The use of Intrauterine Devices (IUD) has increased in recent years. Used correctly, the failure rate for IUD is less than 1%. If a patient gets pregnant with IUD in place, the risk of adverse outcomes like spontaneous abortion and preterm birth increases many-fold.
WHO advises removal of IUD at the earliest gestational age possible if strings are visible on vaginal examination. If strings are not visible there are 3 ways to manage a case of IUD with pregnancy:
Expectant management
Removal with a grasper under ultrasound guidance
Removal under hysteroscopic visualization
Here is a recent video-article published in December issue of Journal Fertility and Sterility, showing step by step procedure of hysteroscopic removal of IUD in 4 patients. In all four cases, the strings were not visible during a vaginal examination. After removal of IUD, all patients had uneventful live term delivery.
All patients were informed about the risk of the procedure, although negligible–– including rupture of gestation sac and pregnancy loss, consent obtained, viability and location of IUD confirmed by pre-op ultrasound and prophylactic antibiotics given. The actual procedure includes:
Vaginoscopic hysteroscopy
IUD localization with or without imaging guidance
Removal of the IUD with the help of hysteroscopic grasper
The key is to use slender hysteroscope and use the minimal amount of distention media. The method is safe with minimum procedure-related complications and > 90% ongoing pregnancy rate.
Here is the American Society for Reproductive Medicine (ASRM) video showing step by step procedure of hysteroscopic removal of IUD in 4 patients.
