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Among current users of intrauterine devices, there is an increased risk of an ectopic pregnancy in the unlikely event pregnancy occurs during use though the absolute numbers are decreased Conclusion Since fewer pregnancies occur for users of contraception, the absolute number of ectopic pregnancies is reduced because there are fewer pregnancies. However, if a pregnancy occurs with either a copper IUD or a levonorgestrel intrauterine system, it is important to rule out the occurrence of an ectopic pregnancy, as it appears that the ratio of ectopic pregnancies to intrauterine pregnancies may be increased. Clinical Question Is there an increased risk of ectopic pregnancy among women using an IUD? Search Terms Intrauterine device, IUD, levonorgestrel intrauterine system, ectopic pregnancy Citation Furlong L. Ectopic pregnancy risk when contraception fails. J Reprod Med 2002;47:881-885. Object of Research Intrauterine devices Research Outcome Ectopic pregnancy rate Study Features This is a review of data submissions by pharmaceutical companies to the US Food and Drug Administration in support of the applications for approval of their contraceptives. Data were obtained from clinical trials conducted by the companies. The US population rate for ectopic pregnancy was obtained from the Center for Disease Control. Evidence Grade: Level 2 The Evidence For the Copper T IUD, the ratio of ectopic pregnancies to total pregnancies was 1:16 compared to 1:50, the estimate for all pregnancies in the United States. In a large post-marketing study in Finland, 18 ectopic pregnancies out of 232 pregnancies were identified though the copper device brands were not provided. This ratio is 1:13 similar to that found in the original FDA submission. For the levonorgestrel IUD, the ratio of ectopic pregnancies to total pregnancies is 1:2, but this ratio is based on only 10 pregnancies from their clinical trial studies. Still, from the large Finnish postmarketing study, 44 out of 108 pregnancies yielding a ratio of 1:2.3 consistent with the data submitted to the US Food and Drug Administration. Appraised by: The Jordan EBM Reproductive Health Group Update by: 22 March 2016