Contraception

Editorial Board

2010-04-01

Bringing research to life: a collaborative partnership dedicated to improving reproductive health care

Wayne C. Shields, Susan Higginbotham — 2010-01-28

The Society of Family Planning (SFP) and the Association of Reproductive Health Professionals (ARHP) are two organizations with different but complementary missions. Together, we write this editorial in order to raise awareness of how we work collaboratively, specifically around translating scientific research in family planning and abortion into direct patient care.

Flexible mifepristone and misoprostol administration interval for first-trimester medical termination

Lilantha Wedisinghe, Deya Elsandabesee — 2009-10-30

Abstract: Background: The administration interval between mifepristone and misoprostol is usually about 36–48 h, which might affect a woman's choice of method of termination. Unwanted outcomes such as uterine bleeding, painful cramps and psychosocial issues which may occur during this long interval can be altered by a shorter administration interval. A shorter interval will be cost-effective as it saves both women's and clinician's time and other resources. If the waiting time interval between therapeutic interventions could be reduced without compromising efficacy, it will potentially improve compliance, patient acceptability and quality of care.Study design: A systematic review of randomized controlled trials published from 1999 to 2008 was conducted to assess the evidence for a shorter mifepristone and misoprostol administration interval at first trimester medical termination. Searching strategy included MEDLINE, EMBASE, CLINAHL and Cochrane Library. The primary outcome measure was complete abortion without the need for a surgical procedure.Results: Five randomized controlled trials (RCT) compared the efficacy of mifepristone and misoprostol administration intervals between 0 and 72 h in 5139 participants. The complete abortion rates varied between 90% and 98%. Although the meta-analysis of pooled data of all RCTs shows no statistically significant difference in efficacy between the shorter and longer dosing intervals, there is a trend toward slightly lower success rates with administration intervals earlier than 8 h.Conclusions: Overall efficacy of complete abortion is not statistically different between the longer and shorter administration intervals. This might encourage the clinician to adopt a ‘flexible policy’ with fully informed consent and consideration of all circumstances.

Clinical pharmacokinetics and interaction of centchroman — A mini review

Jawahar Lal — 2010-01-04

Abstract: This article provides a brief review of the information available regarding the published pharmacokinetics data for the nonsteroidal, once-a-week oral contraceptive, centchroman (INN: ormeloxifene). This agent is a unique need-oriented contraceptive agent which is included in the National Family Welfare Programme of India. Since 1991, centchroman has been used as a need-oriented contraceptive and is being given for treating dysfunctional bleeding of the uterus. Information regarding absorption, tissue distribution, elimination and kinetic interactions is discussed.

Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections

2009-12-14

Abstract: Background: Depot medroxyprogesterone acetate (DMPA) is a highly effective progestin-only contraceptive that is widely used by adolescents. We investigated bone mineral density (BMD) changes in female adolescents during and following use of this method.Study Design: A multicenter, prospective, non-randomized observational study in 98 healthy female adolescents aged 12–18 years who initiated DMPA intramuscular injections for contraception and provided BMD data for up to 240 weeks while receiving DMPA and for up to 300 weeks after DMPA cessation. BMD at the lumbar spine (LS), total hip (TH) and femoral neck (FN) was assessed by dual-energy X-ray absorptiometry. A mixed model analysis of variance was used to examine BMD changes.Results: At the time of their final DMPA injection, participants had mean BMD declines from baseline of 2.7% (LS), 4.1% (TH) and 3.9% (FN) (p<.001 at all three sites). Within 60 weeks of discontinuation of DMPA, mean LS BMD had returned to baseline levels, and 240 weeks after DMPA discontinuation, the mean LS BMD was 4.7% above baseline. Mean TH and FN BMD values recovered to baseline values more slowly: 240 weeks and 180 weeks, respectively, after the last DMPA injection.Conclusions: BMD loss in female adolescents receiving DMPA for contraception is substantially or fully reversible in most girls following discontinuation of DMPA, with faster recovery at the LS than at the hip.

Health care providers' knowledge about contraceptive evidence: a barrier to quality family planning care?

Christine Dehlendorf, Kira Levy, Rachel Ruskin, Jody Steinauer — 2009-12-11

Abstract: Background: The underuse of effective contraceptive methods by women at risk for unintended pregnancy is a major factor contributing to the high rate of unintended pregnancy in the United States. As health care providers are important contributors to women's contraceptive use, this study was conducted to assess provider knowledge about contraception.Study Design: Bivariate and multivariate analyses were performed using data collected from a convenience sample of health care providers (physicians, nurse practitioners and physician assistants) at meetings of the professional societies of family medicine and obstetrics and gynecology.Results: Younger providers were more knowledgeable, as were obstetrician/gynecologists, female providers and providers who provide intrauterine contraception in their practice.Conclusions: The lack of consistent and accurate knowledge about contraception among providers has the potential to dramatically affect providers' ability to provide quality contraceptive care for their patients, which could have an impact on their ability to prevent unintended pregnancies.

Correlates of use of long-acting reversible methods of contraception among adolescent and young adult women

Amy K. Whitaker, Annie M. Dude, Amy Neustadt, Melissa L. Gilliam — 2010-02-01

Abstract: Background: Most pregnancies among adolescent and young adult women are unintended, and adolescent birth rates have risen. Use of long-acting reversible contraception may be an effective strategy to reduce the rate of unintended pregnancy.Study Design: We conducted a secondary data analysis of nationally representative, cross-sectional data from the 2002 National Survey of Family Growth. Our sample included 1722 sexually active women aged 15–24 years. We used multivariable logistic regression to identify correlates of ever-use of depot-medroxyprogesterone acetate (DMPA) or the intrauterine device (IUD).Results: One-quarter of our sample had ever used DMPA, and less than 2% had ever used the IUD. In multivariable analysis, increasing parity was associated with ever-use of DMPA (OR 2.07, 95% CI 1.55–2.77) and ever-use of the IUD (OR 4.57, 95% CI 1.60–13.03), but age and measures of socioeconomic status were not. Having ever been married (OR 5.54, 95% CI 1.23–24.82) and current cohabitation (OR 4.89, 95% CI 1.10–21.71) were associated with ever-use of the IUD. A history of an adolescent pregnancy was associated with ever-use of DMPA (OR 1.79, 95% CI 1.19–2.70) but not of the IUD.Conclusions: While similarities exist between the correlates of use of DMPA and the IUD, we discovered important differences, some of which may reflect provider biases regarding IUD provision.

Cost–benefit analysis of state- and hospital-funded postpartum intrauterine contraception at a university hospital for recent immigrants to the United States

2009-12-07

Abstract: Objective: To examine the hospital and state costs of offering the option of a postpartum intrauterine device (IUD) to an underinsured population of recent immigrants to the United States with Emergency Medicaid (EM) insurance coverage only.Study Design: This study is a retrospective cohort study comparing the costs of offering a reversible long-acting method of contraception (IUD) postpartum to women with EM and the current policy of covering the obstetrical delivery only. A cost–benefit analysis from the perspective of both the hospital and the state was conducted. A database of EM obstetrical patients from 2002 to 2006 was created from hospital billing records to calculate mean pregnancy costs and revenue, as well as the probability of repeat pregnancy and pregnancy outcome. Probability of IUD uptake and continuation was obtained from hospital records and the literature.Results: A postpartum IUD program is not cost beneficial from the hospital's perspective, losing 70 cents per dollar spent on the program. However, the state government would save $2.94 for every dollar spent on a state-financed IUD program.Conclusion: Considering only the direct costs associated with a repeat pregnancy, a program offering the option of postpartum IUD placement to underinsured women would significantly reduce state expenditures on subsequent pregnancies.

Effect of low-dose combined oral contraceptive on aerobic capacity and anaerobic threshold level in active and sedentary young women

2009-12-07

Abstract: Background: The purpose of this study was to evaluate the effect of long-term use of oral contraceptives (OC) containing 0.20 mg of ethinylestradiol (EE) combined with 0.15 mg of gestodene (GEST) on the peak aerobic capacity and at the anaerobic threshold (AT) level in active and sedentary young women.Study Design: Eighty-eight women (23±2.1 years old) were divided into four groups — active-OC (G1), active-NOC (G2), sedentary-OC (G3) and sedentary-NOC (G4) — and were submitted to a continuous ergospirometric incremental test on a cycloergometer with 20 to 25 W min−1 increments. Data were analyzed by two-way ANOVA with Tukey post hoc test. Level of significance was set at 5%.Results: The OC use effect for the variables relative and absolute oxygen uptake V̇O2 mL kg−1 min−1; V̇O2, L min−1, respectively), carbon dioxide output (V̇CO2, L min−1), ventilation (VE, L min−1), heart rate (HR, bpm), respiratory exchange ratio (RER) and power output (W) data, as well as the interaction between OC use and exercise effect on the peak of test and at the AT level did not differ significantly between the active groups (G1 and G2) and the sedentary groups (G3 and G4). As to the exercise effect, for all variables studied, it was noted that the active groups presented higher values for the variables V̇O2, V̇CO2, VE and power output (p .05) at the peak and at the AT level between G1 vs. G3 and G2 vs. G4.Conclusions: Long-term use of OC containing EE 0.20 mg plus GEST 0.15 mg does not affect aerobic capacity at the peak and at the AT level of exercise tests.

Pregnancy coercion, intimate partner violence and unintended pregnancy

2010-01-29

Abstract: Background: Reproductive control including pregnancy coercion (coercion by male partners to become pregnant) and birth control sabotage (partner interference with contraception) may be associated with partner violence and risk for unintended pregnancy among young adult females utilizing family planning clinic services.Study Design: A cross-sectional survey was administered to females ages 16–29 years seeking care in five family planning clinics in Northern California (N=1278).Results: Fifty-three percent of respondents reported physical or sexual partner violence, 19% reported experiencing pregnancy coercion and 15% reported birth control sabotage. One third of respondents reporting partner violence (35%) also reported reproductive control. Both pregnancy coercion and birth control sabotage were associated with unintended pregnancy (AOR 1.83, 95% CI 1.36–2.46, and AOR 1.58, 95% CI 1.14–2.20, respectively). In analyses stratified by partner violence exposure, associations of reproductive control with unintended pregnancy persisted only among women with a history of partner violence.Conclusions: Pregnancy coercion and birth control sabotage are common among young women utilizing family planning clinics, and in the context of partner violence, are associated with increased risk for unintended pregnancy.

Two medical abortion regimens for late first-trimester termination of pregnancy: a prospective randomized trial

2010-01-15

Abstract: Background: Medical abortion regimens based on the use of either misoprostol alone or in association with mifepristone have shown high efficacy and excellent safety profile in early pregnancy abortion. However, no clear recommendation is available for late first-trimester termination of pregnancy.Study Design: A prospective randomized controlled trial included 122 women seeking medical abortion at 9 to 12 weeks of gestation. Seventy-three patients were given a fixed protocol of 200 mg of mifepristone followed 48 h later by 400 mcg oral misoprostol (Group 1). The second group of 49 patients was administered 800-mcg intravaginal single-dose misoprostol (Group 2). This study sought to compare safety, efficacy and acceptability of these two nonsurgical abortion regimens.Results: Fifty-nine (80.8%) women in Group 1 had complete abortion vs. 38 (77.4%) women in Group 2 (p=.66). Abdominal pain was observed significantly more often in Group 2 (35/49 (71.4%) vs. 32/73 (43.8%) in Group 1, p<.0001. Medical abortion was equally acceptable among the two groups [37/49 (75.5%) and 55/73 (75.7%), p=.89].Conclusion: For late first-trimester termination, a single 800-mcg vaginal dose of misoprostol seems to be as effective as the mifepristone+misoprostol regimen, with acceptable side effects.

Relationship of intraamniotic digoxin to fetal demise

Lynn Borgatta, Sarah J. Betstadt, Ann Reed, Kui-tzu Feng — 2010-01-11

Abstract: Background: Induced fetal demise by intraamniotic injection of digoxin is an alternative to methods using intracardiac or umbilical vein injection. This study was designed to evaluate the effectiveness of intraamniotic injection and the timing of fetal demise after injection.Study Design: Twenty-two women had ultrasonic fetal cardiac assessments 1, 2, 4 and 20 to 24 h after intraamniotic injection of 1.5 mg digoxin.Results: Fetal cardiac activity was absent in 21/21 women assessed at least 20 h after injection. One woman had agonal (40 bpm) fetal cardiac activity at 14 h. Most women had fetal cardiac activity 4 h after injection. Signs of toxicity were not seen.Conclusion: Intraamniotic injection of digoxin 1.5 mg is effective at causing fetal demise by 20 to 24 h. However, for most women, fetal demise is not obtained within 4 h.

Can Lactobacillus acidophilus influence the adhesion capacity of Candida albicans on the combined contraceptive vaginal ring?

2010-01-25

Abstract: Background: This study was conducted to evaluate the influence of Lactobacillus acidophilus on the adhesion capacity of Candida albicans on the combined contraceptive vaginal ring (CCVR).Study Design: Two vaginal isolates of C. albicans and an ATCC strain of lactobacilli were used. Isolated and associated yeasts and bacteria (co-aggregated) were employed on the CCVR adherence assays and scanning electron microscopy (SEM).Results: Isolated yeasts and lactobacilli adhered strongly to the CCVR. After the co-aggregation, there were an increase in adhesion capacity of the yeasts (p<.001) and a diminished adhesion of the lactobacilli (p<.001). SEM showed the isolated and co-aggregated microorganisms intimately attached to the irregularities of the CCVR.Conclusions: If these findings correlated with the conditions in vivo, the use of probiotics based on L. acidophilus or its presence in the vaginal microbiota would not protect against the adhesion of C. albicans to the ring.

Intrauterine administration of CDB-2914 (Ulipristal) suppresses the endometrium of rhesus macaques

Robert M. Brenner, Ov D. Slayden, Anita Nath, Y.Y. Tsong, Regine Sitruk-Ware — 2009-12-17

Abstract: Background: Ulipristal (UPA; CDB-2914) is a progesterone receptor modulator with contraceptive potential. To test its effects when delivered by an intrauterine system (IUS), we prepared control and UPA-filled IUS and evaluated their effects in rhesus macaques.Study Design: Short lengths of Silastic tubing either empty (n=3) or containing UPA (n=5) were inserted into the uteri of 8 ovariectomized macaques. Animals were cycled by sequential treatment with estradiol and progesterone. After 3.5 cycles, the uterus was removed.Results: During treatment, animals with an empty IUS menstruated for a mean total of 11.66±0.88 days, while UPA-IUS treated animals bled for only 1±0.45 days. Indices of endometrial proliferation were significantly reduced by UPA-IUS treatment. The UPA exposed endometria were atrophied with some glandular cysts while the blank controls displayed a proliferative morphology without cysts. Androgen receptors were more intensely stained in the glands of the UPA-IUS treated endometria than in the blank-IUS treated controls.Conclusions: In rhesus macaques, a UPA-IUS induced endometrial atrophy and amenorrhea. The work provides proof of principle that an IUS can deliver effective intrauterine concentrations of Ulipristal.

Does over-exposure to copper ions released from metallic copper induce cytotoxic and genotoxic effects on mammalian cells?

Claudia A. Grillo, Miguel A. Reigosa, Mónica A. Fernández Lorenzo de Mele — 2010-01-15

Abstract: Background: A high dissolution of copper from intrauterine devices (IUDs) occurs during the first days after insertion. This work is focused on the assessment of the possible cyto- and genotoxic effects of different concentrations of copper ions released from metallic copper on mammalian cells in vitro.Study Design: Colorimetric tetrazolium/Trypan blue (TB) tests and Comet assay were used to evaluate potential cytotoxicity and genotoxicity, respectively, in Chinese hamster ovary cells (CHO-K1).Results: Reduction of mitochondrial activity by copper ions was observed for extracts at ≥7.42 mg/L concentrations, while TB exclusion test for plasma membrane integrity showed significant decrease in cell viability (close to 90%) for 10.85 mg/L concentration. Additionally, copper-induced DNA damage was detected for 5.67–7.42 mg/L concentration range.Conclusion: Our results demonstrate cytotoxic and genotoxic effects of copper ions released from metallic copper on CHO-K1 cells and emphasize the importance of reducing the initial copper dissolution from IUD without affecting the contraceptive action.

Initial studies on a novel filtering-type intra-vas device in male dogs

2010-03-02

Abstract: Background: To relieve the side effects induced by the complete obstruction of the vas deferens, we created a filtering-type intra-vas device (IVD) which is made of materials composed of nano-SiO2-copper complex cross-linking polymer composites.Study Design: Eight male beagle dogs were grouped into nonimplanted control group and IVD-implanted group. We tested the efficacy of the sperm filtering effect of the new IVD material for 12 months and examined the influence of the IVD materials on the cells of the vas deferens, epididymis and testis.Results: The densities of sperm were reduced significantly after the IVD was implanted; no motile sperm were found after the third month. No obvious morphological changes were found in the cells of the vas deferens, epididymis and testis in the IVD-implanted group.Conclusions: The filtering-type nano-SiO2-copper complex/polymer composite IVD is able to filter the sperm of the male dogs, and the IVD material did not cause obvious damage to the cells of the male reproductive organs after 1 year of implantation.

Comparative study on the spermicidal activity of organic solvent fractions from hydroethanolic extracts of Achyranthes aspera and Stephania hernandifolia in human and rat sperm

2009-10-05

Abstract: Background: This study was conducted to determine the most effective fraction of the hydroethanolic (water:ethanol, 1:1) extracts of Stephania hernandifolia leaves and Achyranthes aspera roots (in a composite manner at a ratio of 1:3, respectively) that will provide maximum spermicidal activity in human and rat spermatozoa out of five different ratios (1:1, 1:3, 1:7, 3:1 and 7:1) that have been studied in pilot experiments.Study Design: n-Hexane, chloroform and ethyl acetate fractions of the hydroethanolic (1:1) extracts of S. hernandifolia and A. aspera were mixed at 1:3. Different concentrations were tested for sperm immobilization, sperm viability, acrosome status, 5′-nucleotidase activity and nuclear chromatin decondensation using human and rat spermatozoa for the selection of the most effective concentration.Results: Out of three fractions of the hydroethanolic (1:1) extracts of the said plants, the n-hexane fraction was most effective, and the chloroform fraction exhibited minimum activity for this purpose. At a concentration of 0.1 g/mL hexane fraction, all sperm of the human sample were immobilized immediately (within 20 s). In case of the rat sample, all epididymal spermatozoa were immobilized immediately (within 20 s) by treatment with hexane fraction at a concentration of 0.004 g/mL. All human sperm were found to be nonviable within 20 min. The activity of acrosome enzymes was reduced, and significant release of 5′-nucleotidase (a plasma membrane marker) into the surrounding medium was noted after treatment with 0.1 g/mL hexane fraction, indicating that the hexane fraction affected the cytoarchitecture of the sperm plasma membrane. The maximum number of human sperm failed to decondense when treated with 0.1 g/mL hexane fraction, and sperm motility was also irreversible. The hexane fraction was tested in rats as vaginal contraceptive and showed 100% efficacy, indicating its potential for development as vaginal contraceptive.Conclusion: The findings indicate that, among the different fractions, the hexane fraction of the hydroethanolic extracts of the two plants produced the most effective spermicidal activity and can be considered as vaginal contraceptive.

Erratum to “Bleeding pattern with drospirenone 3 mg+ethinyl estradiol 20 mcg 24/4 combined oral contraceptive compared with desogestrel 150 mcg+ethinyl estradiol 20 mcg 21/7 combined oral contraceptive” [Contraception 2009;80:445–51]

Leena Anttila, Michael Kunz, Joachim Marr — 2010-01-28

In the abovementioned article, incorrect data were included for the drsp 3 mg/EE 20 mcg 24/4 group in A on page 448. The correct data are included in the figure shown here. The figure now supports the statement that scheduled bleeding intensity tended to be lighter for the drsp 3 mg/EE 20 mcg 24/4 group than for the DSG 150 mcg/EE 20 mcg 21/7 group.