One of the greatest things about being Twitter’s resident OB/GYN is people send me crazy news stories that overlap with reproductive health as they are breaking. More often than not it is a story about some bizarre thing one shouldn’t put in one’s vagina, but today’s treat was a little different. This morning Alexandra Svokos sent me a nugget of information about Ivana Trump. Apparently the first Mrs. ex Donald Trump feels we Americans need to know that she says she got pregnant three times with an IUD in place.
So we are going to discuss IUDs and Trump sperm. Yes, I threw up in my mouth a little as well (and I guess one could say this post is still on theme about things one shouldn’t put in one’s vagina).
IUD failures are possible although rare with modern IUDs. The failure rates with the two modern American IUDs are very low, 0.1% in the first year with the levonorgestrel IUD and 0.8% with the copper. These IUDs perform very well over time and the failure rates do not go up, so don’t freak out too much about the Trump IUD failures.
Ivana’s IUDs (a sentence I truly never thought I would write, but I guess less bizarre than Trump sperm) would not have been the levonorgestrel IUD because she finished childbearing in 1984 and that IUD didn’t hit the market until 1990. We did have the Progestasert back in the day (a progesterone IUD), but it wasn’t very popular so it seems unlikely she would have used it. As a woman with money and a frequently traveler to Europe Ivana would not have been limited to the slim American IUD market of the late 70s and early 80s. She could have had one of a gazillion IUDs that were likely available at the time in Europe. Okay maybe not a gazillion, but there are about 30 or 40 IUDs (probably more) that have come and gone in Europe over the years while we have limped along in the U.S. with less than a handful.
Some European IUDs have a lower surface area of copper (defined as < 300 mm squared) which may impart a slightly higher failure rate, but we are still talking about failure rates of < 2%.
So why do IUDs fail? Well, not everything is perfect. Some failures are actually unrecognized expulsions. Sometimes the IUD slips down a little in the uterus so it isn’t in an ideal spot and if a copper IUD is sitting too low then there may not be enough copper in the Fallopian tubes to nuke any sperm that shoots past. If someone has a fibroid or a uterine anomaly the IUD may never have be positioned quite right to begin with. A low position may be a risk factor for failure although it may be less of a concern for the levonorgestrel IUD as that works on cervical mucus, but obvious if this happens to you then you need a discussion with your doctor about what is best for you! This is something that requires individualized management.
But three IUDs failing? Three separate devices failing three times? If I had a patient who failed an IUD twice I would definitely start looking for reasons, like a fibroid or a uterine anomaly. If I had a patient who had failed an IUD twice today I would likely suggest a different option.
The spacing between the end of Ivana’s first pregnancy (Donald Jr. in December 1977) and when she would have likely conceived Ivanka (early 1981) is about three years. If no other hormonal contraception was an option (birth control pills were higher dose then) and we all know 1979 Donald Trump hated condoms then it might have been reasonable to go with another IUD even after the second one failed as she did get three years of contraception out of the post-Donald Jr. device. Complex contraception needs (i.e. a woman who has failed an IUD twice and a male partner uwilling to wear a condom) requires individualized management.
Obviously this is all hypothetical as I have not seen any medical records, so who really knows? However, what I want to know is why tell us? I mean who cares about the Trump reproductive history of the late 70s and early 80s? How is my life and now yours enriched for knowing that if Ivana has indeed provided correct medical information that there is a something like a 0.0008% chance that she conceived three times with an IUD? I can think of two possibilities:
- Trumps are so super special! You had one pregnancy with an IUD, well I had three!! Putin may ride around shirtless on his horse and lift weights and wrestle bears, but The Donald, our President, has super-duper IUD busting sperm coming out of his Trump tower.
- An anti-abortion dog whistle. Three unplanned pregnancies and no abortions! While Donald may have been worried about what happened if Donald Jr. became a loser at least he made good on those unplanned pregnancies!
So there you have it. More than you could have ever wanted to know about what I think about Ivana Trump’s IUDs.