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Risk of luteal phase pregnancy with any-cycle-day initiation of subdermal contraceptive implants

  • Molly Richards
    Correspondence
    Corresponding author.
    Affiliations
    Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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  • Stephanie B. Teal
    Affiliations
    Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
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  • Jeanelle Sheeder
    Affiliations
    Section of Adolescent Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA

    Division of Family Planning, Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
    Search for articles by this author

      Abstract

      Objectives

      To determine rates of luteal phase pregnancy (LPP) in young women initiating subdermal implants on any day of the menstrual cycle.

      Study design

      We assessed a retrospective cohort of young women receiving contraceptive implants at an adolescent Title-X clinic. Patients with negative pregnancy tests were eligible for same-day insertion, regardless of cycle day, contraceptive use, or last intercourse. We computed LPP rates for those within manufacturer guidelines for insertion (≤5 days of menstrual onset or ≤7 days post-discontinuing hormonal contraception) and outside these guidelines. We reviewed medical records for last menstrual period (LMP), current hormonal contraception, emergency contraception (EC) provision, and pregnancy tests ≤12 weeks post-implant placement, or later evidence of pregnancy. For patients with positive pregnancy tests or reports, we used standard obstetrical dating (LMP and ultrasound) to determine if conception occurred ±2 weeks of implant placement.

      Results

      Of 3180 insertions, 1868 (58.8%) were outside recommended guidelines. Women with insertions within-guidelines were older (20.2 vs. 19.3 years; p<0.001) and more likely to be white (40.4% vs. 29.5%; OR=1.6, 95% CI: 1.4–1.9). Definitive pregnancy data was documented for 1726 patients: 660 (50.3%) in the within guidelines group, and 1066 (57.0%) in the outside guidelines group. Rates of LPP were 0.3% (2/660; 95% CI=0.0–1.1%) in the within guidelines group and 0.9% (10/1066; 95% CI=0.5–1.7%) in the outside guidelines group.

      Conclusion

      The risk of LPP following any-cycle-day insertion of contraceptive implants with negative pregnancy testing is low, regardless of menstrual cycle timing, recent contraceptive use or use of EC.

      Implications

      Adopting a protocol of contraceptive implant placement that includes insertion on any cycle day with a negative pregnancy test, and EC as indicated, does not increase the risk of luteal phase pregnancies, even in a young population with complex reproductive behaviors and challenging historical narratives.

      Keywords

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