One-year pregnancy and continuation rates after placement of levonorgestrel or copper intrauterine devices for emergency contraception: a randomized controlled trial

Recent evidence demonstrates the effectiveness of the levonorgestrel 52mg intrauterine device (IUD) for emergency contraception compared to the copper (Cu T380A) IUD. One-year pregnancy and continuation rates after IUD placement for emergency contraception remain understudied.(s): We compared one-year pregnancy and IUD continuation rates and reasons for discontinuation among emergency contraception users randomized to the levonorgestrel 52mg IUD or a copper IUD.This participant-masked, randomized noninferiority trial recruited emergency contraception clients desiring an IUD from six Utah family planning clinics between August 2016 and December 2019. We randomized participants 1:1 to the levonorgestrel 52 mg IUD or copper T380A IUD. Treatment allocation was revealed to participants at the one-month follow up. Trained personnel followed participants by phone, text, or email at five timepoints over one year and reviewed electronic health records for pregnancy and IUD continuation outcomes for both confirmation and for non-responders. We assessed reasons for discontinuation and used Cox Proportional Hazard Models, Kaplan-Meier estimates, and log-rank tests to assess differences in continuation and pregnancy rates between groups.The levonorgestrel and copper IUD groups included 327 and 328 participants receiving the respective interventions. By intention-to-treat analysis at one year, pregnancy rates were similar between IUD types (9/327 (2.8%) levonorgestrel 52mg IUD vs 10/328 (3.0%) copper IUD (RR 0.9, 95% CI 0.4-2.2, p=0.82)). The majority of pregnancies occurred in participants after IUD removal, with only 1 device failure in each group. One-year continuation rates did not differ between groups with 204/327 (62.4%) of levonorgestrel 52mg IUD users and 183/328 (55.8%) of Cu T380A IUD users continuing IUD use at one year (RR 1.1, 95% CI 1.0-1.2, p=0.09). There were differences with regards for reasons for discontinuation between IUD types, with more bleeding and cramping cited among copper IUD users.(s): Pregnancy rates were low and similar between IUD types. Six in ten IUD emergency contraception users continued use at one year. One-year continuation rates were similar between IUD types.