Pub Date : 2013-09-01DOI: 10.1586/17474108.2013.825477
D. Grossman
After more than a decade, the battle surrounding over-the-counter (OTC) access to emergency contraception (EC) in the USA has finally been won. Science trumped politics in the end, and women are now able to obtain OTC EC on the shelf, and not just in a pharmacy, but in other retail stores as well. Building on this victory, reproductive health advocates in the USA are now beginning to set their sights on the next advance in contraceptive access: OTC oral contraceptive pills (OCPs). OTC access to OCPs might sound revolutionary in the USA or Western Europe, but it is the reality for most women in the world. A recent analysis of prescription requirements for OCPs in 147 countries found that women can easily obtain pills in pharmacies without a prescription in most of these countries [1]. In only 31% of countries, a prescription is required to obtain OCPs. In 24% of countries, pills are formally available OTC, while some countries (8%) require a woman to undergo health screening by a pharmacy worker before pills are provided without a prescription. In 38% of countries, OCPs are technically in a class of drug that should require a prescription, but they are generally available informally in pharmacies without a prescription. A growing body of evidence from some of these other countries, as well as experimental research from the USA, indicate that OTC access to OCPs is both safe and effective. The main safety question is whether women can accurately identify contraindications to use without the assistance of a clinician. In two studies in the USA, women were able to accurately identify contraindications to combined OCPs using a simple checklist, although in one study, 7% of women had unrecognized hypertension that was not identified until they saw a clinician [2,3]. Women were much more accurate at identifying contraindications to progestinonly OCPs, a formulation that has fewer and rarer contraindications compared to combined OCPs [4]. OTC access to OCPs also may help women with method continuation by making it easier to get more supply. In a study from El Paso, Texas, women who obtained OCPs in Mexican pharmacies OTC were significantly less likely to discontinue their method over 9 months compared to women who obtained OCPs by prescription in clinics [5]. In another study from Kuwait, where OCPs are available without a prescription, OTC users had similar method continuation compared to women who used OCPs under the supervision of a physician [6]. Importantly, US women are interested in OTC access to OCPs. A recent nationally representative survey found that 37% of women at risk of unintended pregnancy said they would be likely to use an OTC OCP if one were available [7]. Interest was highest among current OCP users, of which 59% said they were likely to use an OTC pill. In addition, 28% of women using no method and 33% of those using a less effective method, such as condoms
{"title":"Should women have over-the-counter access to oral contraceptive pills?","authors":"D. Grossman","doi":"10.1586/17474108.2013.825477","DOIUrl":"https://doi.org/10.1586/17474108.2013.825477","url":null,"abstract":"After more than a decade, the battle surrounding over-the-counter (OTC) access to emergency contraception (EC) in the USA has finally been won. Science trumped politics in the end, and women are now able to obtain OTC EC on the shelf, and not just in a pharmacy, but in other retail stores as well. Building on this victory, reproductive health advocates in the USA are now beginning to set their sights on the next advance in contraceptive access: OTC oral contraceptive pills (OCPs). OTC access to OCPs might sound revolutionary in the USA or Western Europe, but it is the reality for most women in the world. A recent analysis of prescription requirements for OCPs in 147 countries found that women can easily obtain pills in pharmacies without a prescription in most of these countries [1]. In only 31% of countries, a prescription is required to obtain OCPs. In 24% of countries, pills are formally available OTC, while some countries (8%) require a woman to undergo health screening by a pharmacy worker before pills are provided without a prescription. In 38% of countries, OCPs are technically in a class of drug that should require a prescription, but they are generally available informally in pharmacies without a prescription. A growing body of evidence from some of these other countries, as well as experimental research from the USA, indicate that OTC access to OCPs is both safe and effective. The main safety question is whether women can accurately identify contraindications to use without the assistance of a clinician. In two studies in the USA, women were able to accurately identify contraindications to combined OCPs using a simple checklist, although in one study, 7% of women had unrecognized hypertension that was not identified until they saw a clinician [2,3]. Women were much more accurate at identifying contraindications to progestinonly OCPs, a formulation that has fewer and rarer contraindications compared to combined OCPs [4]. OTC access to OCPs also may help women with method continuation by making it easier to get more supply. In a study from El Paso, Texas, women who obtained OCPs in Mexican pharmacies OTC were significantly less likely to discontinue their method over 9 months compared to women who obtained OCPs by prescription in clinics [5]. In another study from Kuwait, where OCPs are available without a prescription, OTC users had similar method continuation compared to women who used OCPs under the supervision of a physician [6]. Importantly, US women are interested in OTC access to OCPs. A recent nationally representative survey found that 37% of women at risk of unintended pregnancy said they would be likely to use an OTC OCP if one were available [7]. Interest was highest among current OCP users, of which 59% said they were likely to use an OTC pill. In addition, 28% of women using no method and 33% of those using a less effective method, such as condoms","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"25 1","pages":"389-391"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91070367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.1586/17474108.2013.830840
J. Check
Women with diminished oocyte reserve do not have very poor oocyte quality similar to women of advanced reproductive age. The very poor pregnancy rates found in many studies of IVF-ET in this population seems to be related to the use of high-dosage FSH stimulation. The presence of significant elevated FSH levels leave many women more prone to FSH receptor downregulation. The best ‘hypothesis’ to fit the poor success rate found with high FSH stimulation is that FSH receptor downregulation leads to an insufficient production of a factor needed to prevent non-disjunction of chromosomes, leading to the creation of embryos with a high percentage of aneuploidy. Mild stimulation, to a reasonable degree obviates the problem with FSH receptors and results in the production of live healthy babies.
{"title":"Optimizing IVF outcomes for women with diminished oocyte reserve","authors":"J. Check","doi":"10.1586/17474108.2013.830840","DOIUrl":"https://doi.org/10.1586/17474108.2013.830840","url":null,"abstract":"Women with diminished oocyte reserve do not have very poor oocyte quality similar to women of advanced reproductive age. The very poor pregnancy rates found in many studies of IVF-ET in this population seems to be related to the use of high-dosage FSH stimulation. The presence of significant elevated FSH levels leave many women more prone to FSH receptor downregulation. The best ‘hypothesis’ to fit the poor success rate found with high FSH stimulation is that FSH receptor downregulation leads to an insufficient production of a factor needed to prevent non-disjunction of chromosomes, leading to the creation of embryos with a high percentage of aneuploidy. Mild stimulation, to a reasonable degree obviates the problem with FSH receptors and results in the production of live healthy babies.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"78 1","pages":"401-415"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81211219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-09-01DOI: 10.1586/17474108.2013.825481
M. V. Os, J. Ven, B. Kazemier, M. Haak, E. Pajkrt, B. Mol, C. Groot
Preterm birth is the most important cause of perinatal morbidity and mortality worldwide, and ranks among the top 10 of global causes of burden of disease. Since treatment of threatened preterm delivery has limited effectiveness, the focus is on primary and secondary prevention. Identification of risk indicators in early pregnancy provides the opportunity for preventive measures. To determine the potential impact of individualized risk indicators on the prediction of preterm birth, we reviewed the literature on this topic. Risk indicators for spontaneous preterm birth can be categorized in five groups; characteristics of the individual (ethnicity/race), characteristics of the fetus (fetal gender fetal number and chorionicity), obstetric history (history of preterm birth), modifiable risk indicators (social status, life style, infection) and signs of early labour; potential predictors (sonographic markers, biomarkes). Risk for preterm birth can be seen as a continuous transition from one state to the other...
{"title":"Individualizing the risk for preterm birth: an overview of the literature","authors":"M. V. Os, J. Ven, B. Kazemier, M. Haak, E. Pajkrt, B. Mol, C. Groot","doi":"10.1586/17474108.2013.825481","DOIUrl":"https://doi.org/10.1586/17474108.2013.825481","url":null,"abstract":"Preterm birth is the most important cause of perinatal morbidity and mortality worldwide, and ranks among the top 10 of global causes of burden of disease. Since treatment of threatened preterm delivery has limited effectiveness, the focus is on primary and secondary prevention. Identification of risk indicators in early pregnancy provides the opportunity for preventive measures. To determine the potential impact of individualized risk indicators on the prediction of preterm birth, we reviewed the literature on this topic. Risk indicators for spontaneous preterm birth can be categorized in five groups; characteristics of the individual (ethnicity/race), characteristics of the fetus (fetal gender fetal number and chorionicity), obstetric history (history of preterm birth), modifiable risk indicators (social status, life style, infection) and signs of early labour; potential predictors (sonographic markers, biomarkes). Risk for preterm birth can be seen as a continuous transition from one state to the other...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"325 1","pages":"435-442"},"PeriodicalIF":0.0,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76360780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/17474108.2013.811942
G. Secura, Colleen P McNicholas
. Although failure rates with perfect use can be very low, contraceptive methods that require a woman to remember to take medications, return to a clinic for an injection or secure refills result in typical-use failure rates that are much higher. For example, failure rates for the commonly used oral contraceptive pill (OCP) and depomedroxy progesterone acetate injection increase from 1% when used perfectly to 6–9% in real-world use
{"title":"Long-acting reversible contraceptive use among teens prevents unintended pregnancy: a look at the evidence","authors":"G. Secura, Colleen P McNicholas","doi":"10.1586/17474108.2013.811942","DOIUrl":"https://doi.org/10.1586/17474108.2013.811942","url":null,"abstract":". Although failure rates with perfect use can be very low, contraceptive methods that require a woman to remember to take medications, return to a clinic for an injection or secure refills result in typical-use failure rates that are much higher. For example, failure rates for the commonly used oral contraceptive pill (OCP) and depomedroxy progesterone acetate injection increase from 1% when used perfectly to 6–9% in real-world use","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"500 ","pages":"297-299"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91461968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/17474108.2013.811944
L. Webster, A. Shennan
{"title":"The potential of placental growth factor in the diagnosis and management of pre-eclampsia","authors":"L. Webster, A. Shennan","doi":"10.1586/17474108.2013.811944","DOIUrl":"https://doi.org/10.1586/17474108.2013.811944","url":null,"abstract":"","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"112 1","pages":"305-307"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79331613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/17474108.2013.811941
J. Grentzer, Colleen P McNicholas, J. Peipert
The single-rod, etonogestrel-releasing, subdermal implant (ENG implant) is the most effective, long-acting reversible method of contraception available. The failure rate of the ENG implant is 0.05%, which makes it more effective than female sterilization. It is discreet, easy to insert and remove, has no effect on future fertility and is associated with a number of noncontraceptive health benefits. The ENG implant is safe and effective when used in the postpartum and postabortion setting, and in women who have contraindications to estrogen. The most common reason cited for discontinuation is irregular and unpredictable bleeding. However, structured, preinsertion counseling can increase continuation and user satisfaction.
{"title":"Use of the etonogestrel- releasing contraceptive implant","authors":"J. Grentzer, Colleen P McNicholas, J. Peipert","doi":"10.1586/17474108.2013.811941","DOIUrl":"https://doi.org/10.1586/17474108.2013.811941","url":null,"abstract":"The single-rod, etonogestrel-releasing, subdermal implant (ENG implant) is the most effective, long-acting reversible method of contraception available. The failure rate of the ENG implant is 0.05%, which makes it more effective than female sterilization. It is discreet, easy to insert and remove, has no effect on future fertility and is associated with a number of noncontraceptive health benefits. The ENG implant is safe and effective when used in the postpartum and postabortion setting, and in women who have contraindications to estrogen. The most common reason cited for discontinuation is irregular and unpredictable bleeding. However, structured, preinsertion counseling can increase continuation and user satisfaction.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"68 1","pages":"337-344"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74371609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/17474108.2013.811939
David E Cantonwine, Russ Hauser, John D Meeker
Bisphenol A (BPA) is a high production volume chemical with adverse endocrine and reproductive health effects in toxicological studies. Despite widespread general population exposure to BPA, knowledge of its potential impacts upon reproduction and pregnancy in humans is limited. This paper reviews the current epidemiological literature on fertility and adverse pregnancy outcomes associated with BPA exposure. It also provides relevant resources for health care providers who are in a unique position to provide guidance in reducing exposure to this endocrine disrupting chemical.
{"title":"Bisphenol A and Human Reproductive Health.","authors":"David E Cantonwine, Russ Hauser, John D Meeker","doi":"10.1586/17474108.2013.811939","DOIUrl":"https://doi.org/10.1586/17474108.2013.811939","url":null,"abstract":"<p><p>Bisphenol A (BPA) is a high production volume chemical with adverse endocrine and reproductive health effects in toxicological studies. Despite widespread general population exposure to BPA, knowledge of its potential impacts upon reproduction and pregnancy in humans is limited. This paper reviews the current epidemiological literature on fertility and adverse pregnancy outcomes associated with BPA exposure. It also provides relevant resources for health care providers who are in a unique position to provide guidance in reducing exposure to this endocrine disrupting chemical.</p>","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"8 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1586/17474108.2013.811939","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31829552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/17474108.2013.811932
Maria C Di, V. Berghella
The risk of early birth increases markedly with decreasing cervical length (CL) in both singleton and multiple pregnancies. Transvaginal ultrasound of CL can be useful in determining women that are at risk of preterm delivery and may be helpful in preventing unnecessary intervention. Appropriate technique is essential for correct results. Factors that affect the value of CL in the prediction of spontaneous preterm delivery include gestational age, patient obstetrical and medical history, symptoms and the number of fetuses. The value of CL consists of identifying high-risk women for therapeutic strategies, to reduce the rate of spontaneous preterm birth, such as progestogens, cervical cerclage and more recently, cervical pessary. Progestogens and cervical cerclage are more effective in gestations with prior preterm birth.
{"title":"Cervical length for the prediction and prevention of preterm birth","authors":"Maria C Di, V. Berghella","doi":"10.1586/17474108.2013.811932","DOIUrl":"https://doi.org/10.1586/17474108.2013.811932","url":null,"abstract":"The risk of early birth increases markedly with decreasing cervical length (CL) in both singleton and multiple pregnancies. Transvaginal ultrasound of CL can be useful in determining women that are at risk of preterm delivery and may be helpful in preventing unnecessary intervention. Appropriate technique is essential for correct results. Factors that affect the value of CL in the prediction of spontaneous preterm delivery include gestational age, patient obstetrical and medical history, symptoms and the number of fetuses. The value of CL consists of identifying high-risk women for therapeutic strategies, to reduce the rate of spontaneous preterm birth, such as progestogens, cervical cerclage and more recently, cervical pessary. Progestogens and cervical cerclage are more effective in gestations with prior preterm birth.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"4 1","pages":"345-355"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86368095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/14787210.2013.811947
J. Stern
Transfer of multiple embryos for IVF was an early and important advance to improve procedure effectiveness. Along with the increase in live birth rate, this advance resulted in a three-decade long battle to counteract high rates of multiple delivery that have accompanied multiple embryo transfer. This review chronicles the history of the struggle in the USA to reduce the number of embryos transferred and the multiple births that resulted from this practice while continuing to strive for high live birth delivery rates in young as well as older patients. The positive and negative influences of law, professional guidelines, inadequate medical insurance and patient preference are discussed. Recent reporting strategies and technical advances in embryo selection that can help us achieve single embryo transfer are reviewed.
{"title":"An overview of temporal trends in multiple births after assisted reproductive technology in the USA","authors":"J. Stern","doi":"10.1586/14787210.2013.811947","DOIUrl":"https://doi.org/10.1586/14787210.2013.811947","url":null,"abstract":"Transfer of multiple embryos for IVF was an early and important advance to improve procedure effectiveness. Along with the increase in live birth rate, this advance resulted in a three-decade long battle to counteract high rates of multiple delivery that have accompanied multiple embryo transfer. This review chronicles the history of the struggle in the USA to reduce the number of embryos transferred and the multiple births that resulted from this practice while continuing to strive for high live birth delivery rates in young as well as older patients. The positive and negative influences of law, professional guidelines, inadequate medical insurance and patient preference are discussed. Recent reporting strategies and technical advances in embryo selection that can help us achieve single embryo transfer are reviewed.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"65 1","pages":"357-368"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78358868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1586/17474108.2013.811937
R. Moon, N. Harvey
{"title":"Maternal pregnancy vitamin D status and offspring musculoskeletal health","authors":"R. Moon, N. Harvey","doi":"10.1586/17474108.2013.811937","DOIUrl":"https://doi.org/10.1586/17474108.2013.811937","url":null,"abstract":"","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"26 1","pages":"301-303"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77869851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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