激素宫内节育器
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1 2 3 4 5 6 7  Dean G, Schwarz EB. . Hatcher RA, Trussell J, Nelson AL, Cates Jr W, Kowal D, Policar MS  (编).  20th revised. New York: Ardent Media. 2011: 147–191. ISBN 978-1-59708-004-0. ISSN 0091-9721. OCLC 781956734.  p.150:Mechanism of action
 Although the precise mechanism of action is not known, currently available IUCs work primarily by preventing sperm from fertilizing ova.26 IUCs are not abortifacients: they do not interrupt an implanted pregnancy.27 Pregnancy is prevented by a combination of the "foreign body effect" of the plastic or metal frame and the specific action of the medication (copper or levonorgestrel) that is released. Exposure to a foreign body causes a sterile inflammatory reaction in the intrauterine environment that is toxic to sperm and ova and impairs implantation.28,29 The production of cytotoxic peptides and activation of enzymes lead to inhibition of sperm motility, reduced sperm capacite journal and survival, and increased phagocytosis of sperm.30,31… The progestin in the LNg IUC enhances the contraceptive action of the device by thickening cervical mucus, suppressing the endometrium, and impairing sperm function. In addition, ovulation is often impaired as a result of systemic absorption of levonorgestrel.23
p. 162:
Table 7-1. Myths and misconceptions about IUCs
Myth: IUCs are abortifacients. Fact: IUCs prevent fertilization and are true contraceptives.
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。Active substances released from the IUD or IUS, together with products derived from the inflammatory reaction present in the luminal fluids of the genital tract, are toxic for spermatozoa and oocytes, preventing the encounter of healthy gametes and the formation of viable embryos. The current data do not indicate that embryos are formed in IUD users at a rate comparable to that of nonusers. The common belief that the usual mechanism of action of IUDs in women is destruction of embryos in the uterus is not supported by empirical evidence. The bulk of the data indicate that interference with the reproductive process after fertilization has taken place is exceptional in the presence of a T-Cu or LNG-IUD and that the usual mechanism by which they prevent pregnancy in women is by preventing fertilization.
↑  ESHRE Capri Workshop Group. . Human Reproduction Update. May–June 2008, 14 (3): 197–208. PMID 18400840. doi:10.1093/humupd/dmn003 .  温哥华格式错误 (帮助) p. 199:Mechanisms of action
Thus, both clinical and experimental evidence suggests that IUDs can prevent and disrupt implantation. It is unlikely, however, that this is the main IUD mode of action, … The best evidence indicates that in IUD users it is unusual for embryos to reach the uterus.
In conclusion, IUDs may exert their contraceptive action at different levels. Potentially, they interfere with sperm function and transport within the uterus and tubes. It is difficult to determine whether fertilization of the oocyte is impaired by these compromised sperm. There is sufficient evidence to suggest that IUDs can prevent and disrupt implantation. The extent to which this interference contributes to its contraceptive action is unknown. The data are scanty and the political consequences of resolving this issue interfere with comprehensive research.
p. 205:
Summary
IUDs that release copper or levonorgestrel are extremely effective contraceptives... Both copper IUDs and levonorgestrel releasing IUSs may interfere with implantation, although this may not be the primary mechanism of action. The devices also create barriers to sperm transport and fertilization, and sensitive assays detect hCG in less than 1% of cycles, indicating that significant prevention must occur before the stage of implantation.
↑  Speroff L, Darney PD. .  5th. Philadelphia: Lippincott Williams & Wilkins. 2011: 239–280. ISBN 978-1-60831-610-6.  pp. 246–247:Mechanism of action
The contraceptive action of all IUDs is mainly in the intrauterine cavity. Ovulation is not affected, and the IUD is not an abortifacient.58–60 It is currently believed that the mechanism of action for IUDs is the production of an intrauterine environment that is spermicidal.
Nonmedicated IUDs depend for contraception on the general reaction of the uterus to a foreign body. It is believed that this reaction, a sterile inflammatory response, produces tissue injury of a minor degree but sufficient to be spermicidal. Very few, if any, sperm reach the ovum in the fallopian tube.
The progestin-releasing IUD adds the endometrial action of the progestin to the foreign body reaction. The endometrium becomes decidualized with atrophy of the glands.65 The progestin IUD probably has two mechanisms of action: inhibition of implantation and inhibition of sperm capacite journal, penetration, and survival.
↑  Jensen JT, Mishell Jr DR. . Lentz GM, Lobo RA, Gershenson DM, Katz VL  (编). . Philadelphia: Mosby Elsevier. 2012: 215–272. ISBN 978-0-323-06986-1.  p. 259:Intrauterine devices
Mechanisms of action
The common belief that the usual mechanism of action of IUDs in women is destruction of embryos in the uterus is not supported by empirical evidence... Because concern over mechanism of action represents a barrier to acceptance of this important and highly effective method for some women and some clinicians, it is important to point out that there is no evidence to suggest that the mechanism of action of IUDs is abortifacient.
The LNG-IUS, like the copper device, has a very low ectopic pregnancy rate. Therefore, fertilization does not occur and its main mechanism of action is also preconceptual. Less inflammation occurs within the uterus of LNG-IUS users, but the potent progestin effect thickens cervical mucus to impede sperm penetration and access to the upper genital track.
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|  论 编激素避孕（英语：）（G02B, G03A） |
| --- | --- |
雄激素:  仅男性： Testosterone undecanoate  Trestolone 
雌激素:  己烯雌酚  雌二醇  Estradiol benzoate  Estradiol cypionate  Estradiol enanthate  戊酸雌二醇  炔雌醇  美雌醇  Ormeloxifene 
孕激素:  第一代： Estranes: 炔孕酮  Etynodiol diacetate  Lynestrenol  炔诺酮  醋酸炔诺酮  Norethisterone enanthate  异炔诺酮  Quingestanol 第二代： Estranes: Norethisterone enanthate  诺孕烯酮; Gonanes: 左炔诺孕酮  Norelgestromin  Norgestrel 第三代： Gonanes: 去氧孕烯  依托孕烯  Gestodene  Norgestimate 第四代： Estranes: Dienogest; Norpregnanes: Demegestone  Nomegestrol acetate  Promegestone  Trimegestone; Spironolactone derivatives: Drospirenone 其他： Pregnanes: Chlormadinone acetate  醋酸环丙孕酮  Medrogestone  醋酸甲羥孕酮  Megestrol acetate; Miscellaneous: 美服培酮  Ulipristal acetate; Ungrouped: Algestone acetophenide  地屈孕酮  孕三烯酮  孕酮  Proligestone 
宮內節育器（俗稱"螺旋）。
在骨盆放射攝影中可見到Mirena IUD。
Mirena®子宮內避孕器放大圖。