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There is continuing controversy over exactly how IUDs prevent pregnancy. Some researchers think pregnancy is controlled by preventing conception (fertilization), while others believe that the devices prevent embryo attachment to the uterine wall (implantation).

IUDs which release a hormone may prevent pregnancy in several ways. Since one hormonal response is a thickening of the mucous at the entrance to the uterus, it is more difficult for the sperm to gain entry. This prevents the sperm from reaching an ovum. At the same time, the lining of the uterus becomes thinner, making it more difficult for a fertilized egg to implant itself in the uterus. The copper device slowly releases copper which is believed to weaken and perhaps kill sperm. An alternate explanation is that these objects "sweep" the uterus, dislodging any fertilized egg that attempts to implant itself. In addition, both devices tend to cause a mild inflammatory reaction in the lining of the uterus which also has an adverse impact on implantation.

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