Contraception and reproductive medicine最新文献

Background: The progestin norethisterone (NET), which is structurally related to testosterone, and its enanthate form (NET-EN), are used in contraception in women. Oral NET has been shown to interfere with testosterone measurements by some chemiluminescence microparticle immunoassays (CMIA). However, whether serum NET in NET-EN users interferes with these assays is unknown.

Methods: Serum samples were obtained from women randomized to the injectable contraceptives NET-EN or depo medroxyprogesterone acetate intramuscular (DMPA-IM) in a clinical trial conducted in South Africa. Testosterone concentrations were compared after measurement by Abbott Architect CMIA and ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS), from matched samples collected at baseline (D0) and 25 weeks (25W) after initiation.

Results: At 25W, testosterone concentrations in the NET-EN arm were significantly higher (271%) using the CMIA compared to the UHPLC-MS/MS method. Contrary to the UHPLC-MS/MS results showing a significant decrease in testosterone concentrations in the NET-EN arm from D0 to 25W, a significant increase was determined by CMIA. Conversely, in the DMPA-IM arm at 25W, no significant difference in testosterone concentrations between the two methods was detected, and both methods showed a significant decrease in testosterone from D0 to 25W.

Conclusions: We show for the first time that physiological concentrations of NET in premenopausal NET-EN users interfere with testosterone quantification using a CMIA method. The degree of interference is much higher and occurs at lower concentrations of NET than has previously been reported for oral NET and confounds the biological outcome of NET-EN use on testosterone concentrations, individually and relative to DMPA-IM.

Trial registration: The WHICH trial was retrospectively registered with the Pan African Clinical Trials Registry (PACTR 202009758229976).

Background: Family planning (FP) promotes sustainable population growth and enhances societal well-being. Despite its recognized importance, the quality of life (QoL) of women utilizing modern FP methods in Rwanda remains underexplored. Women's experiences and perceptions of contraceptive methods significantly influence their uptake and continued use.

Objective: This study aimed to assess the QoL of women using modern FP methods in Rwanda.

Methodology: A multicenter cross-sectional study was conducted involving 415 women who had been using modern FP methods for at least six months. Participants were recruited from the University Teaching Hospital of Kigali (CHUK) and four selected Health Centers in Rwanda. The Short-Form 36 (SF-36) Health Survey was used to evaluate the QoL. Data analysis was performed using the R programming version 4.0.2.

Results: Participants reported overall favorable QoL across all domains. Social functioning scored the highest (94.16%, SD = 17), while physical functioning scored the lowest (80.6%, SD = 34.45). Women aged 32-38 had significantly higher QoL scores in role functioning, including social functioning, role functioning due to physical issues, and role functioning due to emotional issues (p < 0.001, p = 0.014, and p = 0.034, respectively). The type of FP Method was strongly associated with QoL outcomes in all domains, with Intrauterine Devices (IUDs) correlating with the highest scores, particularly in physical functioning (p < 0.001). Rural women reported better general health (p < 0.001) compared to their urban counterparts.

Conclusion: Women using modern FP methods in Rwanda generally reported a high QoL. Both the FP method type and age significantly influenced QoL outcomes. Thus, there is a need to promote the universal use of Modern FP methods among women of reproductive age in Rwanda.

Background: Copper Intrauterine contraceptive devices (IUDs) and hormonal implants are the two most known safe, convenient, highly effective and long-acting reversible contraceptive methods worldwide that prevent pregnancy for all ages without demanding user action. Regardless of these advantages, its utilisation are low among sexually active women in Nigeria. Thus, this study examines trends, levels and predictors of long-acting reversible contraceptives (LARC) among married women of reproductive age in Nigeria.

Methods: The study used pooled four (4) round of the individual women recode (IR) datasets of the Nigeria Demographic and Health Surveys (NDHS) across four-time points (2003-2018). A weighted sample size of 17,483 sexually active married women of reproductive age (15-49 years) comprising 962, 4839, 5963, and 5719 respondents for 2003, 2008, 2013, and 2018 respectively. Data were analysed using frequency tables, charts, chi-square test of independence and binary logistic regression at 95% confidence intervals (CI) and p < 0.05 to determine predictors of LARC use among respondents in Nigeria.

Results: There was a monotonic upward trend using LARC from 4.7 to 21.7% across the survey years (2003-2018). Generally, LARC use within the reference period (2003-2018) increased by 51.1%. Remarkably, in the same period, the use of IUDs decreased by 12.8% while the use of Implant/Norplant increased by 17,500%. Sexually active married women (15-49) who were working (aOR = 1.4, [95% CI = 1.1, 1.7]; p < 0.01), and those who were exposed to mass media (aOR = 1.2, [95% CI = 1.1, 1.4]; p < 0.05) want more children (aOR = 2.2, [95% CI = 1.8, 2.6]; p < 0.001), visit to health care centres in the last 12 months (aOR = 1.2, [95% CI = 1.0, 1.4]; p < 0.01), within the middle wealth quintiles (aOR = 1.4, [95% CI = 1.0, 1.9]; p < 0.05), and from the North West (aOR = 1.9, [95% CI = 1.5, 2.5]; p < 0.001) had statistically significant higher odds of LARC use compared with those who were not working, exposed to mass media, want no more children, visit health care services, poorest wealth quintiles, and from the North Central respectively.

Conclusion: Even though there is evidence of improvement in the use of LARC, policies and programmes should be directed towards the identified groups to increase the availability, accessibility, and uptake of LARC in Nigeria. Uptake of IUDs and the use of Implant/Norplant should be encouraged through the support and training of private healthcare providers by governmental and non-profit governmental organizations.

Background: Botswana is one of the countries in SSA with the lowest total fertility rate. This study aimed to explore the uptake and correlates of modern contraceptive use among women of reproductive ages (15-49 years) in Botswana.

Methods: The study used secondary data from the 2017 Botswana Demographic Survey. The study used a weighted sample of 1,120,008 women aged 15-49 years, who successfully completed the Botswana Demographic Survey questionnaire. Logistic regression models were used to derive adjusted odd ratio as the measures of association between need, predisposing and enabling factors, and modern contraceptive use among women. All comparisons are considered statistically significant at p > 0.01.

Results: From the 1,120,008 women included in the analysis, contraceptive prevalence was estimated at 80.4%. The most used methods of contraception among the sampled women were condoms (64.2%), followed by injectables (17%) and pills (12.6%). After controlling for confounders, the odds of contraceptive use were significantly higher among women aged 15-24 years (AOR = 1.41; 95% CI: 1.36-1.46) and 25-34 years (AOR = 1.78; 95% CI: 1.73-1.83), compared to women aged 35-49 years. Other significant correlates of contraceptive use included residing in rural areas (AOR = 0.94; 95% CI: 0.91-0.96), having primary (AOR = 1.82; 95% CI: 1.59-2.08) or secondary education (AOR = 2.41; 95% CI: 2.21-2.62), and accessing contraceptives from health facilities (AOR = 1.28; 95% CI: 1.24-1.68), compared to their respective counterparts. Conversely, after adjusting for confounders, the odds of contraceptive use were significantly lower among women who identified as Christians (AOR = 0.91; 95% CI: 0.88-0.94), those of other non-Christian religions (AOR = 0.80; 95% CI: 0.75-0.86), married women (AOR = 0.85; 95% CI: 0.83-0.87), and women who reported experiencing complications (AOR = 0.27; 95% CI: 0.26-0.28), compared to their respective counterparts.

Conclusion: The study reveals a high contraceptive prevalence (80.4%) among women, with condoms being the most used method. Younger women (aged 15-34), those with formal education, and those accessing services from health facilities were more likely to use contraceptives. However, contraceptive use was significantly lower among women in rural areas, those identifying with religious affiliations (both Christian and non-Christian), married women, and those who had experienced complications. These findings highlight the need for targeted interventions that address religious beliefs, marital dynamics, healthcare access in rural areas, and management of contraceptive-related complications.

Background: Modern contraceptives have proven to be more scientifically effective at preventing unwanted pregnancies than the traditional methods. However, there is dearth of evidence on teenage girls' contraceptive use and associated factors in Ghana.

Objective: This study sought to examine teenage girls (15-19 years) contraceptive use and associated factors using a nationally representative data from the Ghana Living Standards Survey 7 (GLSS7).

Methods: The study analyzed data from GLSS7, involving 3233 15-19 year-old teenagers. Using a cross-sectional design, descriptive statistics, chi-square tests, and multiple regression were performed to analyze factors influencing contraceptive use. Stata software version 16 was used, with statistical significance set at p ≤ 0.001.

Results: Out of a total of 3,233 teenage girls aged 15-19years, the majority were in the primary level of education (71.59%). Furthermore, more than two-thirds of the participants were Christians (75.83%). The results showed that only 12.87% of teenage girls reported current contraceptive use. Religion, type of residence, region, wealth index and marital status was found to have a relationship with modern contraceptive use. Also, majority of the respondents preferred modern contraceptive methods (85.60%) as compared to traditional methods (14.40%). The region was significantly associated with preferences for modern contraceptive use. Teenage girls in the Central and Volta regions had 88% and 89% lower odds of preferring modern contraceptive use, respectively as compared with those in the western region. Moreover, marital status was found to have a significant association with barriers to contraceptive use. Teenage girls that were not married had 88% lower odds of having barriers to contraceptive use as compared to those that were married.

Conclusion: The study suggests that the government through the Ministry of Health (MOH) should establish targeted community-based awareness campaigns and enhance access to adolescent-friendly family planning services to increase contraceptive uptake.

Adolescent pregnancy remains a critical public health challenge in Ghana, accounting for a significant proportion of unintended pregnancies, unsafe abortions, and adverse health outcomes. This study explored urban-rural differences in caregivers' willingness to support adolescent girls' contraceptive use, focusing on Awutu Senya East (urban) and Jaman North (rural) districts. A cross-sectional comparative design was employed, involving 366 caregivers. Data were collected using structured surveys and analyzed through descriptive, comparative, and modified Poisson regression techniques. Findings revealed that 68% of caregivers expressed willingness to support adolescent contraceptive use, with higher support in rural areas (76.2%) than in urban areas (63.5%). Key factors influencing caregiver willingness included gender, residential setting, and income level. Female caregivers and those in rural settings demonstrated greater support, while cultural beliefs significantly shaped attitudes toward contraceptive use. Caregivers cited pregnancy prevention, STI reduction, and health improvement as primary motivations for support, while concerns about promiscuity, infertility, and cultural or religious objections were common barriers. The study highlights the importance of addressing socio-cultural misconceptions, enhancing caregiver knowledge, and fostering supportive attitudes through targeted interventions. This study recommends community-based education, affordable contraception policies, and integrated family planning initiatives to enhance caregiver support and improve adolescent reproductive health outcomes.

Background: Improving the endometrial thickness (EMT) and pregnancy outcomes in cases of thin endometrium (TE) induced by severe intrauterine adhesion (IUA) is a significant clinical challenge. This report provides insight into a potential protocol for improving EMT and pregnancy outcomes in challenging cases of TE induced by IUA, especially for patients with concurrent polycystic ovary syndrome (PCOS) and experiencing recurrent spontaneous abortion (RSA).

Case presentation: We report the case of a 29-year-old woman with severe IUA, RSA, and PCOS, who experienced three spontaneous abortions. Copy number variations (CNV's) detection of fetal villi from the last abortion indicated Turner syndrome. Hysteroscopic adhesiolysis (HA) had been performed twice previously. She subsequently underwent superovulation using an antagonist regimen, resulting in oocyte retrieval and cryopreservation of four transplantable blastocysts after genetic testing. After three rounds of HA, the uterine cavity shape returned to normal. She then received two cycles of Femoston and/or estradiol valerate therapy combined with oral low-dose aspirin, vaginal sildenafil, pelvic floor electrical stimulation, and uterine perfusion platelet-rich plasma (PRP); however, the frozen embryo transfer (FET) was canceled as the EMT remained 4.9 mm and 3.9 mm. After three additional HA procedures and one hysteroscopy, the uterine cavity returned to normal. She then received tamoxifen (TAM) with estradiol valerate and human menopausal gonadotropin (HMG), achieving an EMT of 7.5 mm after ovulation. Ultimately, the frozen transfer of a 4BB blastocyst resulted in the birth of a healthy baby boy.

Conclusions: This case highlights the complexities of managing TE induced by IUA using HA and assisted reproductive techniques. It also suggests that patients with TE complicated by PCOS and RSA can be treated with TAM, followed by estradiol valerate and HMG, to improve the EMT and pregnancy outcomes of FET.

Background: Long-acting injectable (LAI) hormonal contraception offers a promising approach to meet women's pregnancy prevention needs. We sought to understand acceptability of and preferences for LAI hormonal contraception among US women, to optimize the design of a sustained-release LAI in development - including which durations to pursue.

Methods: We implemented a national cross-sectional online survey including a discrete choice experiment (DCE) with women ages 18-44 years currently using or interested in using contraception. Recruitment was via Prime Panels. DCE attributes included potential duration of effectiveness (6/12/24-months), effect on menses, side effects, and timing of return-to-fertility after use. We used mixed-multinomial logit models to analyze the data.

Results: Women (n = 1,029) were 28.6 years old on-average, from 49 US states. 30.9% were Black/African American; 11.6% Hispanic/Latina. 71.6% were nulliparous; 49.0% did not want a(nother) child. Common current contraceptive methods were birth control pills (37.4%), male condoms (35.7%), and withdrawal (19.8%); 18.9% reported having had an unintended pregnancy. In the DCE, women had strong negative preferences for: may cause heavier/unpredictable periods, mild headaches/nausea, slight weight gain, and delayed return-to-fertility (6-12 vs. 3 months), and positive preferences for: may cause no period, and shorter/lighter periods (all p < 0.001). Women also preferred the 12-month to the 6-month duration (p = 0.03). When asked directly about their interest in an LAI with no/minimal side effects/effects on menses and quick return-to-fertility, 92.4% expressed interest, with two-thirds preferring a longer duration (12 or 24-months), and one-third the 6-month duration. Preference for the 6-month duration (vs. 12 or 24) was most highly associated with wanting a child within five years, and higher discomfort with hormones (both p < 0.001).

Conclusions: US women report high interest in an LAI. Interest substantially decreases if the LAI may cause unwanted effects such as heavier/unpredictable periods, mild headaches/nausea, slight weight gain, or delayed return-to-fertility. While longer duration (12 + months) is preferred overall, having a 6-month option appears important especially for women who may want to get pregnant within the next few years, and those concerned about hormones (to try it before using a longer duration).

Reproductive rights, including access to abortion, contraception, and comprehensive healthcare, are critical for gender equality and public health. However, these rights remain contentious and heavily influenced by cultural, religious, and political ideologies, creating barriers to equitable care and justice globally. This narrative review examines and compares both abortion laws and policies in the United States and Iran, two ideologically distinct nations with striking parallels in their restrictive approaches. This narrative review identifies key similarities, including the politicization of abortion, the influence of cultural and religious doctrines, and the disproportionate burden of restrictive policies on marginalized populations, leading to unsafe abortions. It also explores major differences, such as the decentralized, state-specific legal variability in the United States versus Iran's centralized theocratic governance, where demographic goals drive restrictions. These findings highlight how geopolitical and ideological contexts shape reproductive governance and health outcomes. Despite ideological contrasts, the United States and Iran exhibit analogous restrictive trends, revealing global challenges in advancing reproductive justice. Addressing these barriers requires a dual approach: targeted legal and policy reforms within national contexts, particularly in the U.S. and Iran, and alignment with international advocacy efforts promoting reproductive autonomy and human rights. The findings provide critical insights for policymakers and healthcare providers aiming to reform reproductive health frameworks and ensure equitable, rights-based care.

Background: Nigeria's contraceptive prevalence rate remains among the lowest in Africa, despite the proven benefits of contraception in preventing unintended pregnancies and unsafe abortions. The rise in internet literacy and social media use offers opportunities to leverage digital platforms for improving reproductive health outcomes. While mobile health interventions have shown promise in enhancing contraceptive awareness and use, their potential to mediate abortion-related outcomes, particularly within resource-constrained and culturally diverse settings like Nigeria, remains underexplored.

Objective: This study examines the interplay between abortion experiences and contraceptive use among Nigerian women of reproductive age, with a particular focus on the role of family planning (FP) information disseminated through mobile phones and social media.

Methods: Drawing on data from the 2018 Nigerian Demographic and Health Survey, the analysis centers on a cohort of 8,687 women aged 15-49 who have expressed no desire for more children. The investigation employs descriptive, bivariate, and multivariate models including interaction terms to analyze the associations between contraceptive behavior, abortion experiences, and exposure to FP messages-operationalized through a composite FP score that integrates mobile phone ownership and receipt of FP messages.

Results: Key findings reveal that while exposure to family planning (FP) messages does not significantly alter abortion experiences, demographic factors such as age and education emerge as substantial determinants, with women aged 30-39 (OR = 1.800) and 40-49 (OR = 1.767) and those with higher education (OR = 1.393), showing higher likelihoods of abortion. Women with fewer cildren (<=2) have significantly less likelihood of abortion (OR = 0.337). Contraceptive use does not significantly impact the likelihood of abortion in the presence of FP messages.

Conclusion: The study reveals that universal approaches to family planning and reproductive health may fall short in resource-constrained settings like Nigeria, where socio-cultural norms, economic barriers, and limited healthcare access hinder contraceptive use, unless they account for socio-cultural and demographic variations. Consequently, it calls for a more comprehensive approach-one that combines FP messaging with culturally informed, community-based outreach and policy frameworks that address the socio-demographic realities influencing reproductive decisions.