Controversies in family planning: intrauterine device placement in solid organ transplant patients

With an ever-increasing number of reproductive-aged women undergoing solid organ transplant and fertility improving after transplant, knowledge of the safety and efficacy of various contraceptive methods is essential to guide patient selection. We present the case of a 22-year-old patient desiring an intrauterine device (IUD) for contraception with a history of liver transplant as a child. The Centers for Disease Control and Prevention (CDC) and American Society for Transplantation (AST) offer conflicting recommendations on the use of IUDs in transplant patients. We review the literature for recommendations on IUD use in this population. While the literature is limited, levonorgestrel (LNG) and copper (Cu) IUDs appear to be safe and effective in solid organ transplant patients, with no evidence of unintended pregnancies or complications compared to those without organ transplant. Ultimately, patient preference should be the primary consideration in contraceptive choice, including between LNG or Cu-IUD.