PIP: The first published paper on actual IUD insertions was made by Dr. Richard Richter in 1909 in Germany. The device he inserted was a ring made of silkworm gut, with 2 ends which protruded from the cervical os enabling him both to check the device and remove it. In the mid 1920s, Ernest Graefenberg the silkworm gut with a coiled metal ring made of an alloy of copper, nickel, and zinc. Although the Graefenberg ring was widely used, it was considered a risky method in continental Europe and in the U.S. As late as 1959, Dr. Alan Guttmacher co-authored a paper in which the IUD was condemned for its ineffectiveness, potential source of infection, and its carcinogenic potential. Since 1960, various kinds of IUDs have been developed, and various organization such as the Population Council showed a renewed interest in IUDs as a contraceptive method. In 1 study of IUD side effects data from 6,450 individuals, there were 10 deaths and 15 instances of intestinal obstruction due to the preforation of the intestine by the device; ectopic pregnancies occurred at 10 times the normal rate; however, the vast majority of 56,000 insertions showed the device was well tolerated. Copper devices, such as the Copper-T, promise an even brighter future for the IUD. It is not yet known how the IUD works, but a promising hypothesis is that it promotes the local formation of prostaglandins.