This paper is only available as a PDF. To read, Please Download here.
Objectives
To determine the incidence of ovulation within five days of etonogestrel (ENG) implant
insertion in the presence of a dominant follicle with and without same-day oral ulipristal
acetate (UPA) administration.
Methods
This single site trial recruited people aged 18–35 with regular menstrual cycles and
interest in an ENG implant without pregnancy risk. We initiated transvaginal ultrasounds
on day 7–9 of menses and randomized participants 1:1 to ENG implant alone or with
concurrent oral UPA when a dominant follicle reached ≥14 mm in diameter. We completed
daily transvaginal ultrasounds and serum hormone levels for up to seven days post-insertion
or transitioned to labs alone if we observed follicular collapse on ultrasound prior
to the end of seven days. We defined ovulation as follicular rupture followed by a
progesterone level ≥3ng/mL.
Results
We enrolled 35 people: 17 with ENG implant alone (mean enrollment follicular size:
15.2 mm ± 0.9 mm) and 18 with ENG implant and UPA (mean enrollment follicular size:
15.4 mm ± 1.2 mm, p=0.6). Ovulation occurred in 35.3% (n=6) of ENG implant–alone participants
and in 61.1% (n=11) of ENG implant and were given UPA(Risk ratio (RR), 0.6; 95% CI,
0.3–1.2; p=0.1).
Conclusions
Although not powered to detect statistically significant differences, mid-cycle ovulation
suppression was more common when the ENG implant was inserted alone than with same-day
UPA administration, supporting concerns for drug-drug interactions between oral UPA
and ENG. Ovulation suppression with the implant exceeds prior reports of oral levonorgestrel.
Thus, the ENG implant is worth testing as emergency contraception.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Identification
Copyright
© 2022 Published by Elsevier Inc.
