title: Failure to insert a levonorgestrel-releasing intrauterine system: a survey based on self-reports by Israeli gynecologists.
abstract: BACKGROUND
  The insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) requires experience and is associated with a low failure rate.
  
  
  OBJECTIVE
  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.
authors: Maccabi Health Care Services, Tel Aviv, Israel.
authors: Amos
authors: A
authors: Ber
authors: Daniel S
authors: DS
authors: Seidman
mesh_terms: D000293:Adolescent; D000328:Adult; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data; D003267:Contraception / Q000592:standards; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D004868:Equipment Failure / Q000706:statistics & numerical data*; D019544:Equipment Failure Analysis / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D007557:Israel; D016912:Levonorgestrel / Q000627:therapeutic use*; D057566:Self Report
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel