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January 12, 1990

Intrauterine Devices-Reply

Author Affiliations

Americal Medical Association Chicago, Ill

Americal Medical Association Chicago, Ill

JAMA. 1990;263(2):236. doi:10.1001/jama.1990.03440020069027

In Reply.—  Both Drs Mishell and Alvarez-Sanchez emphasize the effects that IUDs may have on the reproductive processes that occur outside the body of the uterus.As mentioned in the article, spermatozoa do decrease in number, at least with copper IUDs. How significant this is or what relative proportion of contraception is due to a spermicidal effect of IUDs is still under investigation.1-3 The recent report by Dr Alvarez-Sanchez and colleagues4 suggests that IUDs somehow affect the number and transport of unfertilized ova, resulting in fewer ova being present in the fallopian tube. They also found that among 14 IUD users who had intercourse during their fertile period and who had evidence of spermatozoa in the cervical mucus, no fertilized ova were recovered. This may be due to either spermatozoa not reaching the oocyte or the oocyte being damaged by an adverse tubal environment.Whether the inflammatory reaction