LAUSR

OBJECTIVE This study assessed the timing, frequency, use of backup method and one-month pregnancy rates among individuals who had an intrauterine device (IUD) placed as emergency contraception and reported intercourse within seven days post-placement. STUDY DESIGN In this secondary analysis of a randomized control trial of IUDs for emergency contraception, 518 individuals reporting unprotected intercourse in the preceding five days had a 52mg levonorgestrel intrauterine system (IUS) or 380mm2 copper IUD placed outside the first week of their menstrual cycle. All participants were advised to use backup contraception for seven days. We assessed pregnancy status one month after placement by urine testing or, when not available, by survey responses and electronic health record review.  Participants reported whether their first sexual activity after device placement occurred within seven days of their placement, the frequency of intercourse and whether they used backup contraception. RESULTS Rapid return to sexual activity was common and use of backup contraception was rare, regardless of type of IUD placed. Of participants who resumed penile-vaginal intercourse in the first month, most (286/446, 64.1%) participants reported intercourse within seven days of IUD placement; only 16.4% (74/446) used condoms or withdrawal. No pregnancies occurred among users of the levonorgestrel IUS who reported intercourse within seven days of placement (0/138, 0.0%, 95% CI 0.0%, 2.6%) nor among users of the 380mm2 copper IUD (0/148, 0.0%, 95% CI 0.0%, 2.5%). CONCLUSION Pregnancy rates are low after placement of an IUD for emergency contraception, even among the many who resume intercourse within even days following IUD placement without use of backup contraception.