Contraception RSS feed: Current Issue. The purpose of Contraception is to provide a medium for the rapid communication of advances and new knowledge in all areas of contraception. Manuscripts are received from researchers and clinicians in the following areas of research: chemistry, biochemistry, physiology, endocrinology, biology, the medical sciences, and demography. http://www.contraceptionjournal.org/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Contraception0010-7824856June 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.contraceptionjournal.org/article/PIIS0010782412001552/abstract?rss=yesEditorial Board10.1016/S0010-7824(12)00155-2Contraception 85, 6 (2012)2012-06-01Contraception2012-06-01856S0010-7824(11)X0017-3iihttp://www.contraceptionjournal.org/article/PIIS0010782412001564/abstract?rss=yesContents10.1016/S0010-7824(12)00156-4Contraception 85, 6 (2012)2012-06-01Contraception2012-06-01856S0010-7824(11)X0017-3iiiiihttp://www.contraceptionjournal.org/article/PIIS0010782412001011/abstract?rss=yesThis editorial is adapted from a previous work by the author, “Seven Billion and 31 Gigatons: Making the Population–Climate Connection,” the author's presentation at Reproductive Health 2011, ARHP's annual clinical conference, and “Policy Review: Thoughts on Addressing Population and Climate Change in a Just and Ethical Manner,” which appeared in Population and Environment in 2009 and is cited throughout this editorial .Seven billion and 31 gigatonsSuzanne Petroni10.1016/j.contraception.2012.03.001Contraception 85, 6 (2012)2012-04-04Contraception2012-04-04856S0010-7824(11)X0017-3Editorial523526http://www.contraceptionjournal.org/article/PIIS0010782411005816/abstract?rss=yesAbstract: Background: Women with sickle cell disease have an increased risk of pregnancy-related complications and need safe, effective contraceptive methods to prevent unintended pregnancy.Study Design: We conducted a systematic review to examine the safety of hormonal and intrauterine contraceptive use among women with sickle cell disease.Results: Eight articles met the inclusion criteria. The evidence was of fair to poor quality and suggested that progestin-only and combined hormonal contraception had no effect on frequency of sickle crises or other adverse events and no effect on hematologic parameters associated with sickle crises. No studies examined the risk of thromboembolism in combined hormonal contraceptive users with sickle cell disease. There was insufficient evidence to comment on the safety of intrauterine contraception.Conclusion: While data are limited, there is no evidence to suggest that hormonal contraceptive use among women with sickle cell disease is associated with an increased risk of clinical complications.Contraception for individuals with sickle cell disease: a systematic review of the literatureLisa B. Haddad, Kathryn M. Curtis, Jennifer K. Legardy-Williams, Carrie Cwiak, Denise J. Jamieson10.1016/j.contraception.2011.10.008Contraception 85, 6 (2012)2011-12-07Contraception2011-12-07856S0010-7824(11)X0017-3Review Articles527537http://www.contraceptionjournal.org/article/PIIS0010782411005841/abstract?rss=yesAbstract: Background: Performing magnetic resonance imaging (MRI) on women with gynecological devices is a completely accepted practice. The goal of our review is to assess how safe it is to perform MRI on women using contraceptive implants or devices.Study Design: Literature review, searching in PubMed-Medline/Ovid for the following keywords: magnetic resonance imaging, intrauterine devices, Implanon® and Essure®.Results: Though plastic devices do not represent a contraindication to the use of the technique, those including metallic components have been submitted to several tests, after which they were classified as MR Conditional (devices presenting no risks in MR-specific environments) by the Food and Drug Administration. Thus, the use of MRI can be safely advised to women with this type of device as long as the magnetic resonance equipment is ≤3.0 T.Conclusions: Presently, there is no scientific evidence that contraindicates performing MRI on women with any kind of gynecological device. Therefore, this procedure is safe as long as it is performed under previously tested conditions.Magnetic resonance imaging and gynecological devicesLúcia Correia, Ana Beatriz Ramos, Ana Isabel Machado, Duarte Rosa, Carlos Marques10.1016/j.contraception.2011.10.011Contraception 85, 6 (2012)2011-12-02Contraception2011-12-02856S0010-7824(11)X0017-3Review Articles538543http://www.contraceptionjournal.org/article/PIIS0010782411006251/abstract?rss=yesAbstract: Background: Little is known about the characteristics of second-trimester abortion patients.Study Design: Data come from a national sample of 9493 women obtaining abortions in 2008. Chi-square statistics and logistic regression were used to examine demographic characteristics of women having abortions at 13 or more weeks since last menstrual period (LMP) and women having abortions at 13–15 weeks LMP compared to 16+ weeks LMP.Results: In 2008, 10.3% of abortions in the United States were 13 weeks LMP or later, including 4.0% at 16+ weeks. Groups most likely to have abortions at 13 weeks or later included black women, women with less education, those using health insurance to pay for the procedure and those who had experienced three or more disruptive events in the last year. Groups more likely to have an abortion at 16 weeks or later included black women, higher income women and those paying with health insurance.Conclusions: Black women and those with less education would most benefit from increased availability of first-trimester abortion services.Who has second-trimester abortions in the United States?Rachel K. Jones, Lawrence B. Finer10.1016/j.contraception.2011.10.012Contraception 85, 6 (2012)2011-12-16Contraception2011-12-16856S0010-7824(11)X0017-3Original Research Articles544551http://www.contraceptionjournal.org/article/PIIS0010782411005828/abstract?rss=yesAbstract: Background: Vasectomy has been found to be a highly cost-effective contraceptive method. For couples, tubal sterilization and vasectomy have the same result, but the two methods are used by different segments of the population.Study design: We conducted an analysis of data from male and female samples of the 2006–2008 National Survey of Family Growth, nationally representative samples of men and women in the United States aged 15–44 years.Results: Among married men, 13.1% reported vasectomies (95% confidence interval 10.4%–16.3%), compared to 21.1% (17.8%–24.9%) of married women who reported tubal sterilizations. Men with higher education and income had greater prevalence of vasectomy than those less educated, while women with lower education and income had the highest prevalence of tubal sterilization.Conclusions: Efforts to promote vasectomy use need to understand the reasons behind these differences. Increasing the availability and use of vasectomy will require education about its benefits.Contraceptive sterilization among married adults: national data on who chooses vasectomy and tubal sterilizationJohn E. Anderson, Denise J. Jamieson, Lee Warner, Dmitry M. Kissin, Ajay K. Nangia, Maurizio Macaluso10.1016/j.contraception.2011.10.009Contraception 85, 6 (2012)2011-12-02Contraception2011-12-02856S0010-7824(11)X0017-3Original Research Articles552557http://www.contraceptionjournal.org/article/PIIS0010782411006287/abstract?rss=yesAbstract: Background: Despite the high efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) in preventing pregnancy, uptake of the intrauterine devices remains low in the United States. Decreasing pain at the time of intrauterine device insertion may be one way to increase interest in this method of contraception.Study Design: We conducted a double-blind, placebo-controlled trial, randomizing women to 800 mg ibuprofen or placebo 45 min prior to LNG-IUS insertion to determine effect of ibuprofen on the pain of LNG-IUS insertion.Results: Eighty-one women completed the study: 44 received ibuprofen, and 37 received placebo. Women in the ibuprofen and placebo groups had similar mean scores for anticipated pain (4.07 and 3.91, respectively; p=.79), pain with tenaculum placement (3.86 and 3.81, respectively; p=.90) and pain with insertion (3.69 and 3.34, respectively; p=.91).Conclusion: Administration of ibuprofen prophylaxis for LNG-IUS insertion does not decrease pain at the time of insertion.Ibuprofen prophylaxis for levonorgestrel-releasing intrauterine system insertion: a randomized controlled trialJulie Chor, Julia Bregand-White, Alex Golobof, Bryna Harwood, Allison Cowett10.1016/j.contraception.2011.10.015Contraception 85, 6 (2012)2011-12-16Contraception2011-12-16856S0010-7824(11)X0017-3Original Research Articles558562http://www.contraceptionjournal.org/article/PIIS0010782411006263/abstract?rss=yesAbstract: Background: China launched a nationwide family planning program offering birth control methods and family planning services in the 1970s. Promotion of the widespread use of long-term contraceptive methods has been one of the program's core strategies. This paper reviews the history of China's Family Planning Program at the national level from 1970 to 2010. Special attention is paid to the history of contraception policy.Study Design: This study provides an overview of the last four decades of the Chinese Family Planning Program. Programmatic goals are highlighted during different time periods, with special attention being paid to the role of contraceptive use and the history of contraceptive policy.Results: The Chinese Family Planning Program has experienced several transitions. It has evolved from the 1970s period of moderate policy, represented by wan, xi, shao (late marriage and childbearing, birth spacing and limited fertility), through the strict one-child policy of 1979 to the early 1990s. From the mid-1990s to the present, a relatively lenient policy has been in force, characterized by client-centered informed choice.Conclusions: The success of the Chinese Family Planning Program has long been heavily dependent on policies advocated by the central government, including programs promoting contraception to reduce fertility rates. The Program also depended on a logistical support system, including organizational safeguards and free provision of contraception and family planning services.History of the Chinese Family Planning program: 1970–2010Cuntong Wang10.1016/j.contraception.2011.10.013Contraception 85, 6 (2012)2011-12-16Contraception2011-12-16856S0010-7824(11)X0017-3Original Research Articles563569http://www.contraceptionjournal.org/article/PIIS0010782411006275/abstract?rss=yesAbstract: Background: In China, contraception is the most commonly used practice adopted by couples seeking to limit their number of children and to determine the time interval between births. Since 1980, the implementation of mandatory contraceptive strategy has reduced the fertility rate. Using large-scale data from national statistics and nationally representative sample surveys, the current study aims to assess Chinese trends in contraceptive use and determinants of choice from 1980 to 2010 among married women and men aged 20–49 years.Study Design: Since 1980, national data on contraceptive methods utilization have been gathered by the National Population and Family Planning Commission of the People's Republic of China (NPFPC). Additionally, data from three roughly representative decennial samples (1988, 1997, 2006) of Chinese women of aged 20 to 57 years have been gathered by the NPFPC through the National Family Planning and Reproductive Health Surveys in China.Results: A relatively stable Chinese mode of contraception has been established and maintained since the 1980s. This is characterized by long-term contraceptive use which is still dominant in current China. In addition, China's total contraceptive prevalence rates remain at the highest level across the globe from 1980 to 2010. However, the overall method composition of contraceptive use within China has changed since the mid-1990s. Over the study period, the prevalence rate of sterilization increased from 30.21% in 1980 to 46.47% of married women of reproductive age (20–49 years) in 1994 and then declined to 31.7% in 2010. At the same time, intrauterine device usage increased (39.83% in 1980 to 48.15% in 2010), as did oral contraception (0.3% in 1980 to 0.98% in 2010) and condom usage (2.35% in 1980 to 9.32% in 2010). The results from the multinomial logit model show that an individual's contraceptive choice depends not only on individual characteristics, including ethnicity, age, education level, household registration, region, number of living children and sex of the last living child, but also on the strength of family planning policies. A positive coefficient indicates that the looser the strength of family planning policies is, the more likely the individual is to choose condoms or another short-term contraceptive method.Conclusions: Long-term contraceptive use is still dominant in China. In fact, over the 30-year period (1980–2010) and in comparative world perspective, China continues to have the highest total contraceptive prevalence rate. Additionally, an individual's contraceptive choice is jointly influenced by the strength of family planning policies and individual characteristics.Trends in contraceptive use and determinants of choice in China: 1980–2010Cuntong Wang10.1016/j.contraception.2011.10.014Contraception 85, 6 (2012)2011-12-16Contraception2011-12-16856S0010-7824(11)X0017-3Original Research Articles570579http://www.contraceptionjournal.org/article/PIIS001078241100583X/abstract?rss=yesAbstract: Background: Little is known about contraceptive care within the Veterans Affairs (VA) health care system. This study was conducted to assess the prevalence of documented contraception by race/ethnicity within the VA and to examine the association between receiving primary care in women's health clinics (WHCs) and having a documented contraceptive method.Study Design: We examined national VA administrative and pharmacy data for 103,950 female veterans aged 18–45 years who made at least one primary care clinic visit in 2008. Multivariable regression models were used to examine the associations between race/ethnicity and receipt of care in a WHC with having a method of contraception while controlling for confounders.Results: Only 22% of women veterans had a documented method of contraception during 2008. After adjusting for potential confounders, Hispanic and African–American women were significantly less likely to have a method compared to whites [odds ratio (OR): 0.82; 95% confidence interval (CI): 0.76–0.88 and OR: 0.85; 95% CI: 0.81–0.89, respectively]. Women who went to WHCs were significantly more likely to have a method of contraception compared to women who went to traditional primary care clinics (OR: 2.05; 95% CI: 1.97–2.14).Conclusions: Overall contraceptive prevalence in the VA is low, but receiving care in a WHC is associated with a significantly higher likelihood of having a contraceptive method.Contraceptive care in the VA health care systemSonya Borrero, Maria K. Mor, Xinhua Zhao, Melissa McNeil, Said Ibrahim, Patricia Hayes10.1016/j.contraception.2011.10.010Contraception 85, 6 (2012)2011-12-16Contraception2011-12-16856S0010-7824(11)X0017-3Original Research Articles580588http://www.contraceptionjournal.org/article/PIIS0010782411005786/abstract?rss=yesAbstract: Background: This study was conducted to evaluate and analyze the efficacy and safety of using gemeprost for second- and third-trimester termination of pregnancy (TOP) in women with uterine scar due to previous cesarean section.Study Design: Retrospective analysis of 111 medical TOPs for fetal anomaly or death at 14 to 34 weeks of gestation in women with a history of cesarean section was performed at a German tertiary care center from 2005 to 2009. Abortion was induced via intravaginal application of the prostaglandin analogue gemeprost (1 mg) every 6 h.Results: One hundred eleven women with one (89.2%) or two (10.8%) previous cesarean sections underwent medical TOP with gemeprost. The median induction-to-expulsion interval was 18 h 24 min (range, 2 h 20 min–168 h 28 min), and in 34 (30.6%) cases, the induction interval was longer than 24 h. The overall incidence of severe complications was 9/111 (8.1%), including one case of silent uterine rupture (with the need for blood transfusion), four cases of atonic and three secondary hemorrhages and one case of peritonitis due to uterine perforation during curettage. Failure of induction (induction-to-expulsion >48 h) occurred in 11 cases (9.9%).Conclusion: Gemeprost-induced TOP in the second and third trimester in women with uterine scar due to previous cesarean section is effective and has a low complication rate.Second- and third-trimester termination of pregnancy in women with uterine scar — a retrospective analysis of 111 gemeprost-induced terminations of pregnancy after previous cesarean deliveryChristian M. Domröse, Annegret Geipel, Christoph Berg, Henning Lorenzen, Ulrich Gembruch, Arne Willruth10.1016/j.contraception.2011.10.005Contraception 85, 6 (2012)2011-11-14Contraception2011-11-14856S0010-7824(11)X0017-3Original Research Articles589594http://www.contraceptionjournal.org/article/PIIS0010782411005798/abstract?rss=yesAbstract: Background: This study evaluated the ethinyl estradiol (EE) and levonorgestrel (LNG) pharmacokinetic profiles of AG200-15, a transdermal contraceptive delivery system, compared with a combination oral contraceptive (COC) containing EE 35 mcg and norgestimate 250 mcg.Study design: A Phase 1, open-label, single-center study in 36 healthy women was conducted over three cycles with a randomized crossover design. After a run-in cycle of 21 days on and 7 days off with AG200-15, participants were randomized to receive one of two treatments: a 21/7-day cycle of AG200-15 either followed or preceded by one cycle of the COC. This trial is registered on ClinicalTrials.gov under the identifier NCT01243580.Results: During the third week of AG200-15 use, mean (±standard deviation) maximum serum concentration (Cmax), area under the curve0–168 h and steady-state concentration (Css48–168 h) for EE were 51.3±17.3 pg/mL, 6.26±2.46 ng h/mL and 35.7±14.5 pg/mL, respectively; for LNG, the corresponding values were 2400±1140 pg/mL, 317±159 ng h/mL and 1847±930 pg/mL, respectively. The AG200-15 EE Cmax was approximately 60% lower and the EE Css was 15%–20% lower than those obtained with the COC. The calculated daily dose of AG200-15 was equivalent to a 30-mcg EE COC. The most common adverse events (AEs; >10%) in the AG200-15 group were headache, nausea and application-site irritation. All drug-related AEs were mild, and no serious AEs were reported.Conclusions: EE and LNG daily exposure during AG200-15 treatment was within the range reported for a low-dose COC. The daily EE dose with AG 200-15 was equivalent to a 30-mcg COC and was safe and well tolerated.Ethinyl estradiol and levonorgestrel pharmacokinetics with a low-dose transdermal contraceptive delivery system, AG200-15: a randomized controlled trialDavid F. Archer, Frank Z. Stanczyk, Arkady Rubin, Marie Foegh10.1016/j.contraception.2011.10.006Contraception 85, 6 (2012)2011-12-02Contraception2011-12-02856S0010-7824(11)X0017-3Original Research Articles595601http://www.contraceptionjournal.org/article/PIIS0010782411005774/abstract?rss=yesAbstract: Background: Proprotein convertase 5/6 (PC6) is critical for endometrial epithelial receptivity and stromal cell decidualization for embryo implantation in women. We hypothesized that inhibiting PC6 could block implantation for contraception. The aim of this study was to prove this concept using human cell models and rabbits.Study Design: A potential PC6 inhibitor, C1239-PEG-Poly R, was biochemically confirmed to be a potent PC6 inhibitor. The potential contraceptive action of the inhibitor was then tested in decidualization of primary human endometrial stromal cells in a human trophoblast spheroid attachment model and in vivo in rabbits.Results: The PC6 inhibitor C1239-PEG-Poly R inhibited in a dose-dependent manner both decidualization and spheroid attachment. Vaginal delivery of 200 μL of the inhibitor at a final concentration of 5 mM to rabbits over a 3-day period starting 6 days after mating resulted in a 60% decrease in implantation and, hence, pregnancy.Conclusions: This study presents proof of concept that PC6 inhibition has the potential to block embryo implantation, providing nonhormonal contraception for women.Inhibition of proprotein convertase 5/6 activity: potential for nonhormonal women-centered contraceptionMohamad Aljofan, Harmeet Singh, Huiting Ho, Shuwu Xie, Yan Zhu, Zhaogui Sun, Xiangjie Guo, Jian Wang, Guiying Nie10.1016/j.contraception.2011.10.004Contraception 85, 6 (2012)2011-11-14Contraception2011-11-14856S0010-7824(11)X0017-3Original Research Articles602610http://www.contraceptionjournal.org/article/PIIS0010782412000674/abstract?rss=yesIn , we update our results on the cost-effectiveness of contraceptives in the United States to reflect recent increases in the average wholesale price (AWP) of the Mirena IUS to $844 (an increase of 44% over the AWP of $586 in the original paper), of the ParaGard IUD to $718 (an increase of 45% over the AWP of $494 in the original paper), of the Implanon implant to $791 (an increase of 26% over the AWP of $627 in the original paper) and of the injectable Depo-Provera to $102 (an increase of 34% over the AWP of $76 in the original paper). The results for Implanon are the same for its replacement Nexplanon. We also correct an error in the annualized cost of the Mirena IUS in years 1–4 in previous corrections and updates; we are grateful to Anna Filonenko for pointing out this error. We note that calculated benchmark price has replaced AWP as the new pricing term but is calculated the same way.Update on and correction to the cost-effectiveness of contraceptives in the United StatesJames Trussell10.1016/j.contraception.2012.02.009Contraception 85, 6 (2012)2012-03-29Contraception2012-03-29856S0010-7824(11)X0017-3Letter to the Editor611611