A proposed classification for intrauterine device position:the Tal-Reeves classification

The lack of a common system for classification of intrauterine device (IUD) position is problematic. In one study, where IUD position was determined by expert opinion alone, increased IUD removal resulted in more pregnancies, while no pregnancies occurred among those with a 'mal-positioned' IUD with no specific criteria used.1 In practice, physicians often see patients with IUDs located in different areas of the uterus and the position changes over time.2 After initial placement, some IUDs are found higher in the uterus while others are found lower. Aside from the multiple locations of the IUD in the uterus, unilateral or bilateral 'embedment' or penetration of the IUD's arms into the myometrium is also common. Patients using IUDs often present symptoms relating to the device including pain, menstrual cramps and bleeding. The symptoms may be related to the position of the IUD in the uterus and the amount of arm embedment into the myometrium, but without a system for classification of position, it is not possible to conduct adequate clinical research on the relationship between position and symptoms.