**Question:** All the following are contraindications for Cu containing IUCD's except

A. Pregnancy
B. Allergy to copper
C. Breastfeeding
D. Patient refusal

**Core Concept:**
Contraceptive intrauterine devices (IUCDs) are long-acting reversible contraceptives used to prevent pregnancy. Cu containing IUCDs, such as the CuT 380A, contain copper which acts as a foreign body and induces a foreign body response that prevents sperm from reaching the uterus and fertilizing the egg.

**Why the Correct Answer is Right:**
A. Pregnancy: Cu containing IUCDs can be safely inserted after a woman has completed childbearing and is post-menopausal. In pregnancy, the Cu containing IUCD can cause miscarriage, perforation of the uterus, or even fetal copper poisoning.

B. Allergy to copper: Copper is a known allergen, and inserting an IUCD into a patient with a known allergy to copper can lead to severe reactions such as anaphylaxis or local inflammation.

C. Breastfeeding: Inserting a Cu containing IUCD can potentially lead to a drop in milk production due to hormonal changes. This is not considered a contraindication for IUCD insertion, but should be discussed with the patient and a decision made considering individual circumstances.

D. Patient refusal: If a patient refuses to use any contraceptive method, including IUCD, then inserting an IUCD would be considered inappropriate.

**Why Each Wrong Option is Incorrect:**
A. Pregnancy: As mentioned above, inserting a Cu containing IUCD in a pregnant woman is a contraindication due to potential complications for both the mother and the fetus.

B. Allergy to copper: Copper is a known allergen, making this patient a high-risk candidate for severe reactions upon insertion.

C. Breastfeeding: While breastfeeding is a contraindication, it is important to discuss this with the patient, as individual circumstances should be taken into account before deciding against inserting an IUCD.

D. Patient refusal: If a patient refuses to use any contraceptive method, the physician should respect the patient's choice and not proceed with inserting an IUCD.

**Clinical Pearl:**
Inserting an IUCD in a patient with a known allergy to copper is particularly dangerous due to the risk of severe reactions. In other situations where patient refusal is involved, it is crucial to ensure patient autonomy and respect their decision while providing proper counselling on the benefits and risks of the method, and offering alternative methods if needed.