"Dr J. Lippes (Figure 3) is an example of the thoroughbred American (born at Buffalo, NY in 1925), who since 1957 has been Head of the Department of Obstetrics and Gynecology of the State University of New York at Buffalo. Although he had become acquainted with the Gräfenberg Ring in 1952, he had not dared to use it for fear of being accused of malpractice. Seven years later, two papers on intrauterine contraception appeared, both in English. The first, written by the Japanese gynecologist Ishihama and published in the Yokohama Medical Journal, gave an enthusiastic clinical assessment of the Ota Ring. In the second paper, Dr W. Oppenheimer of Jerusalem overviewed the results of three decades of personal experience with the modified Silk Ring. The fact that the latter paper had been accepted by the authoritative American journal of Obstetrics and Gynecology was perceived by Dr Lippes as a sign that intrauterine contraception had become a discussable subject in his country. That same year he started inserting Silk and Presea Rings under the auspices of the Buffalo PIanned Parenthood Center. The former device being too flexible, and the latter too stiff, Dr Lippes decided to remove the spokes from the Ota Ring and affix a piece of monofilament nylon to the IUD to facilitate removal and to allow the wearer to check that the device was still present. However, the modified Ring tended to rotate in utero and to wind the marker thread into the cavity, eliminating its intended uses. Therefore, to prevent IUD rotation, a radical change of shape was needed. After many experiments, the double-S Loop (the Lippes Loop) emerged in 1961. Due to its particular shape (trapezoid), the Lippes Loop fits the (relaxed uterine cavity snugly. The Lippes Loop was to become extremely popular and, of all first-generation IUDs, had the greatest worldwide impact."