Levonorgestrel intrauterine device placement: Survey of United States obstetrician-gynecologists

OBJECTIVE: To assess practice patterns of U.S. providers regarding levonorgestrel intrauterine device (IUD) placement techniques. STUDY DESIGN: Members of the Society for Academic Specialists in General Obstetrics and Gynecology and the Ryan Residency Program Faculty were surveyed regarding practices for levonorgestrel IUD placement. RESULTS: Of 363 invitations to participate, we received 132 responses. Survey responders practiced throughout the U.S., varied from 0–5 to 21+ years of practice, and were 81% female. Evaluation of adherence to manufacturer’s placement instructions revealed that only 7.5% of respondents always perform every recommended technique. Bimanual examination was always performed by 75% of respondents, with only 13% reporting rarely or never performing. Only 36% of respondents reported always changing into sterile gloves, and 36% have patients return for string checks. Tenaculum use and use of uterine sound prior to placement were steps eliminated by 30% and 20% of physicians, respectively. Use of ultrasound for placement evaluation during, immediately after, or at a later date was rare: only 2% of respondents answered anything other than “rarely” or “never.” Sixty-seven percent responded that they “rarely” or “never” premedicate patients for placement; 33% said they “always” or “frequently” premedicate. Of those, 48% use paracervical block and 92% use ibuprofen. CONCLUSION: Among providers in the U.S., placement of levonorgestrel intrauterine devices is performed using varied techniques. Further investigation to determine best practices among these variations is warranted.