Department of Obstetrics and Gynecology, George Washington University, Washington, DC, USA.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA.
J Assist Reprod Genet. 2020 Jan;37(1):45-52. doi: 10.1007/s10815-019-01624-5. Epub 2019 Nov 11.
Intrauterine devices (IUDs) are effective and safe long-acting reversible contraceptive methods for preventing unplanned pregnancies. While extensive studies were conducted to evaluate return to fertility after removal of IUDs, majority of them were focused on multiparous women using copper IUDs. Current trends indicate increased use of levonorgestrel (LNG) IUDs in nulliparous women for very long periods of time, with both nulliparity and long duration of LNG-IUD use being potentially associated with trends towards longer time to conception post removal. Understanding the effects that LNG-IUDs may have on endometrial morphology and gene expression has important implications to further understanding their mechanism of action. Studies examining endometrial gene expression show persistent changes in receptivity markers up to 1 year after removal of an inert IUD, and no similar studies have been performed after removal of LNG-IUDs. Given the current gap in the literature and trends in LNG-IUD use in nulliparous young women, studies are needed that specifically look at the interaction of nulliparity, long-term use of LNG-IUD, and return to normal fertility. Herein, we review the available literature on the mechanism of action of IUDs with a specific focus on the effect on endometrial gene expression profile changes associated with IUDs.
宫内节育器（IUD）是一种有效且安全的长效可逆避孕方法，可预防意外怀孕。虽然已经进行了广泛的研究来评估取出 IUD 后生育能力的恢复，但大多数研究都集中在使用铜 IUD 的多产妇身上。目前的趋势表明，更多的未产妇长时间使用左炔诺孕酮（LNG）IUD，未产妇和 LNG-IUD 使用时间长可能与取出后怀孕时间延长的趋势有关。了解 LNG-IUD 对子宫内膜形态和基因表达的影响对于进一步了解其作用机制具有重要意义。研究表明，在取出惰性 IUD 后长达 1 年，子宫内膜的接受性标志物仍持续发生变化，而在取出 LNG-IUD 后则没有类似的研究。鉴于目前文献中的空白以及未产妇中 LNG-IUD 使用的趋势，需要进行专门研究，以探讨未产妇、长期使用 LNG-IUD 以及恢复正常生育能力之间的相互作用。本文回顾了 IUD 作用机制的相关文献，特别关注了与 IUD 相关的子宫内膜基因表达谱变化的影响。
