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Contraceptive choice in Vigevano, Italy, 1983-1993.

The authors, after general consideration of family planning programs, present a study of 22714 women, who, in the decade 1983-1993, required contraceptive protection from the Family Planning Centers in the region of Vigevano (Italy). The authors underline the importance of a protocol used before beginning treatment to help prevent women receiving methods carrying too great a health risk. The results show a very high prevalence of oral contraception, increasing in recent years with the introduction of triphasic pills, while use of intrauterine contraception seems to be declining. Other conventional methods, such as barrier (diaphragm and condom) and 'natural' methods, had a low incidence in the sample studied. The reasons for these behaviors are analyzed and the relative trends discussed.

Adolescent↗

Fertility awareness-based methods for contraception: systematic review of randomized controlled trials.

CONTEXT: Fertility awareness-based (FAB) methods of family planning estimate the fertile days of the menstrual cycle whether by observing fertility signs such as cervical secretions and basal body temperature or by monitoring cycle days. The efficacy and acceptability of these methods are unclear. METHODS: We retrieved and analyzed all randomized controlled trials that examined any FAB method used for contraception. RESULTS: Because of poor methods and reporting, pregnancy rates could not be determined. A trial in Colombia found similar numbers of pregnancies among women randomized to the ovulation and symptothermal methods, but a trial in Los Angeles observed more pregnancies in the group assigned to the ovulation method. In the two American trials, recruitment of participants was unexpectedly difficult. Continuation rates were poor. CONCLUSION: Despite intensive training and ongoing support, most participants in these trials discontinued prematurely. The comparative efficacy of these methods remains unknown. However, with the ovulation and symptothermal methods, pregnancies appear to be common; method continuation rates are low.

Awareness↗

The rhythm method of contraception.

The rhythm method (safe period) is the only contraceptive method which is approved and actively promoted by the Roman Catholic Church. It therefore holds and attraction to a large number of followers. This paper reviews the historical development of the method from the initial efforts in the nineteenth century to the work of Ogino and Knaus, and covers the variations which are based on alteration of the basal body temperature and changes in cervical mucus. Although this method should be devoid of side effects, certain risks have been reported due to the possible fertilization of an overripe ovum. There may also be a higher risk of ectopic pregnancy than normal to users of this method and these reports are reviewed. The results of field trials concerning the use effectiveness of the method are also examined.

Animals↗

Sex of offspring of women using oral contraceptives, rhythm, and other methods of birth control around the time of conception.

Sex ratios were studied in a cohort of 33,205 newborns whose mothers had been questioned in early pregnancy about contraceptive use around the time of conception., The proportion of males was 0.517 (95% confidence limits [CL], 0.512 to 0.522). In the 9279 offspring of women who had used oral contraceptives (OC) in the 5 months prior to conception the sex ratio was 0.517 (0.507 to 0.527). There are sufficient numbers available for study for us to be 95% certain that OC causes no shift in sex ratio of 1% or more. Women who conceived within 2 months of stopping the pill had a small excess of males (0.528; 95% CL, 0.510 to 0.546), but this excess was probably due to chance. OC failures were followed by a raised sex ratio in the offspring (0.543; 95% CL, 0.509 to 0.577), and this excess of males was observed consistently in subgroups of maternal age, parity, race, and education. Failures of rhythm contraception were also associated with a consistent excess of male births (0.567; 95% CL, 0.514 to 0.620). No changes were observed after failures of IUDs, barrier, or chemical methods.

Adult↗

[Natural contraception--a real option?].

In the article, a method developed by John Billings is introduced, based on the presumption that a woman will learn to know her fertile days and the day of ovulation by observing the consistency of the cervical mucus. The method has many uses. The woman gets to know her body and its functions. The woman can avoid becoming pregnant without long periods of continence and she can get pregnant when she wants it herself. The method can also provide help in various problems of childlessness.

Adult↗

An objective method for detecting the shift in basal body temperature in women.

The upward shift in basal body temperature (BBT) observed in women of child-bearing age is often used as an indicator that ovulation has occurred and that a period of infertility has begun. In natural family planning programmes it is important to detect the BBT shift reliably and with a minimum of user uncertainty, against a background of physiologically induced temperature variations. The cumulative sum (CUSUM) test is adapted to the problem of detecting BBT shift and applied to 137 BBT charts obtained from 21 women using natural family planning. Results show successful detection of the shift in all cases. Shifts occurred at gynaecologically appropriate times in the menstrual cycle.

Analysis of Variance↗

Misinformation, mistrust, and mistreatment: family planning among Bolivian market women.

Results of an ethnographic study suggest that, despite stereotypes to the contrary, urban Aymara women in Bolivia want to regulate their fertility, and sociocultural norms support fertility regulation. However, the norms also make such regulation difficult to achieve. One barrier is a deep suspicion of modern medicine and medical practitioners, who are not seen as reliable sources of information. This suspicion is reinforced when the quality of health services is inadequate. Among urban Aymara, the level of acceptability of most modern methods of contraception is low. Many would prefer to use traditional methods, even when use of these methods entails considerable sacrifice and risk of conflict with their partners, unwanted pregnancies, and recourse to unsafe abortion.

Abortion, Induced↗

Research on methods of fertility regulation.

Researchers continue to discover improved methods of fertility regulation. The primary goal has been to find methods that are as effective as oral contraceptives and the intrauterine device, but that have fewer side effects. Ease of administration and long-term usage are highly desirable secondary goals. Hormonal methods (various pills, implants, vaginal rings, and injectables), new intrauterine devices, and other methods under study are discussed.

Contraception↗

Induction of follicular growth, ovulation and luteinization in the human ovary.

Studies on human ovulation are described, in which follicular growth and ovulation were controlled by HMG, clomiphene and HCG. Three regimes of treatment were employed: several injections of HMG, followed by an injection of HCG, a course of clomiphene followed by an injection of HCG and an injection of HCG alone timed to just pre-date the surge of LH during the natural cycle. Aspects of follicular growth and the timing of ovulation have been studied following the use of these treatments. Follicles rupture some 37 hr after the injection of HCG in cycles where HMG or clomiphene were used to stimulate follicular growth. The timing of ovulation was established with less precision when HCG was used to induce ovulation in the natural cycle, since the LH surge sometimes occurred before HCG was injected and other problems arose during luteinization. The numbers of follicles growing in response to stimulation with clomiphene or HMG showed only a slight relationship to the levels of oestrogen excreted in urine. The morphology of the preovulatory follicle was noted and some biochemical and physiological parameters were measured, including the levels of various steroids and prostaglandins in follicular fluid. The morphology of the oocyte and granulosa cells was recorded. These observations are discussed in relation to several physiological and clinical aspects of ovarian activity: the regulation of follicular growth, the timing of ovulation following the LH surge, factors affecting ovulation, and the relation of studies on follicular growth and ovulation to the rhythm method of contraception and other medical situations.

Chorionic Gonadotropin↗