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Background and Aim: IUD is a reliable and impermanent method of contraception. Sometimes the complications lead to its removal. The aim of this study was to determine the incidence rate of IUD failure and its side effects during four years (2002-2007) among women referring to gynecological clinics in Birjand.   Materials and Methods: In this descriptive- analytic study, all 500 IUD users that referred to Health centers were assessed. The questionnaire consisted of demographic characteristics and questions regarding side effects of IUD and the reasons for removal. The collected information was prepared as tables of figures after statistic analyzing by chi-square tests and regression logistic model ( α=0.05).   Results: According to the findings, the mean age of the subjects was 31.4±6.1 year, the mean duration of use was 47.3±24.1 months, mean number of deliveries was 2.5±1.3 and the failure rate was 0.8%. The most common side effects were frequent bleeding and spotting (24.2%), infection (17.4%), pain (9.8%), the reasons for removal were frequent side effects due to IUD use and desire of person. There was a meaningful relation between incidence chance and education (P=0.006) and type of IUD (P=0.02), but there was not a significant relation between occupation (P=0.21), age of person (P=0.06) and the number of deliveries (P=0.09) with having side effects.   Conclusion: The most common reason for IUD removal was side effects. These complications are preventable and education seems necessary to reduce them. The technicians should also receive sufficient training for insertion of IUDs, and thereby prevent early expulsions

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