Polished but pointless? Assessing the potential of gold and silver-alloy IUDs versus copper-only devices in a large multinational cohort (EURAS-LCS12).

BACKGROUND Some copper intrauterine devices (IUDs) contain gold or silver to enhance durability, ultrasound visibility, and reduce infection risk, though evidence thereof is limited.

OBJECTIVE To evaluate potential benefits of copper-gold and copper-silver alloys over copper-only IUDs regarding the occurrence of product technical complaints (PTC), pelvic inflammatory disease (PID), and unintended pregnancy.

METHODS This exploratory analysis used data from the ongoing EURAS-LCS12 study, comparing outcomes across IUD types using descriptive statistics and incidence rates with 95% confidence intervals (CI).

RESULTS Among 28,280 copper IUD users, copper-only IUDs were most common (63.4%) followed by copper-silver (32.4%) and copper-gold IUDs (4.2%). Overall, 114 PTC were reported within a follow-up time up to 113 months. The incidence of PTC was highest in copper-gold IUD users (copper-gold: 1.20 [95% CI, 0.86-1.70]; copper-silver: 0.21 [95% CI, 0.15-0.29]; copper-only: 0.09 [95% CI, 0.07-0.13] per 100 women-years [WY]). In total, we observed 28 events of PID with no substantial differences between groups (copper-only: 0.48 [95% CI, 0.29-0.75]; copper-silver: 0.40 [95% CI, 0.17-0.79]; copper-gold: 0.35 [95% CI, 0.01-2.00] per 1,000 WY). The incidence of unintended pregnancy was similar across groups (copper-gold: 0.46 [95% CI, 0.24-0.78]; copper-only: 0.43 [95% CI, 0.37-0.50]; copper-silver: 0.35 [95% CI, 0.27-0.45] per 100 WY).

CONCLUSION We did not observe any differences in the clinical outcomes PID and unintended pregnancy between copper-only, copper-silver and copper-gold IUDs. However, copper-gold IUD users experienced more PTC.