The use of hormonal contraception or a copper intrauterine device (IUD) significantly lowers the risk of ectopic pregnancy compared with use of condoms or no contraception, according to the results of a secondary analysis of the Contraceptive CHOICE Project (CHOICE) published in the American Journal of Obstetrics and Gynecology.1

The initial results of the CHOICE Project were first published in 2010; the study authors aimed to “introduce and promote the use of long-acting reversible methods of contraception [LARCS].”2 To build on this research, Paige Schultheis, BA, a medical student at the Indiana University School of Medicine, and colleagues calculated the number of ectopic pregnancies that occurred during use of various contraceptive methods. This information was collected in follow-up telephone surveys of CHOICE participants.

Through these surveys, researchers collected 20,381 person-years of follow-up data, during which there were 13 ectopic pregnancies. Seven participants reported ectopic pregnancies in the no contraception/condom group compared with 6 participants in the overall contraception group (4 using the levonorgestrel IUD [LNG-IUD], 1 using the copper IUD, and 1 using an oral contraceptive [OC]).

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The rate of ectopic pregnancy per 1000 person-years was 6.9 in the no contraceptive/condom group compared with 0.5 in the LNG-IUD group; 0.46 in the copper IUD group; and 0.22 in the contraceptive patch group, OC, or vaginal ring subgroups. No ectopic pregnancies were reported among participants choosing implant or depot medroxyprogesterone acetate (DMPA) methods.

Participants who used an LNG-IUD (hazard ratio [HR], 0.06), copper IUD (HR, 0.08), OC, contraceptive patch, or vaginal ring (HR, 0.04) had a reduced risk of ectopic pregnancy compared with participants who used no contraceptive methods or condoms.

The study authors pointed out that 75% of the cohort was using highly effective contraceptive methods; therefore, the total number of ectopic pregnancies available for analysis across each contraceptive method was inherently limited.

They noted, however, that CHOICE is one of the largest prospective cohort studies (N=9256) to analyze the effect of varied contraceptive methods on ectopic pregnancy rates. “Our study covers a wider range of contraceptive methods than previous studies, and the forms of contraception included in our study are more contemporary than currently included in previous literature,” the researchers said.

Disclosure: 2 authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


  1. Schultheis P, Montoya MN, Zhao Q, Archer J, Madden T, Peipert JF. Contraception and ectopic pregnancy risk: a prospective observational analysis. Am J Obstet Gynecol. 2021;224(2):228-229. doi:10.1016/j.ajog.2020.10.013
  2. Secura GM, Allsworth JE, Madden T, Mullersman JL, Peipert JF. The Contraceptive CHOICE Project: reducing barriers to long-acting reversible contraceptionAm J Obstet Gynecol. 2010;203(2):115.e1-115.e1157. doi:10.1016/j.ajog.2010.04.017