Yes, a coil can migrate in your body

Promoters of the coil, also known as the IUD contraceptive, will normally say reports of it migrating in the body are nothing more than old wives tales.

But not so for a 34-year-old Kenyan woman who had her IUD disappear only to be discovered embedded far into the Fallopian tube.

The lady, a mother of one then, had visited the Accident and Emergency Department of a top private hospital in Nairobi complaining of vomiting and abdominal pains.

“We describe a case of a patient who presented with ruptured ectopic pregnancy and was found to have a LNG IUS embedded in the Fallopian tube,” says a team of doctors who attended to the patient. LNG IUS which stands for levonorgestrel-releasing intrauterine system, also commonly referred to as Mirena or hormonal coil, is one of two types of ‘coils’, the other being the Copper T.

While the latter releases copper to stop a pregnancy, Mirena releases hormones, and the devices can last for between three and 10 years.

The doctors, who attended to this woman, also say while migrating of the device is rare, it may happen but this was an even rarer case.

Malposition of an IUD, including, displacement, expulsion, rotation, or embedment the doctors say may happen but migration is uncommon. When it happens, the device may move into the colon or the urinary tract.

“Having an IUD embedded within a tubal ectopic pregnancy, like in this case is an even rarer phenomenon,” the team wrote last month (March 9, 2021) in the Journal of Medical Case reports.

Two years before the lady presented to the hospital’s emergency department, the doctors say she had been fitted with a LNG IUS by a gynaecologist.

“One year following insertion, she had a desire to conceive and was scheduled for removal of the LNG IUS device,” the doctors said.

However, when observed, the strings, normally attached to the device could not be seen, neither was it retrievable using forceps.

The patient was therefore sent for a pelvic ultrasound to locate the lost coil, but still the device could not be found.

“At this point, the patient was, however, lost to follow-up until she presented with symptoms of ruptured ectopic pregnancy.”

During the visit she had complained of vomiting and abdominal pain for the last three days all which had worsened on the day of presentation.

She reported several episodes of vomiting with associated loose stools, abdominal fullness and viginal bleeding that had started five days  earlier, explained the report.

On examination, the doctors say she was in good general health apart from some tenderness on the left side of the abdomen and some abnormal bowel sounds.

Ultrasound investigations had then indicated ruptured ectopic pregnancy. “The diagnosis at this point was a ruptured left tubal ectopic pregnancy.”

An ectopic pregnancy occurs when a fertilised egg attaches somewhere outside the womb and can cause life threatening bleeding if not attended to early enough.

The patient underwent a laparoscopy — a surgical procedure also known as keyhole surgery or minimally invasive surgery which normally requires very little incisions on the skin.

On surgery, a ruptured left ectopic pregnancy was identified while the whole coil was found embedded in the Fallopian tube.

The patient was treated and discharged the following morning with recovery reported to have been uneventful.

On follow-up, the patient had expressed the desire to conceive and consequently received appropriate counseling.

Three months later, the team reports the lady presented to the hospital with a five-week-old pregnancy, suggesting the epic journey was headed for a happy ending.

This team and other reproductive health experts are in agreement that the IUD is extremely effective in preventing pregnancy. Failure rate is put at less than one per cent and almost comparable to permanent sterilisation.

However, the doctors warn that if a pregnancy occurs while using this hormonal IUD, there is a high risk of it being an ectopic pregnancy.

“Current IUD use is a known risk factor for ectopic pregnancy,” says the expert team.

Other factors that can lead to an ectopic pregnancy include pelvic inflammatory disease (PID), previous tubal surgery, previous ectopic pregnancy, and smoking.

PID normally occurs when sexually transmitted bacteria spread into the various reproductive organs including the uterus, Fallopian tubes, or ovaries.

The LNG IUS is credited with other benefits such as reduced menstrual bleeding, anemia, and cramps.

However, data shows the uptake of IUD in Kenya is still low despite Mirena, for example having being in the country since 2010. Trending misconceptions about the coil that need to be addressed, says a Kenya market assessment by Marie Stopes International, include the “belief that the IUD will get lost in the body, fall out, or be implanted within the baby.”