the device was then recreated with an [[alloy]] of copper, nickel, and zinc (then called [[Nickel silver|German silver]], also known as nickel silver). It was widely used in the UK and the [[Commonwealth of Nations|Commonwealth]], but discouraged from use in the US and Europe due to the perceived risk of infection, cancer, and inefficacy.<ref>{{cite journal | vauthors = Baldauf P, Tönnes R, Simon S, David M | title = A Report on the Hysteroscopic Removal of a Gräfenberg Ring After Almost Fifty Years in Utero | journal = Geburtshilfe und Frauenheilkunde | volume = 74 | issue = 11 | pages = 1023–1025 | date = November 2014 | pmid = 25484377 | pmc = 4245252 | doi = 10.1055/s-0034-1383130 }}</ref><ref name=":5" />

In 1934, Japanese physician [[Tenrei Ōta]] developed a variation of Gräfenberg's ring that contained a supportive structure in the center. The addition of this central disc lowered the IUD's expulsion rate and increased the surface area. Though his research was hampered by the fascist government's stance against contraception and his need to spend time in hiding, after World War II he returned to the development of IUDs. Gold and silver, which had been used by Gräfenberg, were in very short supply in post-war Japan, which led Ōta to other metals, silk, and nylon. By the end of the 1950s, there were 32 different frame shapes used in Japan, and larger studies showed no connection between these devices and development of [[endometrial cancer]], which had been a theoretical concern due to the inflammatory properties of metals in the uterus. Ōta's devices were used in Japan until the 1980s.<ref>{{Cite web |title=Muvs - Tenrei Ota (1900-1985) |url=https://muvs.org/en/topics/pioneers/tenrei-ota-1900-1985-en/ |access-date=2025-02-02 |website=muvs.org |language=en}}</ref><ref name=":5" />

The first plastic device was developed by [[Lazar C. Margulies|Lazar Margulies]] and first trialed in 1959; it was made of a polyethylene ring filled with a radiopaque solution. The appearance gave rise to the colloquial term "coil", which persists despite the change in appearance of modern IUDs. Due to its size (6&nbsp;mm), the cervix had to be dilated prior to insertion, it was poorly tolerated, and the device was prone to expulsion. Margulies modified it to add a beaded tail in 1962.<ref name=":7" /><ref name=":5" />

The Lippes Loop, a slightly smaller plastic device with a monofilament tail, was introduced in 1962 and gained in popularity over the Margulies device.<ref name="slides">{{Cite web | vauthors = Lynch CM |title=History of the IUD |url=http://www.contraceptiononline.org/meetings/IUD/lynch/presentation_text.cfm?cme_activityid=47&showmenu=1 |url-status=dead |archive-url=https://web.archive.org/web/20060127085615/http://www.contraceptiononline.org/meetings/IUD/lynch/presentation_text.cfm?cme_activityid=47&showmenu=1 |archive-date=January 27, 2006 |access-date=July 9, 2006 |website=Contraception Online |publisher=Baylor College of Medicine}}</ref>

Stainless steel was introduced as an alternative to the copper-nickel-zinc alloy in the 1960s and 70s,<ref name=":5" /> and was subsequently widely used in China because of low manufacturing costs. The Chinese government banned production of steel IUDs in 1993 due to high failure rates (up to 10% per year).<ref name="Treiman 1995" /><ref>{{cite journal | vauthors = Kaufman J | title = The cost of IUD failure in China | journal = Studies in Family Planning | volume = 24 | issue = 3 | pages = 194–196 | date = May–Jun 1993 | pmid = 8351700 | doi = 10.2307/2939234 | jstor = 2939234 }}</ref>

American obstetrician [[Howard Tatum]] conceived the plastic T-shaped IUD in 1967,<ref name=":32">{{Cite journal |date=April 2013 |title=Advancing long-acting reversible contraception |url=https://link.gale.com/apps/doc/A328532694/ITOF |journal=[[Population Council|Population Briefs]] |volume=19 |issue=1}}</ref> but its high failure rate (approximately 18%) made it nonviable.<ref name=":5" /><ref>{{Cite web | vauthors = Corbett M |date=March 20, 2024 |title=A History: The IUD |url=https://www.reproductiveaccess.org/2024/03/a-history-the-iud/ |access-date=February 1, 2025 |website=[[Reproductive Health Access Project]] |language=en-US}}</ref> Shortly thereafter [[Jaime Zipper]], a Chilean doctor, discovered that the nickel silver alloy had spermicidal properties due to its copper percentage, and added a copper sheath to the plastic T, bringing the failure rate to approximately 1%.<ref name=":5" /><ref name="slides" /><ref>{{Cite web | vauthors = Van Kets HE |year=1997 | veditors = Capdevila CC, Cortit LI, Creatsas G |title=Importance of intrauterine contraception |url=http://www.contrel.be/IUD%20GENERAL/Mhistory.htm |url-status=dead |archive-url=https://web.archive.org/web/20060810052406/http://www.contrel.be/IUD%20GENERAL/Mhistory.htm |archive-date=August 10, 2006 |access-date=July 9, 2006 |website=Contraception Today, Proceedings of the 4th Congress of the European Society of Contraception |publisher=The Parthenon Publishing Group |pages=112–116}} (Has pictures of many IUD designs, both historic and modern.)</ref> It was found that copper-containing devices could be made in smaller sizes without compromising effectiveness, resulting in fewer side effects such as pain and bleeding.<ref name="Treiman 1995" /> T-shaped devices had lower rates of expulsion due to their greater similarity to the shape of the uterus.<ref name="salem 2006">{{Cite journal | vauthors = Salem R |date=February 2006 |title=New Attention to the IUD: Expanding Women's Contraceptive Options To Meet Their Needs |url=http://www.infoforhealth.org/pr/b7/chap1.shtml#outdated |url-status=live |journal=Popul Rep B |issue=7 |archive-url=https://web.archive.org/web/20071013110643/http://www.infoforhealth.org/pr/b7/chap1.shtml#outdated |archive-date=October 13, 2007}}</ref>

Tatum developed many different models of the copper IUD. He created the TCu{{Nbsp}}220{{Nbsp}}C, which had copper collars as opposed to a copper filament, which prevented metal loss and increased the lifespan of the device. Second generation copper-T IUDs were also introduced in the 1970s. These devices had higher surface areas of copper, and for the first time consistently achieved effectiveness rates of greater than 99%.<ref name="Treiman 1995" /> The final model developed by Tatum, the TCu{{nbsp}}380A, was approved by the US FDA in 1984 and is the most recommended model today.<ref name=Kulier2008 /><ref name="Corbett">{{cite web |vauthors=Corbett M, Bautista B |title=A History: The IUD |website=Reproductive Health Access Project |date=20 March 2024 |url=https://www.reproductiveaccess.org/2024/03/a-history-the-iud/ |access-date=11 March 2025}}</ref>