title: Unprotected intercourse in the 2 weeks prior to requesting emergency intrauterine contraception.
abstract: BACKGROUND
  Previous emergency contraception studies have excluded women who report >1 episode of unprotected or underprotected intercourse. Thus, clinical recommendations are based on exposure to a single episode of underprotected intercourse.
  
  
  OBJECTIVE
  We sought to assess the prevalence and timing of underprotected intercourse episodes among women requesting emergency contraception and to examine the probability of pregnancy following an emergency contraception regimen including placement of either a copper intrauterine device or a levonorgestrel intrauterine device with simultaneous administration of an oral levonorgestrel pill in women reporting multiple underprotected intercourse episodes, including episodes beyond the Food and Drug Administration-approved emergency contraception time frame (6-14 days).
  
  
  METHODS
  Women seeking emergency contraception who had a negative pregnancy test and desired either a copper intrauterine device or levonorgestrel emergency contraception regimen enrolled in this prospective observational study. At enrollment, participants reported the number and timing of underprotected intercourse episodes in the previous 14 days. Two weeks later, participants reported the results of a self-administered home pregnancy test.
  
  
  RESULTS
  Of the 176 women who presented for emergency contraception and received a same-day intrauterine device, 43% (n = 76) reported multiple underprotected intercourse episodes in the 14 days prior to presenting for emergency contraception. Women with multiple underprotected intercourse episodes reported a median of 3 events (range 2-20). Two-week pregnancy data were available for 172 (98%) participants. Only 1 participant had a positive pregnancy test. Pregnancy occurred in 0 of 97 (0%; 95% confidence interval, 0-3.7%) women with a single underprotected intercourse episode and 1 of 75 (1.3%; 95% confidence interval, 0-7.2%) women reporting multiple underprotected intercourse episodes; this includes 1 of 40 (2.5%; 95% confidence interval, 0-13.2%) women reporting underprotected intercourse 6-14 days prior to intrauterine device insertion.
  
  
  CONCLUSIONS
  Women seeking emergency contraception from clinics commonly reported multiple recent underprotected intercourse episodes, including episodes occurring beyond the Food and Drug Administration-approved emergency contraception time frame. However, the probability of pregnancy was low following same-day intrauterine device placement.
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT. Electronic address: Jessica.sanders@utah.edu.
authors.forename: Jessica N
authors.initials: JN
authors.lastname: Sanders
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors.forename: Laura
authors.initials: L
authors.lastname: Howell
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors.forename: Hanna M
authors.initials: HM
authors.lastname: Saltzman
authors.affiliation: University of California Davis Medical Center, Sacramento, CA.
authors.forename: E Bimla
authors.initials: EB
authors.lastname: Schwarz
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors.forename: Ivana S
authors.initials: IS
authors.lastname: Thompson
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
authors.forename: David K
authors.initials: DK
authors.lastname: Turok
mesh_terms: D000293:Adolescent; D000328:Adult; D003075:Coitus; D044363:Contraception, Postcoital / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage* / Q000627:therapeutic use; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D013997:Time Factors; D047568:Unsafe Sex / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: contraception; emergency contraception; family planning; intrauterine device; unprotected intercourse