US 3913573 A
An intrauterine contraceptive device comprising an elongated shank having divergent convoluted portions at its distal end, the convoluted portions being generally sinusoidal in nature, the device having incorporated in the shank a permanent magnet and having a substantial portion of its surface covered with a biologically inert, silicone elastomeric material which may contain an analgaesic or anti-fertility agent which is gradually released in utero. In a preferred embodiment of the invention, the proximal end of the shank contains a pair of downwardly extending divergent, resilient legs which tend to prevent inadvertent expulsion of the device. In another preferred embodiment, the lower end of the device is formed with a small container for certain types of medication which are released gradually into the vagina over a prolonged period of time for the prevention and cure of such diseases as gonorrhea and syphilis.
Description (OCR text may contain errors)
United States Patent 1 Gutnick 1 Oct. 21, 1975  Inventor: Morton Gutnick, 8329 Fairview Road, Elkins Park, Pa. 19117  Filed: Jan. 11, 1974  Appl. No; 432,435
Related [1.8. Application Data  Continuation-impart of Ser. No. 294,200, Oct. 2,
Vennard 128/129 Ansan 128/130 Primary Examiner-Richard A. Gaudet Assistant Examiner.1. C. McGowan Attorney, Agent, or FirmRobert S. Bramson, Esqx, James A. Drobile, Esq.
 ABSTRACT An intrauterine contraceptive device comprising an elongated shank having divergent convoluted portions at its distal end, the convoluted portions being generally sinusoidal in nature, the device having incorporated in the shank a permanent magnet and having a substantial portion of its surface covered with a biologically inert, silicone elastomeric material which may contain an analgaesic or antifertility agent which is gradually released in utero. in a preferred embodiment of the invention, the proximal end of the shank contains a pair of downwardly extending divergent, resilient legs which tend to prevent inadvertent expulsion of the device. In another preferred embodiment, the lower end of the device is formed with a small container for certain types of medication which are released gradually into the vagina over a prolonged period ottime for the prevention and cure of such dis' eases as gonorrhea and syphilis.
30 Claims, 11 Drawing Figures U.S. Patent 0a. 21, 1975 Sheet 1 on 3,913,573
US. Patent Oct. 21, 1975 Sheet20f3 3,913,573
U.S. Patent Oct. 21, 1975 Sheet 3 Of3 3,913,573
INTRAUTERINE CONTRACEPTIVE DEVICES WITH PLURAL PARALLEL LEG SEGMENTS REFERENCE TO RELATED CASE This is a continuation-impart of U.S. Pat. application Ser. No. 294,200, filed Oct. 2, I972, now abandoned.
BACKGROUND OF THE INVENTION 1. Field of the Invention The invention relates to both new and useful improvements in intrauterine contraceptive devices.
2. State of the Art It has been known for many years that a foreign object in the uterus will prevent conception. To date, many different types of intrauterine contraceptive devices, aslo known as IUD's, have been proposed, and several types are in widespread use, but none have been fully satisfactory.
Bleeding and pain account for 85 per cent of the complications or side effects of intrauterine contraceptive devices. Therefore, any device that would reduce or eliminate bleeding and pain would lead to fewer removals of intrauterine contraceptive devices for "cause," and would allow a greater percentage of patients to continue to use" the IUDs and would proba bly also expand the usage of IUDs.
Lack of confidence in the IUDs, as a result of unnoticed spontaneous expulsion of the device with the resulting potential for unwanted pregnancy or the improper positioning of the device resulting in a loss of the thread or threads in the uterus, contine to plague the presently available intrauterine contraceptive devices. When the tail of a conventional IUD cannot be seen at the cerivcal os, the physician is faced with a dilemma, since he must make a distinction between unnoticed expulsion, ascent of the tail into the uterine cavity and possible perforation of the uterus. With presently available IUDs, in order to determine their presence within the uterine cavity, the physician must either send the patient for an X-ray, with its attendant exposure, radiation exposure, the possibility of the patient being pregnant, and additional loss of confidence in the IUD by the patient, or probe blindly" in the uterus, with a sound, a long, thin metal instrument, and with nothing to guide the sound this can become a painful, difficult and even dangerous procedure.
Syphilis and gonorrhea can be extremely harmful diseases, if not controlled, and are of epidemic proportion. No adequate technique for preventing these diseases has been demonstrated, although it is well-known that certain antibiotics will kill the organisms that cause these diseases. Accordingly, it is extremely desirable to be able to kill any gonoccocus or syphilitic organism immediately as they are transmitted in order to prevent either disease from developing in the host, individual.
BRIEF SUMMARY OF THE INVENTION The invention comprises an IUD having a shank portion in which there is embedded a permanent magnet, the shank portion terminating at its distal end in a pair of convoluted loops having substantially transverse arms or arm segments with respect to the axis of the shank and sinusoidal arms extending laterally from the shank. One of th convoluted loops may be longer than the other in the elongated position in which the loop is coextensived with the shank, and may terminate in a bulbous end portion. In one embodiment, the transverse arms are connected to the shank and the convo luted loops depend therefrom. In another embodiment, the convoluted loops are connected to the shank and the transverse arms are connected to the outer ends of the respective convoluted loop members. Each of the convoluted loops is substantially sinusoidal in configuration and comprises at least three linear segments sub stantially parallel to the shank and connected by the transverse arm to the shank. The IUD is formed of a flexible thermoplastic material having plastic memory, so that the convolutions may be straightened out and the IUD placed into an elongated tube for proper uterine insertion by a physician or other medical professional.
In a preferred embodiment of the invention, the arms and convolutions and a substantial portion of the shank are formed of or covered with a thin coating of a material which does not cause foreign body reactions, even after prolonged periods of time, and minimizing bleeding from contiguous areas, such as a silicone rubber, to lessen the incidence of any problems, such as bleeding, resulting by the residence of the IUD in utero.
In the preferred embodiment of the invention the proximal end of the shank terminates in a pair of downwardly extending divergent flexible legs, which serve to retain the IUD in place and prevent expulsion. The legs form an acute angle in the range from about 6 to about 30, and preferably about 10. The proximal end of the shank, or, in the case of the preferred embodiment, the ends of the divergent legs, terminate in a small nodular segment or segments to which a thin filament or thread is fastened to extend from the uterus into the vagina and provide a tangible manifestation of the presence of the IUD in situ.
The permanent magnet which is incorporated in the shank of the IUD serves two functions. First of all, it prevents inadvertent expulsion of the IUD from the uterus because it is positioned at the top of the shank, thereby making the IUD top heavy and less likely to be expelled, and because the use of the magnet allows the IUD to be located by the use of a ferrous sound or a magnetic or electromagnetic sound so that the physician, when he is probing in the uterus to locate the IUD will be able to do so by virtue of the attraction of the ferrous or magnetic or electromagnetic sound to the magnet incorporated in the IUD.
The IUD preferably has incorporated therein a suffi cient amount of barium or a barium salt to make the IUD radio-opaque whereby it may be located by X-ray, if necessary.
In an embodiment of the invention, a medication, such as a topical anesthetic or other pain relieving drug or an anti-fertility agent, may be incorporated into the silicone rubber material of the IUD, and will be leached out therefrom, to permit a controlled release of drug into the uterus during the initial and subsequent periods of use of the IUD.
In an alternate embodiment of the invention, the convolutions of the IUD are wrapped with fine copper wire, in order to improve the efficacy of the IUD in pre venting conception.
In yet another embodiment of the invention, a small container for liquid medication is formed within the shank portion of the IUD, preferably at its lower end, and terminating in a self-sealing globule which will gradually release the liquid medication into the uterus or vagina. The shank can be formed to extend through the cervix into the vagina and can therefore release medication directly into the vagina. This embodiment is particularly useful for the release of certain antibiotics, such as penicillin, erythromycin or tetrocycline, which will prevent or cure syphilis and gonorrhea. The material of the globule, which permits the gradual re lease of medication therefrom, also permits the reseal able introduction of a fine hypodermic needle therein to refill the container with medication and thereby to avoid the necessity for removing the IUD and inserting a substitute IUD. The size of the globule, and the attendant rate of release of medication therefrom, can be varied to release the minimal inhibitory concentration of antibiotic necessary to inhibit the growth of the particular gonococcal strain in the country of use, it being well recognized that strains in some geographic areas being more virulent than the gonococcus strains present in other areas.
OBJECTS OF THE INVENTION An object of this invention is to provide an intrauterine contraceptive device which is safe and effective in comparison to the prior art devices.
Another object of this invention is to provide an IUD which will spread over most of the endometrial cavity and thus lessen the changes of pregnancy.
Still another object of this invention is to provide an IUD which, once placed properly, will remain relatively fixed in its intrauterine position and will not easily be expelled inadvertently, but which can readily be removed when removal is desired.
A concomitant object of this invention is to provide an intrauterine contraceptive device whose presence and proper position in the uterus can be readily determined by the use of a ferrous, magnetic or electromagnetic sound.
Another object of the present invention is to provide an IUD which is less likely to be expelled inadvertently than prior art devices.
Yet another object of the present invention is, when possible and medically advisable, to provide an IUD construction which can be retrieved by an electromagnet in order to save the patient an abdominal operation in cases of partial perforation of the uterus.
Still another object of this invention is to provide an IUD formed with a medically acceptable outer material to minimize uterine bleeding due to a foreign material in the uterus.
Yet another object of this invention is to provide an IUD construction which incorporates topical anaesthetics, steroids or medicaments, when medically advisable, in the material of the IUD for the slow release of pain relieving drugs or anaesthetics in utero.
It is similarly an object of this invention to provide an IUD which is of unique mechanical design, which can be worn with comfort for years, and then easily removed without discomfort to the patient.
A further object of this invention is to provide an IUD that may be presterilized, that lends itself to easy insertion into the uterus with the help of a simple instrument, and that will not interfere with either menstruation or vaginal function.
An additional object of this present invention is to provide an IUD which a nulliparous patient can use effectively with no or minimal discomfort, thereby to expand the number of potential users of IUDs. Another object of this invention is to provide an IUD that will release mediation into the uterus or vagina at a con trolled rate over a prolonged period of time for the prevention or treatment of diseases. such as syphilis and gonorrhea.
Yet another object of this invention is to provide an IUD that will release medication directly into the vagina and can be refilled with medication without removing the IUD from the vagina.
DESCRIPTION OF THE DRAWINGS FIG. I is a front elevational view of the IUD of this invention, located in the tubular insertion device and inserted in the uterus for introduction of the IUD in utero;
FIG. 2 is a front elevational view of the preferred em bodiment of the IUD of this invention, located in utero in its position of use;
FIG. 3 is a view, similar to FIG. 2, showing a second embodiment of the invention;
FIG. 4 is a view, similar to FIG. 3, showing yet another embodiment of the invention;
FIG. 5 is a cross-sectional view, taken along line 55 of FIG. 1;
FIG. 6 is a cross-sectional view, taken along line 66 of FIG. 3;
FIG. 7 is a front elevational view of the preferred embodiment of the invention, and the insertion device, as packaged prior to use;
FIG. 8 is a front elevational view, similar to FIG. 2, showing yet another embodiment of the invention where the convoluted loops are fastened directly to the shank;
FIG. 9 is a view similar to FIG. 8, but including means for the sustained release of liquid medication;
FIG. 10 is a partial cross-sectional view of yet another embodiment of the invention, similar to that of FIG. 3, but including means for the sustained release of liquid medication; and
FIG. 11 is a view similar to FIG. 10, but with an elongated shank entending through the cervix for the direct release of medication into the vagina.
DETAILED DESCRIPTION OF THE INVENTION Viewing FIG. 2, the preferred embodiment of the intrauterine contraceptive device of this invention, which is generally designated by numeral 10, is seen to comprise -a thin, elongated central stem or shank 16, of generally rectangular cross-section with rounded corners, although this shape may also be elliptical or oval. At the proximal end 18 of the shank 16, there is formed a pair of downwardly extending, divergent flexible legs, respectively designated by numerals 20 and 22. The legs are preferably integrally formed with the shank l6, and extend at angles in the range from about 3 to about [5", and preferably about 5, with respect to the vertical. Therefore, the angle between legs 20 and 22 is in the range from about 6 to about l5 and is preferably about IO". At the proximal extreme of each of the two legs 20 and 22 is located an eye or nubbin, respectively designated as 24 and 26, to which filaments or tails, designated by the letter T, are fastened, as by knotting, through an aperture therethrough, fusion, or by means of a suitable medically acceptable adhesive.
Embedded within shank 16 is a permanent magnet 28, which, in the preferred embodiment, occupies at least 50% of the length of the shank l6, and preferably occupies approximately the upper two-thirds of the length of the shank I6. The permanent magnet also occupies at least 80% of the cross-section of shank 16, in the preferred form of the invention, so that the thermoplastic material of shank 16 only provides a thin cover ing layer for the permanent magnet 28.
The distal end 30 of the intrauterine device is integrally formed with a pair of divergent arms 32 and 34, which extend in a transverse direction with respect to the axis of shank 16. Each of the arms 32 and 34 is a part of a convolute or loop section, respectively designated by numerals 36 and 38. Viewing convolute sec tion 36, it is seen to comprise the arm 32, a depending leg 40 connected to arm 32 by curved section 42, and upwardly and substantially vertically extending leg 44 connected to leg 40 by curved section 46, a depending leg 48 connected to leg 44 by curved section 50, and an upstanding leg 52 connected to depending leg 48 by a curved section 54. Leg 52 terminates at its free end in an enlarged bulbous extremity or nodule 56, which may be of spherical or disc-shaped configuration, the purpose of which will be explained hereinafter.
Viewing convolute section 38, it is seen to comprise the transverse arm 34, which is connected by arcuate section 58 to depending leg 60, which is, in turn, connected by arcuate section 62 to upstanding leg 64. Upstanding leg 64 is connected by arcuate section 66 to depending leg 70.
It is to be noted that the corresponding legs of the convolute sections 36 and 38 of approximately the same length, but what convolute 36 has an additional leg section 52 and connecting section 54, not present in convolute 38. Accordingly, when the convolute sections are stretched out to be substantially conextensive with the longitudinal axis of shank l6, leg 52 and its enlarged bulbous end 56 will extend beyond the leg 70. The purpose of having this longer leg and bulbous end is to facilitate the insertion of the IUD into the insertion member and its subsequent proper placement in the frontal plane of the uterine cavity. The bulbous end 56 is of greater cross-section than the aperture in the insertion member, which is described below, and prevents the IUD from being drawn completely into the insertion member. Bulbous end 56 also, because of its smooth and round leading edge, facilitates insertion of the IUD into the uterus and minimizes the likelihood of irritation of the walls of the cervical canal and of the uterus during the placement of the IUD In the preferred form of the invention for a patient, the shank 16 has a length of approximately 16 mm., a width of approximately 4 mm. and a depth of approximately 2.5 mm. Each of the legs and 22 has a length of about 8 mm., a width of 2mm. and a depth of 2.5 mm. The over-all dimensions of the IUD unit in situ are about 38 mm. wide and 26 mm. high. The permanent magnet 28 is 9 mm. long and 3 mm. in diameter. However, the dimensions given are for general guidance only, and may be varied to suit the needs of the patient and to accommodate best the largest number of patients.
Each of the convolute sections, in cross-section, has a rounded-corner rectangular configuration, and has a width of 2 mm. and a depth of 2.5 mm., and when straightened out so that the convolute legs are substantially coextensive with shank 16, the entire unit has a length of approximately 100 mm.
For a nulliparous patient, the IUD of this invention would preferably have somewhat different dimensions.
The permanent magnet would be of 2 mm. or less diameter, so that shank I6 would be about 2.5 mm. wide. The entire IUD unit would occupy a width of about 26 mm. and a height of about 26 mm.
The filaments or tails T are preferably round in shape, about 0.2 mm. in diameter and about 100 mm, in length and are preferably extrusions of nylon, polyethlene, polytetrafluoroethylene or other flexible, medically acceptable material. The tails T may be fastened to the nubbins 24 and 26, by tying, adhesive or fusionv The length of each of the filaments T is such that a substantial amount of residual length can be cut after the IUD is inserted so that a string of about 75 mm. remains in the vagina.
The foregoing dimensions as to the IUD device of this invention are not critical, but are optimum from a prac' tical standpoint for proper, snug fit of the IUD in the endometrial cavity, and may be modified to suit the characteristics of the patients to be using the IUDs of this invention. However, it is to be noted that the IUD of this invention is designed to have minimum bulk to insure minimum likelihood of pain or discomfort on insertion. It is noteworthy that the IUD must be substantially planar in configuration, to allow it to conform properly to the shape of the uterus, which is thin and flat.
The shape of convolute sections 36 and 38 is of par ticular importance in the invention because it conforms substantially to the configuration of the endometrial cavity and spreads to occupy most of the endometrial cavity. Thus, the outer legs 40 and 60 and transverse arms 32 and 34 of the respective convolutes 36 and 38 should be substantially straight to conform to the shape of the walls of the endometrial cavity. The inner legs of convolutes 36 and 38, that is to say, legs 44, 48 and 52 of convolute 36 and legs 64 and 70 of convolute 38, are preferably substantially straight and parallel to shank [6. However, it is within the purview of this invention for those legs to be somewhat curved in configuration, the primary consideration being the necessity for occupying the maximum portion of the endometrial cavity.
Although the shank, legs, and convolute sections of IUD 10 are preferably of rounded corner rectangular cross-section, it is within the purview of this invention for these elements to be of oval or elliptical or other non-circular cross-section. Non-circular cross-section is desirable to insure that the IUD may properly be located in the correspondingly shaped insertion unit, to allow the IUD readily to be placed in the frontal plane of the uterus.
The intrauterine contraceptive device 10 is preferably formed of a resilient, biologically inert, medially acceptable material having plastic memory, i.e. resistance to cold flow, so that the device will resume its convoluted shape after it has been held in the elongated position in the insertion device for a resonable period of time. The material of choice is polyethylene, and a selection of medically acceptable polyethylene of optimum molecular weight and other characteristics is within the purview of the skilled artisan. In molding the intrauterine device of this invention, it is desirable to add about 10% or more by weight of barium or a barium salt, in order to make the intrauterine device radioopaque, whereby it may be viewed by X-ray, in the event that the exact location of the IUD is required to be determined.
The device is preferably covered, at least in areas other than those immediately overlying the magnet 28, with a thin layer ofa medically acceptable silicone elastomer, such as Silastic, a product of Dow Chemical Company. It is also within the purview ofthis invention to incorporate medicaments, such as local anesthetics, and anti-fertility agents, such as steroids, in effective quantities into the silicone elastomer sheeting or coating which may then be leached out for gradual release into the uterus, in instances in which the introduction of such material is desirable. safe and efficacious.
When its is desired to incorporate a topical anes thetic into the Silastic, lidocaine, also sold under the trademark Xylocaine, is the anesthetic of choice. This anesthetic may be used in concentrations of up to 4% by weight, but is preferably in concentrations of lor 2 by weight. This anesthetic is stable and boilable, non irritating to tissues, and the onset of anesthetic effect is immediate, diffusing rapidly into the tissues. The typical dose would maintain the anesthetic effect for about 1 to PA hours.
It may be desired to desensitize both the cervical canal and the endometrial cavity prior to the insertion of the IUD of this invention, particularly in a nulliparous patient. This can conveniently be achieved by introducing or instilling about l cc. of l or 2 weight percent Xylocaine solution into the cervical canal and introducing or instilling about 2 to 4 cc. of Xylocaine solution into the uterine cavity. A suitable presterlized syringe, containing the proper concentration of anesthetic solution may be packaged in the same sterile sealed package as the intrauterine device.
The electrical activity of the human uterus in the presence of an IUD has been measured, and it has been determined that there is marked uterine activity shortly after the introduction of the IUDv Increased uterine activity has been noted at the time of ovulation, and particularly at the time of menstruation. This is why the expulsion of an IUD is most likely to occur after or during menses.
The use of an anesthetic incorporated in the IUD of this invention can be quite helpful in reducing the frequency of expulsion of IUDs, a primary cause of ineffectiveness of IUDs in many patients. Irritation of the cervix and/or uterus upon insertion of the IUD, and the pain of discomfort associated therewith, substantially increases the likelihood of expulsion of IUDs. Therefore, incorporation into the silicone elastomer ofa sufficient amount of a local anesthetic, such as Lidocaine or Xylocaine will desensitize the cervix and uterus for a sufficient period of time after insertion of the IUD in utero to reduce the likelihood of IUD expulsion.
When it is desired to incorporate medication into the silicone elastomeric material of the IUD, this may be done in one ofthree ways. Ifthe IUD is constructed primarily of a material such as polyethylene, the shank and other parts of the IUD may be covered with a sheet or spray coating of medical grade Silastic elastomer in which the medicament has been incorporated, in a matter to be discussed hereinafter. Alternatively. the shank of the IUD, or the entirely of the IUD, may be formed of medical grade Silastic elastomer, having the medicament incorporated therein.
Suitable medicaments for incorporating into the silicone elastomeric material are local anesthetics, such as Xylocaine or Lidocaine, or anti-fertility agents, such as progesterone or medroxy progesterone acetate. If one of the progestogens is incorporated into the silicone elastomeric material, medication is released during the first few days of residence of the IUD in utero at a fairly rapid rate, and after the first few days of residence the drug continues to be released at a much slower, relatively constant rate for a prolonged period of time. Other steroids, such as estradiol, testostrone, cortisol and androstenedione, which are the more polar ste roids, may also be used, but they are not released at as high a rate as the less polar steroids.
The medicament can be incorporated into the sili cone elastomer by admixing with the silicone elastomer when it is in a fluid state, and subsequent formation of the amorphous or fluid elastomer into the element of the IUD by extrusion, die casting, or the like. Alterna tively, the medicament may be incorporated in the elastomer, when the elastomer is in the fluid state, and sprayed in a fluid state onto all or selected portions of an IUD of a different material, such as polyethylene.
An alternative method for insertion of the medication is to place an amount in the range form between 50 to 500 milligrams of the medication, in the form of milled crystals, within a hollow tube ofthe silicone elastomeric material of medical grade. Such a tube would constitute all or part of the shank of the IUD of the invention, but the tube would have an outside diameter not substantially in excess of 3 to 4 millimeters, The open end of the tube would be sealed with a medical grade adhesive, such as a silicone rubber adhesive. The medication would then be leached out through the sillcone elastomeric walls of the hollow tube. It is important to note that the rate of passage or diffusion of the medication through the Silastic wall is not influenced by the weight of medication contained therein; rather, its releases are dependent upon the surface area and wall thickness of the elastomric material. That is to say, more medication will pass through a long tube than a short tube, and for a given amount of surface area, sub stantially moe medication passes through a thin wall of material than through a thicker wall. The thickness of the wall and the surface area of the elastomeric tube can thereby be controlled in dimension to control the rate of release of medication.
It is also within the purview of this invention to incorporate more than one medication into the material of the invention, in different sections of the IUD of this invention, in order to provide for the controlled re lease, at different rates if desired, of different medica tions.
Also, to increase the efficacy of properly situated IUDs, the silicone elastomer can include a sufficient amount of an anti-fertility material, as noted above. This would be released uniformly and gradually during a prolonged period of time of months or even years and further increase the efficacy of IUDs in preventing conception. The advantage of this uterine introduction of anti-fertility agent over oral ingestion is tha the oral form requires daily usage and motivation and can be forgotten or "skipped".
It is also within the purview of this invention to con struct the IUD totally of a silicone elastomer of suitable resilience, flexibility and plastic memory, and which is medically acceptable and biologically inert, has a low hemolysis index and non-wetting surface property. The non-wetting surface helps to reduce incrustation with calcium salts, such as calcium carbonate, and consequent clotting, which is somewhat of a problem when polyethylene is used.
The inserting instrument, for inserting the IUD of this invention into the patient, is best seen in FIG. 7. The inserting instrument itself, which is generally designated by numeral 80, comprises an elongated hollow tube 82 and a plunger member 84 for discharging the IUD 10 from a position within the tube 82 into the uterus.
The tube 82, in the preferred embodiment, is approximately 196 mm. form the distal end 86 to the finger rest 88 which is located at the proximal end of the tube 82. Mounted peripherily about the tube 82 and spaced approximately 45 mm. from distal end 86 is a horizontal flange 90, the purpose of which is to limit the degree of insertion of the tube into the uterus, to prevent excess penetration of the insertion instrument and possible harm to the patient. The plunger 84 comprises a stem 92, a piston 94, mounted at the distal end of the stern, and a handle 96, mounted at the proximal end of the stem. The proximal ends of filaments T are fastened to stem 92 or piston 94 of plunger 84, as by tying, fusion or a suitable adhesive and a substantial length of filaments T resides alongside stem 92 of plunger 84 and readily unwinds as the inserting device is removed from the uterus after the IUD I is inserted. A clearance is provided between plunger piston 94 and the inner diameter of insertion tube 82 to permit easy movement of the plunger in the tube, thereby allowing for the presence of the filament therein.
The tube 82 and piston 94 of plunger 84 are preferably of rounded-corner rectangular cross-section, having a width of about 6 mm. and a depth of about mm. and a wall thickness of about 0.5 mm. The piston 94 of plunger 84 has a width of about 3mm., a depth of about 2 mm. and a length of approximately 202 mm. The foregoing dimensions are optimum, but are not critical, and will be varied to accommodate the particular shape and dimensions of the IUD being inserted. For exam ple, if the IUD I0 is of elliptical cross-section, the insertion tube 82 and piston 94 will also be of elliptical cross-section.
The inserting instrument 80 is desirably molded of a medically acceptable material, such as medical grade polytetrafluoroethylene.
In practice, the IUD 10 is packaged in package 12 with the inserting instrument 80, in the manner shown in FIG. 7, but preferably not with the proximal end of the preferred embodiment of the IUD partially inserted into the distal end of 86 of tube member 82. The reason for not inserting the IUD [0 into the tube in packaging, is to avoid any loss of plastic memory of the convolute section 36 and 38 and the legs and 22 of the IUD.
The IUD and inserting device are packaged in a hermetically sealed, sterilized container 12, of a well known type of material and in a manner which is wellknown in the art, such as by forming the container, evacuating the container, replacing the interior of the container with a sterilizing atmosphere such as ethylene oxide gas, evacuating that gas and then completing the sealing of the container.
In use, the IUD of this invention is inserted as follows. The usual time period for the insertion of the intrauterine device would be during the last day or two of a normal menstrual period. Prior to inserting the IUD, the physician or other medical professional, by history and pelvic examination of the patient would consider the contraindications to its use. The most important such contraindications are suspicion of pregnancy or actual pregnancy, acute cervicitis, acute salpingitis, suspected carcinoma, distortion of uterine cavity by fibroids, septate or bicronuate uterus, or menorrhagia or unexplained bleeding. When none of the containdications to the use of the IUD is present, the patient's legs are inserted in stirrups on the examining table in the usual pelvic examination position, and the physician may do another pelvic examination to confirm the size and po sition of the uterus and confirm the diagnosis of ante flexion or retroflexion and the depth of the uterine cavity. Subsequently, the cervix would be cleaned with an antiseptic solution, applying a long (190 mm.) tenaculum to the anterior lip of the cervix and sounding the uterus with a sterile sound. Prior to dilating and/or sounding, a sterile local anesthetic may, if desired, be applied to the cervix and cervical canal to eliminate discomfort.
For insertion of the intrauterine device, the sterile package 12 would first be opened by the physicians or medical professionals assistant. Using sterile gloves, the insertion device would be held in one hand, and the other hand would compress and insert the legs 20 and 22 of the IUD 10 into the open distal end of tube 82. Plunger 84 would then be pulled outwardly, so that the filaments T, which are attached at one end to IUD l0 and at the other end to the plunger 84, and the slack of which is located beside stem 92, would be used to pull the body of the intrauterine device 10 down into the tube 82. The plunger would be pulled inwardly until all but the bulbous end 56 of the intrauterine device 10 has been drawn into the tube 82, making sure that both the IUD and the flat surface of the insertion tube flange are in a horizontal plane, to insure proper placement of the IUD in the frontal plane of the uterine cavity. Of course, when located in the insertion tube, the convolute sections 36 and 38 of the intrauterine device 10 would be straightened out and would be substantially coextensive with shank 16. Preferably, the IUD I0 is not inserted into the insertion tube 82 until one or two minutes prior to use, in order not to interfere with the memory" of the intrauterine contraceptive device.
The tenaculum would be slightly pulled on by the physician to straighten out the uterine canal and give a slight counter-pressure. Gently and slowly, the insertion device 80 would be inserted into the cervical os until the flange 90 reaches the anterior edge of the cer' vical os and the insertion device is in the position shown in FIG. I. The plunger 84 is then pushed gently and slowly into tube 82, as far as it will go. As the IUD I0 is introduced into the frontal plane of the uterine cavity by the movement of plunger 84, it regains its original configuration, as illustrated in FIG. 2 and is properly emplaced within the uterine cavity. The inserting unit 80 is then withdrawn from the cervical canal, and the tail T of the IUD is pulled out from along side stem 92 is then cut, leaving approximately 75 mm. of the tail attached to IUD 10 and extending into the vagina.
Of course, any instruments used to assist in the insertion of the IUD should be removed. Once the IUD has been properly inserted, the patients legs may be straightened out, and the patient should be allowed to rest for a few minutes after the insertion.
In the event that the IUD is desired to be removed at any time, the physician my grasp the proximal end of the tail T with a uterine dressing forceps or sponge for cups, and pull outwardly with steadily, gentle force. This would tend to pull the legs 20 and 22 of the IUD inwardly, so that the IUD can gently be withdrawn from the uterus. The convolutes 24 and 26 will straighten out, for ease of withdrawal, as the IUD is pulled through the cervix.
The IUD 10 illustrated in FIG. 3 is identical to the IUD 10 of FIG. 2, with the sole exception that the shank I6 terminates, at its proximal end 18, in a small round nubbin 24', to which the filaments T are tied or otherwise fastened. Therefore, IUD 10' does not have divergent legs which assist in preventing its accidental expulsion. In use, the IUD 10 of FIG. 3 is handled in the same manner as the IUD of FIG. 2, with the exception that it may be desired to package the IUD 10' with the shank 16 extending into tube 82 of the inserting de vice, so that all that is required to be done to complete insertion of the IUD into the inserting device is to pull outwardly on knob 96 of plunger member 84 to straighten out convolute sections 36 and 38 draw them into tube 82.
In the embodiment of FIG. 4, it will be seen that legs 40" and 60" of the respective convolute sections 36" and 38" of IUD I" are wrapped with copper wire 100. Copper wire 100 is of about 0.l mm. diameter, and is of a length to provide at least 100 millimeters of surface area on each leg. The copper wire 100 is wound on each of the two legs 40" and 60" in a spiral winding. The function of the copper wire is to enhance the contraceptive effect of the IUD by inhibiting implantation of the blastocyst and by the tendency of copper to inactivate spermatoza. Although copper wire is shown only on legs 40" and 60", if a greater amount of copper wire is desired, it may be wound on other segments of the convolutes 36" and 38". The copper wire may, if desired, be would on other legs of the convolutes, instead of legs 40" and 60".
In the use of the IUD of this invention, in the event that the physician is attempting to locate the IUD, and the tail T has accidentally been lost, the physician may locate the IUD inutero, without the need for X-rays, by the insertion of a ferrous sound, a well known instrument, into the uterus and by detecting, by feel, the pull of the permanent magnet 28 on the ferrous sound. An electromagnet or a magnetic sound of reverse polarity from that of the proximal end of magnet 28 may also be used to facilitate the location and the removal of a "lost" IUD or, under certain conditions, an IUD which has pierced the wall of the uterus.
The embodiment of IUD illustrated in FIG. 8 is substantially identical to that illustrated in FIG. 2, with the sole exception that there is no transverse arm connecting the convoluted portions to the shank, and one of the convoluted portions does not end in a bulbous member. Rather, in the embodiment of FIG. 8, IUD 10 is formed of a shank member 16, which is identical with the shank member illustrated in FIG. 2, and contains embedded therein the permanent magnet 28. Shank 16 terminates at its lower end in the bifurcated legs 20 and 22, which have apertures formed therein through which the threads T are fastened to extend from the uterus into the vagina, to facilitate removal of the IUD.
The IUD 10" possesses two transversely extending arms I02 and 104, but unlike the counterpart arms of FIG. 2, these are not directly connected to the shank 16. Rather, the outer ends ol'the arms I02 and 104 are connected to the convoluted loop sections, generally designated I06 and I08, each of which comprises four interconnected vertical segments designated 110, I12, H4 and 116. The vertical section 116 which is closeest to the shank is connected to the shank by connecting member 118.
The embodiment of FIG. 8 functions in the identical manner as that of FIG. 2, the convoluted portions being capable of straightening out when the IUD is inserted in the applicator for insertion into the uterus. The convoluted portions 106 and 108 fill the uterus in the same optimal fashion as described with respect to the embodiment of FIG. 2, and because more convolutes are present in this embodiment, do a somewhat better job of filling the uterus. It will be appreciated that the end of horizontal members 102 and 104 will have to be curved, so as not to present any sharp surface which will in any way damage the uterus.
The embodiment of FIG. 9 is identical with that of FIG. 8, except that the shank contains a shorter magnet formed therein to allow for the medicament container which is formed within the IUD itself. The medication container is formed as a latex sleeve 122 located and formed in the bottom portion of the shank l6, and teminating in the globule portion I24 which extends beneath the shank and between the arm 20 and 22.
FIG. 10 illustrates another embodiment of the invention, similar to that illustrated in FIG. 9, except that the IUD does not terminate in bifurcated arms. Rather, in the manner illustrated in FIG. 3, the IUD merely terminates in the elongated shank. FIG. I0 better illustrates the manner in which the medication container 122 is formed in the end of the shank 16. It will be appreciated that the incorporation of the container into the shank of FIG. 10 is substantially the same as its incorporation into the shank of FIG. 9, with the exception that in the embodiment of FIG. 9, the globule is partly seated in suitable cut-outs from the bifurcated arms 20 and 22. Moreover, it is to be understood that the embodiment of FIG. 10 can be used with either of the arm configurations illustrated in FIG. 2 and FIG. 8.
The medicament container 122, which is formed in shank 16 has an elongated cylindrical portion 132, which is formed of latex. At the lower end of the cylindrical section 132 is the globular section 134, which is formed of Silastic material, the silicone elastomer described above. The medicament container may be prefilled with medicament. prior to insertion into the shank of the IUD, such as by leaving the upper end of the container open, and subsequently capping it with an end cap of latex which is heat or solvent sealed closed. Alternatively, because the Silastic material is resealable, after the container has been inserted and mounted or formed in the IUD, the medicament can be introduced into the container 122 by the introduction of a fine hypodermic needle into the Silastic globuel 134 for the purpose of introducing the appropriate quantity of medication, of the desired concentration, into the globule. The latex container portion may be pre-formed and mounted in the shank by the use of a suitable adhesive or solvent.
Because of the unique characteristic of the Silastic material, it will gradually release medicament contained in the container 122 into the surrounding body cavity. Therefore, in the embodiment illustrated in FIG. I0, whatever medicament is contained within the container 122 will be released into the mouth of the womb proximate the entrance of the uterus. A certain amount of this medication will migrate through the cervix into the vagina in the normal body fluids.
The use of the IUD containing medication in prolonged release form is particularly desirable from the standpoint of the prevention and cure of veneral diseases, such as syphilis and gonorrhea, which are extremely widespread, and which present an enormous health of epidemic proportions. It is well known that syphilis and gonorrhea organisms can be killed or controlled by the use of suitable antiobiotics or antibacterial agents, such as penicillin, erythromycin, and Rima tane, tetracycline, doxycycline and getamycin. Thus, by the gradual release of one of these antibiotics in situ, the syphilis or gonorrhea organisms present in the vagina or the uterus will be killed by the medication before they have an opportunity to grow.
The container 122 is filled with a quantity and concentration of a suitable antibiotic or antibacterial agent which will provide a continuous and sustained release of the agent during a period of about I to about 6 months, it being understood that the instantaneous amount of agent released from the container need only be small, because of the cumulative effect of the release over a substantial period of time.
The rate of release and duration of release of the medicament can be controlled by regulating the concentration of the medicament, the volume of medicament in the container 122, the size of the surface area of globule 134, and the thickness of the globule wall. Thus, these factors can be varied to suit the particular needs of the patient to provide for given rates of release and periods of release of the various medications.
In addition to the antibiotics described, it is also within the purview of this invention to incorporate in the container 122 an acid, such as lactic acid, which is known to be hostile to the gonococcus but is not injurious to the patient.
It is to be noted that with respect to any of the medicaments utilized, it will be necessary to have present in the vagina the minimum inhibitory concentration of the medication sufficient to use the inactivation or inhibition of the growth of the gonococcus organism or to cause its destruction or disintegration. Among the various gonococcus strains, the resistance of these strains to various medications can vary. In particular, the strains present in the Far East, such as the Neisseriae gonococcus are more resistant to treatment by medication than are the organisms which are indigenous to the western hemisphere. Accordingly, with respect to the more resistant organisms, it will be necessary to present a greater concentration of medication in container 122. It will, therefore, be appreciated that, when the IUDs of the invention are manufactured for use in different countries, they would be manufactured with a construction and medication which is designed to release the minimum inhibitory concentration of medication for the particular gonococcal organism in the area in which the IUD is to be used.
Once the IUD has been inserted in the uterus of the user, the medication in the container will be distributed during a period of from 1 month to 6 months or even 1 year. The particular period of release will be indicated on the package for the IUD, so that the physician can know when the effect of the medication will cease, and will advise the patient that it will be necessary to come into the physician's office for a reintroduction of medication into the IUD a reasonable period of time before the exhaustion of the contents of the container. Because the Silastic can be manufactured to be self sealing, new medication can be introduced by the physician by the utilization of a hypodermic syringe containing the desired volume of medication, and using a relatively fine needle, such as a 24, 25 or 26 gauge hypodermic needle. A hypodermic syringe with an appropriate size of needle and containing the necessary medication, in a quantity sufficient to fill the container 122 of the IUD can be prepackaged for disposable use for this purpose. In the instance of the embodiment illus trated in FIG. 10, the physician, in order to introduce the medication into the globule, would have to insert a vaginal speculum into the patient to expose the surface of the IUD, and pull down gently on the vaginal filaments T of the IUD until the globule I34 is exposed. The surface of globule 134 would then be painted with a suitable antisetpic solution, such as aqueous Zephiran or Betadine solution, after which the hypodermic sy ringe could be utilized to recharge the container 122 of the IUD.
FIG. II shows yet another embodiment of the invention which avoids some of the limitations of FIG. 10, in that the embodiment of FIG. 11 contains an elongated shank having a section 138, which is part of the shank, and which extends through the cervix and opens into the vaginal cavity itself. The outer diameter of this elongated section 138 is somewhat less than the outer diameter of the upper portion of the shank 16, which resides in utero, and the proximate end of the extension 138 extends into the vagina. Similar to the embodiment of FIG. 10, this IUD contains a latex container 140 for a suitable medication, and, because of the greater length of the extended shank 138, is capable of holding a substantially greater amount of medication for re lease into the vagina. As is seen in FIG. I], the globule 142 of Silastic material located at the proximate end of the shank extention 138 extends into the vagina, so that the medication for the control of the gonococcus or syphilis organism is more readily available in the vagina itself for purpose of killing the organism before it enters the cervix and to insure a maximum concentration of medication in the vagina per se.
The embodiment of FIG. 11 facilitates the introduction of additional medication into the container in the situation where the container is exhausted or almost exhausted, because with this embodiment it is not necessary to pull the IUD down from the cervix to expose the globule below the entrance to the cervix. Consequently, when it is desired to refill the embodiment of FIG. 11, it is merely necessary to cleanse the globule 142 with an antiseptic solution and subsequently to inject the charge of refill medication into the container.
It is to be noted that both embodiments of FIGS. 10 and I1 retain, located within the shank, the magnet 28, as described above, for the purpose of facilitating the location of the IUD, in utero, with the use of a ferrous sound.
It will be appreciated that numerous modifications and permutations of the invention disclosed herein may be made without departing from the spirit of scope of the instant invention. For example, other materials hav ing similar properties to those disclosed herein may be used efficaciously.
What is claimed is:
1. An intrauterine contraceptive device comprising:
a. a thin, elongated body member having a longitudinal axis, a proximal end and a distal end;
b, a pair of arms extending substantially transversely with respect to said axis, each arm having an outer end;
c. each of said outer ends terminating in a convolute member which extends downwardly toward the proximal end of said body member and inwardly toward said body member and having a connecting section connecting each convolute member to said body member;
(1. each of said convolute members including at least three substanially elongated leg segments substantially parallel to said body member and connected to substantially arcuatc segments; and
e. said body, arms and convolute members being formed of a flexible thermoplastic material.
2. An article as set forth in claim I, wherein said body member includes a container portion, integral there with and formed of latex, said container portion opening to the surface of said body member and terminating in an enlarged globular member of silicone elastomeric material capable of releasing therefrom uniformly and gradually over a prolonged period of time a medicament contained therein, said container portion being capable of being refilled by the introduction of medicament therethrough from a hypodermic syringe.
3. An article as set forth in claim 2 wherein said body member is of such length that it can extend through the cervix while the convolute member is seated in the uterus.
4. An article as set forth in claim 2, wherein said container is filled with a medically acceptable solution of an antiobiotic or antibacterial agent for the prevention, treatment or cure of the syphilis or gonorrhea organisms.
5. An article as set forth in claim 1, wherein the proximal end of said body member terminates in a pair of downwardly extending divergent, flexible legs.
6. An article as set forth in claim 5, wherein each of said legs is at an angle of approximately 5 with respect to the axis of said body member.
7. An article as set forth in claim 5, including at least two strands of thin, flexible material, each having a dis tal end, and means fastening the distal end of a strand to the proximal end of each of said legs,
8. An article as set forth in claim 1, wherein said body member includes, as an integral part thereof, an elongated member of a magnetic material occupying at least one-half of its length and at least 80% ofits crosssection.
9. An article as set forth in claim 8, wherein said magnet is located proximate the distal end of said body member.
10. An article as set forth in claim 1, wherein said arms extend in a direction which is substantially transverse to the axis of said body member, and said convo lute members having outer legs which are dependent from said arms, said convoluted members being generally sinusoidal in configuration.
11. An article as set forth in claim 1, wherein at least the surface of said arms, said convolute members, and a substantial portion of said body member are covered with a silicone elastomeric material.
12. An article as set forth in claim 1, wherein said article is formed ofa medically acceptable material having plastic memory, whereby said arms aand convolute members may be deformed to be substantially coextensive with the axis of said body and will, after such deformatron, return to their original configurations.
13. An article as set forth in claim 1, wherein each of said body member and convolute members are of rounded edge non-circular cross-section.
14. An article as set forth in claim 1, including a thin copper wire covering at least a portion of each of said convolute members, each of said copper wires having a surface area of at least millimeters.
15. An article as set forth in claim 1, wherein said thermoplastic materiai includes a radio-opaque material incorporated therein.
16. An article as set forth in claim 1, including at least one thin, flexible strand of material having a distal end, and means fastening said distal end to the proximal end of said body member.
17. An article as set forth in claim 1, wherein at least a portion of the surface of said article is formed of medically acceptable silicone elastomeric material having incorporated therein for controlled release in utero at least one compound selected from the group consisting of anesthetics, analgesics and anti-furtility agents.
18. Apparatus as set forth in claim 1, wherein said body member has maximum outside diameter of about 4 mm.
19. An intrauterine contraceptive device comprising:
a. a thin, elongated body member having a longitudinal axis, a proximal end and a distal end;
b. a pair of divergent arms connected to the distal end of said body, each of said arms terminating in a convolute member which extends downwardly toward the proximal end of said body and inwardly toward said body member;
c, each of said convolute members ending in a free end proximate said body member, one of said free ends being closer to said body member than the other and comprising a bulbous member;
. each of said convoluted members including at least three substantially elongated leg segments substantially parallel to said body member and interconnected by arcuate segments; and
e. said body, arms and convolute members being formed of a flexible thermoplastic material 20. An intrauterine contraceptive device compaising:
a. a thin, elongated body member having a longitudinal axis, a proximai end and a distal end;
b. a pair of short connecting arms connected to the distal end of said body member, each of said arms terminating in a convolute member which extends downwardly toward the proximal end of said body and outwardly from said body member;
c. each of said convolute members ending in a free arm remote from said body member and extending inwardly toward said body member proximate the distal end thereof;
d. each of said convoluted members including at least three substantially elongated, substantially linear leg segments substantially parallel to said body member and interconnected by arcuate segments; and
c. said body, arms and convolute members being formed of flexible thermoplastic material.
21. An article as set forth in claim 20, wherein the proximal end of said body member terminates in a pair of downwardly extending divergent, flexible legs.
22. An article as set forth in claim 21, wherein each of said legs is at an angle of approximately with respect to the axis of said body member.
23. An article as set forth in claim 20, wherein said arms extend in a direction which is substantially transverse to the axis of said body member, and said convolute members have outer legs which are dependent from said arms. said convoluted members being generally sinusoidal in configuration.
24. An article as set forth in claim 20, wherein at least the surfaces of said arms, said convolute members, and a substantial portion of said body member are covered with a silicone elastomeric material.
25. An article as set forth in claim 20, wherein said article is formed of a medically acceptable material having plastic memory, whereby said arms and convolute members may be deformed to be substantially coextensive with the axis of said body and will, after such deformation, return to their original configurations.
26. An article a set forth in claim 20, wherein each of said body member and convolute members are of rounded edge non-circular cross-section.
27. An article as set forth in claim 20, wherein at least a portion of the surface of said article is formed of medically acceptable silicone elastomeric material having incorporated therein for controlled release in utero at least one compound selected from the group consisting of anestetics, analgesics and anti-furtility agents.
28. An article as set forth in claim 20, wherein said body member includes a container portion. integral therewith and formed of latex, said container portion opening to the surface of said body member and terminating in an enlarged globular member of silicone elastomeric material capable of releasing therefrom uniformly and gradually over a prolonged period of time a medicament contained therein. said container portion being capable of being refilled by the introduction of medicament therethrough from a hypodermic syringe.
29. An article as set forth in claim 28 wherein said body member is of such length that it can extend through the cervix while the convolute member is seated in the uterus.
30. An article as set forth in claim 29, wherein said container member is filled with a medically acceptable solution of an antibiotic or antibacterial agent for the prevention, treatment or cure of the syphilis or gonorrhea organisms.