Expulsions following 1000 GyneFix insertions

Context. The GyneFix intra-uterine device has been used in our family plann ing service since 1997. One of the perceived advantages is its low expulsio n rate, as reported by clinical trials. Objective. To calculate expulsion rates in routine clinical use and to look at possible reasons for expulsion. Design. Retrospective casenote analysis and opportunistic client consultati on. Setting. A city centre family planning clinic. Participants. The first 1000 GyneFix insertions. Main outcome measures. Parity of client, experience of clinician carrying o ut insertion, time from device insertion to expulsion. Results. Overall expulsion rate it-as 7.6%. There was no significant differ ence in parity of clients experiencing expulsion. Most (4.7%) expulsions we re early, occurring within 3 months of insertion. There was considerable va riation in early expulsion rate front one clinician to another. Later expul sions also occurred, tip to 28 months after insertion. Increasing experienc e of the inserting clinician led to lower rates of late expulsion. Unnotice d expulsion led to four unplanned pregnancies. Conclusions: The GyneFix expulsion rate in our service is higher than quote d in clinical trials. Early expulsions may be related to insertion techniqu e, representing insufficient implantation of the anchoring knot into the fu ndal myometrium. Late expulsions also occur, often many months after insert ion; the reason for these is unclear. Users should be taught to check for t he presence of the thread after each menstrual period and unnoticed expulsi on should be confirmed by ultrasound and abdomino-pelvic plain X-ra.