History of the IUD

Birth control has a diverse, often gendered history that emphasizes contraception created for the female anatomy. There are many birth control options available for those with a uterus, though stark options for those without. Some options for female birth control are the birth control pill, a birth control shot, a vaginal ring, and a birth control patch, to name a few. An IUD, otherwise known as Intrauterine Device, is a tiny device put into your uterus to prevent pregnancy. It’s long-term, reversible, and one of the most effective birth control methods out there. The history of the IUD is an interesting one. Before the 20th Century, there was no clear evidence of the insertion of foreign objects into the uterus to act as contraception. The first documentation of the idea came in 1909 when Dr. Richard Richter reported on his insertions of a ring made of silkworm gut into the uterus. He cut off the two ends at the level of the outside of the cervix to make checking and removal easier. Unfortunately for Dr. Ritcher, his idea was not credited and was later copied in the mid-1920s by Karl Prust and Ernest Graefenberg. The two produced early versions of the IUD similar to that of Ritcher’s. Prust recommended a silkworm ring placed in the uterus with a stiff cervical extension of a tightly wound thread and a glass button to cover the cervix; Graefenberg created his version of the IUD in Germany. First, he took the wings off of the silkworm ring in order to prevent infections. After that, he used an x-ray machine to identify the position of the ring in the uterus and attached a silver wire to it. The pregnancy rate of this device was reported to be 3%. 

Dr. Graefenberg moved to develop his model of the IUD further and decided to wrap his device entirely in silver. This plan backfired on him as the women’s bodies absorbed the silver surrounding the IUD, and they developed gingival argyrosis in which their gums turned a bluish-black color. After this incident, Graefenberg tried using “German Silver” wire, made from an alloy of a mix of metals. This was the first IUD that included copper in the mix, a metal that later became popular in more modern versions of the IUD. The German silver IUD had a pregnancy rate of 1.6%. This ring was used in England and across the British empire but was never adopted by the US or women in continental Europe. The tail end of the 1930s saw the start of WWII, and with this came a decline in research surrounding contraception such as the IUD. Germany forbade any contraception (including condoms) during the war. This led to Dr. Mary Halton inventing yet another IUD that utilized silkworm gut in the 1950s. She would wrap it around her finger and then press the ring into a gelatin capsule. She then inserted this into the uterus, where the gelatin liquefied and spread the thread. For this iteration of the device, the pregnancy rate was its lowest ever at 1.1%. 

Regardless of the previous version’s effectiveness, doctors continued to improve upon the hot new form of birth control. Dr. Lazar Margulies created the first coiled version of the device in 1960 made of polyethylene and his first patient was his wife!  Part of Dr. Margulies purpose with this device to was overcome the fear of infection that most IUDs with tails had instilled in women. This concern was resolved by having the end of the device protrude through the cervix. He reported his findings to multiple other doctors so they could review his work. After him, more doctors made their versions of the IUD, with 1969 being one of the biggest years for the device. Dr. Howard Tatum was the first doctor who tried to decrease the size of the IUD after women were reporting an increase in cramps and bleeding. Tatum devised a simple plastic “T,” which was well-tolerated but had a pregnancy rate of 18%. That same year, Dr. Jaime Zipper in Chile discovered that putting a copper wire in one horn of the uterus of a rabbit protected that somewhat isolated horn from pregnancy while it did not protect the other horn. Thus, the contraceptive effect of intrauterine copper was discovered, revolutionizing IUD effectiveness. The following year, Dr, Antonio Scommegna devised a T-shaped device with the hormone progesterone in a semi-permeable capsule. It was one of the most popular IUDs on the market until the early 2000s. 

The IUD is still a prevalent form of birth control in the modern day. Five different IUD brands are FDA approved for use in the United States: Paragard, Mirena, Kyleena, Liletta, and Skyla. These IUDs are divided into two types: copper IUDs (Paragard) and hormonal IUDs (Mirena, Kyleena, Liletta, and Skyla). Birth control is continuing to evolve in America and as I noted before there are a lot of other birth control options available for women. It’s unfortunate that the industry is so gendered and there has been recent discourse in the media surrounding the creation of male birth control. As of Jan 20th, 2022 The University of Utah has been testing a new hormonal birth control gel for men; “the scientists believe the hormonal gel decreases a man’s sperm production––reducing his chances of fathering a child––without decreasing his sex drive.” I think the future of birth control is male contraception, as it’s only fair that the traditional female narrative starts to change. 

By Alyssa Morterud