Failure to insert a levonorgestrel-releasing intrauterine system: a survey based on self-reports by Israeli gynecologists.

BACKGROUND The insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) requires experience and is associated with a low failure rate. OBJECTIVES To assess the reasons given by gynecologists why they failed to insert a LNG-IUS. METHODS We obtained data from the sole distributor in Israel that prospectively recorded these cases when contacted by gynecologists following an insertion failure. RESULTS The mean rate of failed insertions was 0.95% (range 0.77-1.03%) for the 5 year study period 2006-2010. The most common reasons reported by gynecologists for LNG-IUS insertion failure were loss of sterility of the device, inability to insert the device due to a stenotic cervical canal, accidental removal of the device following a successful insertion due to hasty removal of the inserter or the use of blunt scissors, and removal of the newly inserted LNG-IUS following ultrasound evidence that it was misplaced. CONCLUSIONS Gynecologists should be aware of the common pitfalls associated with insertion of an LNG-IUS. Several techniques that may aid in avoiding these mishaps are described.