Contraception and reproductive medicine最新文献

Background: This study examines the likelihood of contraceptive use among married women in sub-Saharan Africa, focusing on the influence of spousal age difference.

Methods: Binary logistic regressions predicting contraceptive use were estimated using a sample of 478,193 women in first union from 29 sub-Saharan African countries spanning two decades from 1999 to 2022. The data were sourced from the Demographic and Health Surveys (DHS).

Results: The regression results indicate that spousal age difference is negatively correlated with the likelihood of contraceptive use with each additional year reducing the odds of using contraception by 1.1 percent. The association between the two variables has remained largely consistent over time. The findings also show substantial variation in the influence of spousal age differences on contraceptive use ranging from statistically significant and negative odds in some countries to not statistically significant but positive odds in others. Measures of female autonomy, education and healthcare decision-making, had a modest influence on the size and significance of the association between spousal age difference and contraceptive use.

Conclusions: The relationship between spousal age difference and contraceptive use is of concern given the prevalence of age-disparate relationships in the context. These findings add to the literature on the potentially negative implications of age-disparate relationships, while highlighting that the association is not uniformly negative across countries.

Background: Adenomyosis can lead to infertility and failure of in vitro fertilization. Limited evidence suggests that the use of long-term treatment with gonadotropin-releasing hormone (GnRH) agonists followed by frozen-thawed embryo transfer (FET) may be the preferred approach for women with adenomyosis.

Objective: The aim of this randomized controlled trial is to compare the efficacy of an ultra-long GnRH agonist with standard downregulation in women with adenomyosis undergoing FET.

Materials and methods: This randomized controlled trial enrolled 72 women with adenomyosis diagnosed by sonographic criteria who underwent FET cycles at the Avicenna Infertility Center. These women were randomly assigned to two equal groups: one received GnRH agonist treatment for three months before the FET cycle and the other served as the standard downregulation group. Results were reported as chemical and clinical pregnancy rates.

Results: The two groups were similar in age, body mass index, anti-Müllerian hormone levels, number of previous pregnancies and miscarriages, presence of uterine myomas, and endometriosis. However, the total dose of estradiol used until embryo transfer was significantly higher in the ultra-long GnRH agonist group than in the standard group (96.14 mg vs. 80.52 mg, p-value = 0.004). Nevertheless, chemical and clinical pregnancy rates did not differ significantly between the two groups.

Conclusions: Ultra-long GnRH agonist downregulation did not improve the chemical and clinical pregnancy rate in the FET cycle in women with adenomyosis compared with standard GnRH agonist downregulation in the other words, ultra-long GnRH agonist downregulation is not superior to standard protocol. In women with adenomyosis (without history of endometriosis), downregulation of standard GnRH agonists prior to frozen-thawed embryo transfer may be the preferred embryo transfer protocol to gain higher clinical/chemical pregnancy rate.

Trial registration: Clinical trial registry: IRCT20160717028967N9, available at: https://irct.behdasht.gov.ir/trial/36103 .

Background: Women's intentions to use any contraceptive method are critical for better understanding their future needs and making them more likely to act on that intention. This study assessed the factors associated with the intention to use modern contraceptives among women of reproductive age in Benin.

Methods: This was a cross-sectional study that used the 2017-2018 Benin Demographic and Health Survey (BDHS). The study analyzed a weighted sample of 13, 582 women of reproductive age who were non-users of contraceptives. The intention to use contraceptives was the outcome variable. Multivariate logistic regression analysis was conducted to determine the factors associated with the intention to use contraceptives among women of reproductive age. The results were estimated using an adjusted odds ratios (aOR) with a 95% confidence interval (CI) and statistical significance set at p < 0.05.  RESULTS: Approximately 35.0% of the women had the intention to use modern contraception. We found that women aged between 30 and 34 (aOR = 0.70, 95%CI: 0.57, 0.86), 35-39 (aOR = 0.52, 95%CI: 0.42, 0.66), 40-44(aOR = 0.30, 95%CI: 0.22, 0.39) and 45-49 (aOR = 0.10, 95%CI: 0.07, 0.14), Muslim women (aOR = 0.68, 95%CI: 0.53, 0.85) and those who perceived the distance to a health facility not to be a big problem (aOR = 0.75, 95%CI: 0.67, 0.84) were less likely to have the intention to use modern contraceptives compared with their counterparts. On the other hand, women who attained primary (aOR = 1.21, 95%CI: 1.07, 1.36), secondary (aOR = 1.39, 95%CI: 1.21, 1.59), and higher education (aOR = 1.60, 95%CI: 1.13, 2.26), women who were employed (aOR = 1.39, 95%CI: 1.23, 1.57), women with no religion (aOR = 1.32, 95%CI: 1.04, 1.69), women whose partners were working (aOR = 1.69, 95%CI: 1.16, 2.44), women who heard about family planning in the media (aOR = 1.51, 95%CI: 1.16, 2.44), and women in the poorer (aOR = 1.31, 95%CI: 1.10, 1.54), middle (aOR = 1.42, 95%CI: 1.20, 1.67]), richer (aOR = 1.23, 95%CI: 1.03, 1.47), and richest households (aOR = 1.42, 95%CI: 1.15, 1.75) were more likely to have the intention to use contraceptives than their counterparts.

Conclusion: The study provides valuable insights into the intention to use contraceptives among women of reproductive age in Benin. The findings indicate that the proportion of women who have intention to use contraceptives remains low. The findings of this study could inform the development of targeted interventions and policies to increase access to and uptake of contraceptives in Benin, with the ultimate aim of improving the reproductive health and well-being of women and their families.

Background: We report a rare and unusual case of intravesical migration of an intrauterine device with stone formation. The intrauterine device (IUD) is the most common method of reversible contraception in women. However, its insertion is not without risk, it can cause early or late complications. IUD can perforate the uterus wall and migrate into adjacent structures.

Case presentation: A 35 year-old female 5 gravid, 4 para has been benefited from intrauterine contraceptive device (IUCD) 5 years ago, she was presented to gynecological consultation for chronic pelvic pain with urinary symptoms. There was history of a good IUD insertion 5 years ago, considered expelled after one month of its pose. Physical examination was normal, but a pelvic ultrasound and a plain abdominal radiography allowed the detection of an IUD outside the uterine cavity, but inside bladder. A diagnostic and therapeutic cystoscopy was performed, and the IUD with calculus was successfully removed. There were no postoperative complications.

Conclusion: This case is reported to highlight and to reiterate the need to think about one of the rare complication of IUD insertion, which every practitioner must know, it's the transuterovesical migration, before concluding wrongly to its expulsion. It's a consequence of, non-compliance with the rules for inserting an IUD and poor monitoring. The evolution towards calcification is a certain consequence; its screening involves rigorous clinical monitoring.

Objective: To investigate the association between a low oocyte maturity ratio from in vitro fertilization cycle and blastocyst euploidy.

Methods: A total of 563 preimplantation genetic testing (PGT) cycles (PGT cycles with chromosomal structural rearrangements were excluded) were performed between January 2021 and November 2022 at our center (average oocyte maturity rate: 86.4% ± 14.6%). Among them, 93 PGT cycles were classified into the low oocyte maturity rate group (group A, < mean - 1 standard deviation [SD]), and 186 PGT cycles were grouped into the average oocyte maturity rate group (group B, mean ± 1 SD). Group B was 2:1 matched with group A. Embryological, blastocyst ploidy, and clinical outcomes were compared between the two groups.

Results: The oocyte maturity (metaphase II [MII oocytes]), MII oocyte rate, and two pronuclei (2PN) rates were significantly lower in group A than in group B (5.2 ± 3.0 vs. 8.9 ± 5.0, P = 0.000; 61.6% vs. 93.0%, P = 0.000; 78.7% vs. 84.8%, P = 0.002, respectively). In group A, 106 of 236 blastocysts (44.9%) that underwent PGT for aneuploidy were euploid, which was not significantly different from the rate in group B (336/729, 46.1%, P = 0.753). However, euploid blastocysts were obtained only in 55 cycles in group A (55/93, 59.1%), which was lower than the rate in group B (145/186, 78.0%, P = 0.001). The clinical pregnancy rate in group B (73.9%) was higher than that in group A (58.0%) (P = 0.040).

Conclusion: Our results suggest that a low oocyte maturity ratio is not associated with blastocyst euploidy but is associated with fewer cycles with euploid blastocysts for transfer, lower 2PN rates, and lower clinical pregnancy rates.

Background: Sierra Leone is a religiously diverse country, with Christianity and Islam being the dominant faiths. This religious landscape plays a significant role in shaping attitudes towards family planning and contraceptives. We examined religious leaders' knowledge of family planning and modern contraceptive methods.

Methods: In September 2021, data was collected from 116 religious leaders in Sierra Leone, including 32 Muslims and 84 Christians from nine different denominations from sixteen districts, through 16 focus group discussions. The data was subjected to a thematic analysis using NVIVO 12 software.

Results: The study found a spectrum of opinions among religious leaders, both between religions (Christianity vs. Islam) and within denominations of Christianity. There was a general acceptance of natural birth spacing methods, like abstinence during fertile periods, across both Christian and Muslim leaders. Views on modern contraceptives were more divided. Catholics generally opposed them, citing religious doctrines against interfering with procreation. Pentecostals and some Muslims, however, found them permissible under certain circumstances, like promoting family well-being or spacing births for health reasons.

Conclusion: The study reveals that religious leaders' views on family planning in Sierra Leone are multifaceted. Understanding these nuances is crucial for designing effective family planning programs. By working with denominations that are more accepting of modern methods and leveraging the support for natural birth spacing methods across religions, there's potential to improve reproductive health outcomes in Sierra Leone.

Background: Given that South Africa has one of the highest rates of pregnancy amongst adolescent girls and young women (AGYW) globally, the provision of contraceptives to this group has been a key focus in recent years. Pregnancy prevention involves an on-going continuum of decision-making around contraceptive method choice, uptake, use, experience, continuation, and discontinuation.

Methods: This paper presents analysis of data from a cross-sectional survey with 2376 AGYW, as well as qualitative in-depth interviews (IDIs) with 54 AGYW, inclusive of contraceptive journey narratives. We examine the preferences, valued characteristics, choices, beliefs, understandings and experiences of choosing and using contraceptives amongst AGYW in two South African communities characterised by high rates of pregnancy.

Results: These findings shed light on the preferences towards, beliefs about, and experiences of choosing, using and discontinuing contraceptive methods amongst this population, with survey data suggesting that the most popular methods were the injection, followed by the implant, and then the oral pill. Findings illustrate the complexity and dynamic nature of contraceptive decision-making and the varied embodied and lived experiences of contraceptive use, and how these are impacted by contraception service provision.

Conclusions: Our findings show that contraception experiences of each individual are cumulative, and comprise a continuum of method initiation, use, discontinuation, method switching and on-going circular decision-making influenced by multiple social, structural, contextual and interpersonal factors, combined with shifting preferences, values and needs. To maximise the use of contraceptives amongst South African AGYW, it is necessary to provide responsive contraception service provision to reflect the changing contexts and preferences of users, in order to ensure that pregnancy prevention needs are catered for throughout their reproductive life course.

Background: Early implant removal not only results in method wastage and strains healthcare resources but also exposes women to the risk of unplanned pregnancies and associated complications if an alternative contraceptive is not promptly adopted. Studies have demonstrated that prevalence and factors associated with contraceptive use vary across different cultures and regions even within Uganda. We determined the prevalence and associated factors of early implant removal, among women attending public family planning clinics in Mbarara City, southwestern Uganda.

Methods: We conducted a cross-sectional study from April to July 2023 at four public family planning clinics in Mbarara City. We consecutively enrolled women and administered a questionnaire to obtain data on demographic, and medical characteristics. We defined early removal as implant discontinuation within a period < 2 years. We excluded women who did not have a written record of the date of insertion of the contraceptive implants. We used modified Poisson regression analysis to determine factors associated with early implant removal.

Results: We enrolled 406 women, with a mean age of 29 ± 6 years. The prevalence of early contraceptive implant removal was 53% (n = 210; 95%, CI: 48-58%). Factors associated with early implant removal were experiencing side effects (adjusted prevalence ratio [aPR] = 1.63, 95% CI: 1.20-2.21), inserting an implant to achieve career goals (aPR = 1.88, 95% CI: 1.26-2.81) and intending to use the implant for < 24 months (aPR = 1.36, 95% CI: 1.11-1.66).

Conclusion: Approximately half of the surveyed women removed their contraceptive implant early. Women who experienced side effects, chose an implant due to career obligations and those whose intended implant use was < 2 years were more likely to have an early contraceptive implant removal compared to their counterparts. We recommend strengthening of pre- and post- insertion counselling to address concerns among those who may experience side-effects. Women who intend to use implants for < 2 years and those who have career obligations should be encouraged to use short-acting methods as an option.

Background: Globally, modern contraceptives remain underutilized among postpartum mothers resulting in the rise of short birth intervals. While there are a range of other factors that moderate the uptake of contraceptive services, understanding the significance of their influence is critical in public health programming. This study sought to analyze maternal and health facility factors influencing the utilization of contraceptives among postpartum mothers in urban areas of Uganda.

Methods: Using a cross-sectional study design, a health facility-based study in urban areas of Kampala was conducted from January to March 2023. A total of 332 women aged between 15 and 22 years were randomly selected for the interviews using semi-structured questionnaires. The data was analyzed using a statistical software program R version 4.1.2. Chi-square and multivariable logistic regression were used to determine factors associated with postpartum contraceptive intake among adolescent mothers.

Results: Overall, 28.3% of contraceptive usage was reported in the current study. The majority of the respondents, 98 (29.52%), were within the age group of 17-18 years, and the unmarried were 255 (76.81%). Factors associated with contraception use were income below UgX 500,000 (OR 4.546; CI 1.785-12,193, p = 0.002), occupation status of housewife and student (OR: 3.526; CI: 1.452-8.812, p = 0.006), distance of less than 5 km from health facility (OR: 2.62; CI 1.97-3.55; p = 0.028), and having a contraceptive preference (OR: 3.526; CI: 1.452-8.812, p = 0.006).

Conclusions: Contraceptive use is low among adolescent post-partum mothers. Income, occupation status, proximity to a health facility, and preference for a particular contractive method are factors associated with contraceptive use in this study. Understanding attitudes and views regarding contraception use is therefore essential for creating effective interventions, given the detrimental effects of adolescent pregnancy.

Background: Loss of Intra Uterine Device (IUD) following silent perforation of the uterus either during or after IUD insertion is an uncommon finding due to a lack of immediate follow-up. We report a rare case in which uterine perforation following the migration of IUD to the right fallopian tube without visceral injury. The patient presented with lower abdominal pain and pain during sex for one year since IUD insertion. On examination, we noted tenderness on the right suprapubic region and on speculum examination, no IUD thread was seen. A radiological pelvic examination showed an empty uterus without an IUD. Laparotomy and retrieval of migrated IUD was done followed by repair of perforated uterus.

Conclusion: Migrated IUD with silent uterine perforation without visceral injury is a distressing clinical condition both to the patient and the clinician. This case is reported to increase awareness in doing immediate vaginal examination and pelvic ultrasound post-IUD insertion.