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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Article info
Publication history
Published online: February 02, 2017
Accepted:
January 28,
2017
Received in revised form:
January 20,
2017
Received:
November 16,
2016
Footnotes
☆This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sector.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
