Failure to insert a levonorgestrel-releasing intrauterine system: a survey based on self-reports by Israeli...

The insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) requires experience and is associated with a low failure rate.

To assess the reasons given by gynecologists why they failed to insert a LNG-IUS.

We obtained data from the sole distributor in Israel that prospectively recorded these cases when contacted by gynecologists following an insertion failure.

The mean rate of failed insertions was 0.95% (range 0.77-1.03%) for the 5 year study period 2006-2010. The most common reasons reported by gynecologists for LNG-IUS insertion failure were loss of sterility of the device, inability to insert the device due to a stenotic cervical canal, accidental removal of the device following a successful insertion due to hasty removal of the inserter or the use of blunt scissors, and removal of the newly inserted LNG-IUS following ultrasound evidence that it was misplaced.

Gynecologists should be aware of the common pitfalls associated with insertion of an LNG-IUS. Several techniques that may aid in avoiding these mishaps are described.