Advances in contraception : the official journal of the Society for the Advancement of Contraception最新文献

The aim of this paper is to survey the current contraception use and analyze the sexual patterns in women above 35 years of age in India. Five hundred women, of whom 250 were at least 35 years old and 250 were less than 35 years old (control group) were interviewed with the help of a prepared questionnaire. A permanent surgical method of contraception had been accepted by 40.4% of women > or = 35 years old versus 16.8% of women < 35 years old. Of various temporary methods, an intrauterine device (IUD) was used by 5.2% and 22.8% oral contraceptive pills (OCs) by 1.2% and 9.6%, and natural methods by 6.4% and 3.2%, in women > or = 35 years and < 35 years, respectively. No contraception was used by 25.6% women > or = 35 years. A history of medical termination was given by 67.18% of non-contraceptive users vs. 27.41% of contraceptive users in women > or = 35 years. Coital frequency was noted at 4.32 times/month in women > or = 35 years but 7.2 times/month in women <35 years. Among contraceptive users > or = 35 years, coital frequency was 4.9 times/month compared with 3.9 times/month in non-contraceptive users. There is a high acceptance of irreversible sterilization and a high abortion rate in women > or = 35 years. Use of contraceptives was linked with increased sexual activity and a decreased abortion rate.

A study was performed to establish the tolerance, acceptability and associated efficacy of a levonorgestrel-releasing intravaginal ring (IVR) in a sample of British women requiring contraception. This was achieved with an open non-randomized prospective study of 1710 women aged 18-40 years, recruited in 75 centers geographically spread around the UK using an IVR designed to release 20 microg/day of levonorgestrel. Assessments were made at baseline, after 6 weeks, after 3 months and then 3-monthly. After initial insertion of the IVR, it was changed at 3-monthly intervals. A total of 1591 women were eligible for analysis, with 572 available after 12 months and 34 after 24 months of use. Life-table analysis revealed pregnancy rates of 5.1% and 6.5% at 12 months and 24 months, respectively. The IVR was rated as acceptable or very acceptable as a form of contraceptive by 60.7% of women at 12 months. The most common adverse events were menstrual disturbance, headache and vaginal discharge. No significant pattern of biochemical, hematological, microbiological or cytological abnormalities was found but vaginal erythematous lesions were noted at some centers. This IVR was found to be a generally well-accepted method of contraception with a failure rate comparable to some other progestogenonly methods. On this basis, further development of hormone-releasing intravaginal rings is justified.

Studies on the ultrastructure of the vas deferens have been carried out in control, vasectomized (6 and 24 months) and vasovasostomized (12 months) langur monkeys (Presbytis entellus entellus Dufresne). Vas deferens epithelium of the control animals depicted four types of cells, viz. the basal cells, principal cells, mitochondria-rich or apical cells and pencil or dark cells. The basal cells were short, cuboidal in nature with prominent nuclei, and contained sparse cytoplasmic organelles. The principal cells were characterized by the presence of nuclei with irregular outline and intranuclear electron-dense granules, well-developed Golgi bodies with prominent secretory vesicles, cisternae of rough endoplasmic reticulum, mitochondria, free ribosome particles, lysosomes and stereocilia in the cytoplasm, suggesting an active secretory role, as well as the absorptive functions of the cells. The mitochondria-rich cells consisted of numerous mitochondria, and other cytoplasmic organelles were sparse. The pencil cells were dark, slightly compressed and situated between the principal cells. Vasectomy resulted in reduction of cytoplasmic volume and vacuolization of the cytoplasm, especially in the Golgi region of the principal cells. Rough endoplasmic reticulum and mitochondria were poorly defined. Vasovasostomy showed no appreciable improvement in the configuration of the cytoplasmic organelles. The results suggest that a persistent reduced secretory activity of the cells following vasectomy and vasovasostomy might also be one of the factors responsible for unsuccessful vasovasostomy.

This paper summarizes ten years of experience with 2766 interval insertions of the TCu200 device. One hundred and twenty months of use were completed by 572 patients and the cumulative woman-months of use were 159,664. For evaluating the overall performance, gross cumulative and yearly specific life-table termination and continuation rates were calculated as suggested by Tietze [2]. The cumulative pertinent rates at the end of the ten-year follow-up period were as follows: pregnancy 10.2; expulsion 6.3; bleeding/pain 32.3; and removal for other medical reasons 19.4. The gross annual rates for the same conditions at the end of the first year of use were: 1.8, 2.4, 4.2, and 2.0, while in the tenth year they were: 0.6, 0.1, 4.4, and 2.8, respectively. The continuation rate was 89.1 at the end of the 12th month and 33.2 at the end of the 10th year. Based on this evaluation, the TCu200 IUD has a good overall performance and a longer lifespan than was previously expected.

In 1997, a random sample of Finnish men (n = 395) and women (n = 393) aged 18-50 years received a postal questionnaire concerning family planning, in which they were asked which contraceptive methods they had ever used and which three methods they considered to be best. Men's contraceptive preferences were compared to those of women. The response rate for men was 45% and for women 56%. The majority of both men and women had used, together with their partners, condom, oral contraceptives (OCs) and intrauterine devices (IUDs). The use of diaphragm, Norplant, Depo Provera and postcoital IUDs was not common. Among the men, 2-11% did not know whether their partner/partners had used the contraceptives in question. Concerning the three best contraceptive methods, men placed the condom first and women OCs. No male or female respondents rated postcoital emergency pills a superior method. Both men and women appreciated the most reliable means.

This study evaluated endometrial histology in women using the once-a-month injectable contraceptive Cyclofem for one year or more. The study received IRB approval. Seventeen Cyclofem users accepted to be submitted to an endometrial biopsy. All the samples were collected with an endometrial suction curette (Z-Sampler, ZSI Gynecological Product, Chasworth, CA, USA) in an outpatient clinic, 27-33 days after the last injection. The material was fixed immediately in Bouin solution prior to wax embedding and screened as a routine histological examination by a senior pathologist. The pathologist did not know the bleeding status of each woman or the number of injections each woman had received before the biopsy. All women recorded bleeding and spotting for the last 60 days prior to the biopsy. The mean age of volunteers was 25.9 years (range 21-32) and the mean number of injections received was 24.8 (range 14-47). The results were: 4 out of 17 biopsies were found to be inadequate for diagnosis because they consisted of only blood and mucus. Two of these women were bleeding regularly and the other 2 had amenorrhea. Eight endometrial samples presented a proliferative pattern and, in this group, 3 women had amenorrhea and 5 were bleeding regularly. The other 5 biopsies were reported as secretory endometrium, and 4 of them showed pseudodecidual reaction compatible with the administration of progestin. All of these women were bleeding regularly. The results of the biopsies were not related to the number of injections received nor to the age of the women. In conclusion, long-term administration of the injectable contraceptive Cyclofem did not produce adverse alterations in the endometrium as hyperplasia.

Insertion of intrauterine devices (IUDs) by trained health workers other than physicians is increasing, particularly in developing countries. Twenty nurse-midwives in government service in the Sudan, called health visitors (HVs), were trained to provide intrauterine contraceptives in a research project designed to evaluate the safety of insertion of IUDs by medical personnel who are not physicians. After training, they inserted 763 IUDs. Independent evaluation of 520 clients was conducted by gynecologists who found that only six devices (1.2%) had been incorrectly inserted. Outcomes for clients of the health visitors, with respect to perforations, infections, expulsions, and pregnancies, compared well with those of eight physicians who participated in the study. The research strongly supports the concept of nurse-midwife training for IUD insertion. This would greatly expand the availability of family planning services and would conserve physician time and skills for problem cases.

A non-surgical method of female sterilization is needed because many women are at high risk of complications with standard surgical methods, especially in developing countries. Also, some women who desire sterilization refuse it for fear of surgery. To meet these special needs, we initiated a trial of quinacrine sterilization (QS), a non-surgical method involving transcervical insertion of 252 mg quinacrine as pellets by a modified IUD inserter. Diclofenac (50 mg) was inserted with the quinacrine pellets. This insertion was repeated a month later and a 150-mg injection of depo medroxyprogesterone was administered at the time of the first insertion. One hundred and thirty-four women of reproductive age entered the trial. Of these, 92 were considered to be at high risk for surgery, 27 had refused surgery, and 15 had had failed surgical sterilization. Mean follow-up was 3.46 years. No pregnancies or serious complications were experienced. The main side-effect was menstrual irregularity, due probably to the depo medroxyprogesterone injection. QS is a suitable option for women at high risk of surgical complications.

Contraceptive efficacy, reversibility and toxicity, if any, of the benzene, chloroform and ethyl acetate chromatographic fractions of the chloroform extract of the seeds of Carica papaya have been investigated in adult male rabbits at a dose regimen of 50 mg/animal/day for 150 days of treatment. Body weight, semen analysis, hematology, serum clinical biochemistry and the fertility status of control and treated animals were evaluated. Chloroform and ethyl acetate chromatographic fractions did not produce appreciable changes in these parameters. However, the benzene chromatographic fraction resulted in uniform azoospermia after 15 days of treatment, which was maintained for the remainder of the 150-day observation period. The levels of fructose, glycerophosphocholine, acid phosphatase and lactate dehydrogenase in the seminal plasma were within the control range. Hematology and the serum clinical parameters showed no appreciable changes, indicating lack of toxicity. The libido of the treated animals was normal and the fertility rate was zero. Complete normalcy of altered parameters was observed 60 days following withdrawal of treatment. It is concluded that the benzene chromatographic fraction of the chloroform extract of the seeds of Carica papaya possesses reversible male contraceptive potential and the effects appear to be mediated through the testis.