Spontaneous Fracture of Copper Intrauterine Devices: A Decade-Long Retrospective Analysis From a Single Tertiary...

BACKGROUND Intrauterine devices (IUDs) are widely used for contraception and are generally well tolerated. A rare complication is spontaneous fracture of the IUD while in situ. This study aimed to evaluate the prevalence of spontaneous IUD fractures and compare occurrence between 2 IUD types. MATERIAL AND METHODS This retrospective study included 463 women who underwent IUD insertion and follow-up between January 1, 2011, and December 31, 2021. Two IUDs were evaluated: Type 1, a copper IUD with a gold core (375 mm²), and Type 2, a copper IUD (300 mm²) without a gold core. Spontaneous fractures were identified based on symptoms or routine annual ultrasonography. Statistical analyses included descriptive statistics, normality testing, and comparisons using chi-square, t-tests, or Mann-Whitney U tests. A p value <0.05 was considered significant. RESULTS Among 463 patients, 183 used a Type 1 IUD and 280 used Type 2. Spontaneous fractures were observed in 12 of 183 Type 1 users (6.56%, 95% CI: 2.97-10.15%), while no fractures occurred among Type 2 users. Overall fracture prevalence was 2.59% (95% CI: 1.49-4.48%). Fractured arms were often located in the uterine cornua (n=9) and cervical canal (n=3). Fragments in the canal were removed using Novak extraction, while those in the cornua required hysteroscopy. CONCLUSIONS Spontaneous IUD fractures can occur without symptoms and must be considered during follow-up. Prompt recognition is essential to avoid complications. Hysteroscopy and Novak extraction are effective for fragment removal. Clinicians should consider routine ultrasonographic evaluation to detect asymptomatic IUD fractures, especially in users of Type 1 devices.