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PubMed1992

A long-term study of mortality in men who have undergone vasectomy.

BACKGROUND: Vasectomy is a reliable and widely accepted method of contraception, but there is some uncertainty and few data about a possible long-term adverse effect on health. METHODS: We examined the relation between vasectomy and mortality rates from cardiovascular disease, cancer, and all causes in a retrospective cohort of husbands of members of the Nurses' Health Study. In 1989 we obtained data by questionnaire on 14,607 men who had undergone vasectomy as of 1976 and 14,607 men who had not. RESULTS: Among the men who were free of cancer at the start of the study, 1052 died: 446 of cardiovascular disease, 341 of cancer, and 265 of other causes. Vasectomy was associated with reductions in mortality from all causes (age-adjusted relative risk, 0.85; 95 percent confidence interval, 0.76 to 0.96) and mortality from cardiovascular disease (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.92). Vasectomy was unrelated to mortality from all forms of cancer (relative risk, 1.01; 95 percent confidence interval, 0.82 to 1.25). Among men who had a vasectomy at least 20 years earlier, the procedure had no relation to mortality from all causes (relative risk, 1.11; 95 percent confidence interval, 0.92 to 1.33) or that from cardiovascular disease (relative risk, 0.85; 95 percent confidence interval, 0.63 to 1.16). However, mortality from cancer was increased in men who had a vasectomy at least 20 years earlier (relative risk, 1.44; 95 percent confidence interval, 1.07 to 1.92). The excess risk of cancer in these men was due primarily to lung cancer. None of the observed associations were confounded by smoking habits, body-mass index, alcohol consumption, or educational level. CONCLUSIONS: Vasectomy is not associated with an increase in overall mortality or mortality from cardiovascular disease. Our study also found no increase in overall mortality from cancer after vasectomy, but there was an apparent increase in the risk of cancer 20 or more years after vasectomy that requires further study.

Adult↗
PubMed1989

Psychological impact of abortion: methodological and outcomes summary of empirical research between 1966 and 1988.

A systematic "roadmap" through the medical literature that empirically examines the incidence of psychological sequelae of induced abortion is presented. Because outcome incidence rates and methodological profiles vary substantially across studies, selective use of articles from this literature without an accompanying rationale for that selectivity could foster erroneous conclusions. Information compiled here can facilitate a rapid methodological critique of citations in abortion-related materials. Investigations published in English between January 1966 and April 1988 that quantitatively examined psychological sequelae using prospective, retrospective, or comparative methodologies are summarized in tables to produce a synopsis of the demographics, methodological limitations, and gross statistical features of each article. This quantitative guide is designed to facilitate appropriate use of the current literature, provide needed background to assess positions arising from the currently available data, and provide methodological focus for planning better studies in the future.

Abortion, Induced↗
PubMed1989

Reduced fecundability in women with prenatal exposure to cigarette smoking.

Animal studies have suggested that fertility may be impaired by transplacental exposures, but little is known about human prenatal exposures and subsequent adult reproduction. A possible relation between prenatal exposure to cigarette smoking and adult fecundability in women was explored, with the use of data from a prospective study of 221 North Carolina couples. These couples were recruited during 1983-1985, at the time they stopped using birth control in order to become pregnant. The relative fecundability of exposed compared with unexposed women was estimated by applying a discrete-time proportional probabilities model to the cycle-by-cycle conception rates. Women with prenatal exposure to their mother's cigarette smoking had reduced fecundability. The fecundability ratio associated with prenatal exposure to mother's smoking, adjusted for age, frequency of intercourse, current smoking status, age at menarche, and childhood exposure to cigarette smoking, was 0.5 (95% confidence interval 0.4-0.8). This association was not changed by further adjustment for other possible confounding variables, including educational level, reproductive history, body weight, and consumption of alcohol and caffeine. Thus, women whose mothers smoked while pregnant with them may be on average substantially less fecund than women whose mothers did not smoke during pregnancy.

Adult↗
PubMed1989

Obsessive-compulsive disorder apparently related to abortion.

This case study presents a young woman who developed a severe obsessive-compulsive disorder after a routine medical procedure. It is suggested that this procedure brought back repressed guilt from three abortions and thus led to the onset of symptoms. The case is discussed in relationship to available research and theory.

Abortion, Induced↗
PubMed1998

The effects on mortality of the use of combined oral contraceptives.

OBJECTIVE: To assess, using a computerised model, the effects on mortality of the use of combined oral contraceptives (COCs). DESIGN: Two hypothetical cohorts of one million women each, identical except for their use of contraception. The impact of COC use was explored by applying, to each cohort, death rates which were adjusted according to a series of assumptions about the risks associated with COC use. The model also explored the effects of a number of different patterns of COC use. SETTINGS AND SUBJECTS: Women aged 16, followed through to ages 50 and 75, exposed to 1994 UK death rates. MAIN OUTCOME MEASURES: Numbers of deaths from various cancers and cardiovascular diseases attributable to COC use. RESULTS: Based on the standard pattern of use, there were 1.7 per cent more deaths in the COC cohort to age 50. The important effects on mortality of different patterns of use and of different assumptions about risks in ex-users were illustrated. CONCLUSIONS: The results confirm the findings of earlier work and provide some reassurance about the likely adverse effects of COC use.

Adolescent↗
PubMed1980

Serum copper in long-term users of copper intrauterine devices.

A study was undertaken to determine whether long-term use of a copper intrauterine device (IUD) was associated with any alteration in the serum copper levels and thereby whether absorption of copper from the device in utero could result in copper toxicity. Serial estimations in copper IUD wearers showed that there was no alteration in serum copper levels for a period of up to 24 months. The mean range and frequency distribution of serum copper levels in long-term copper IUD wearers was similar to that seen in the normal population. There was no difference in the mean 24-hour urinary copper excretion between the control group and the copper IUD wearers. Data suggest that the copper released from a copper IUD may not be readily absorbed from the uterine fluid. This hypothesis needs verification.

Copper↗
PubMed1989

Long-term effects of progestin and RU 486 on prolactin production and synthesis in human endometrial stromal cells.

Previous studies have shown that the production of prolactin (PRL) is increased in human endometrial stromal cells cultured with medroxyprogesterone acetate (MPA) for 3-5 days. In the present study, we have investigated the effect of prolonged treatment of progestin and anti-progestin, RU 486, on the production and synthesis of PRL. Stromal cells were isolated from human endometrium obtained from non-pregnant women and cultured for 20-30 days in medium RPMI 1640 with 2% fetal calf serum or supplemented with MPA, RU 486, alone or in sequence. The PRL content in medium was measured by radioimmunoassay. The production rate was estimated from the PRL content in medium accumulated in 24 h. The PRL production rate was progressively increased in stromal cells continuously treated with MPA for 30 days (greater than 100-fold over the control value, i.e. 0-0.01 microgram/0.1 mg cell DNA/day). RU 486 alone had no effect on the production of PRL. However, the production of PRL was increased by MPA in stromal cells pretreated with RU 486 indicating that the effect of RU 486 is reversible. When stromal cells were treated with MPA and RU 486 sequentially, RU 486 stimulated the PRL production (approximately 2-fold over the MPA-treated cells) for 2-3 days and then reduced to basal levels over a 5-day period. The stimulatory and inhibitory effects of RU 486 on PRL production in stromal cells pretreated with progestin was also observed in the rate of synthesis of PRL estimated by incubating the stromal cells with [35S]methionine and immuno-isolating the [35S]PRL with anti-PRL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1979

Delayed reproductive complications after induced abortion.

An investigation was undertaken regarding subsequent pregnancy in 619 women who had their preceding pregnancy terminated by legal abortion, compared with an age- and parity-matched group of 619 women who continued with the pregnancy to delivery. The groups were compared for complications such as first and second trimester abortion, cervical incompetence, pre-term delivery, ectopic pregnancy and sterility. The total complication rate was 24.3 per cent in the abortion group, and 20.2 per cent in the controls. No significant difference was found between the two groups for any of the parameters examined, except for a significantly higher rate of complications amongst women who had not had a previous delivery: 25.5 per cent as opposed to 13.2 per cent in the control group.

Abortion, Induced↗
PubMed1988

Adolescent marriage and childbearing: the long-term economic outcome, Canada in the 1980s.

The purpose of this paper is to examine the long-term economic outcomes (education, labor force participation, occupation, and income) associated with female adolescent marriage and childbearing. The 1981 Canadian census is the data source for all women in Canada at age 30, controlling for age at marriage and at first birth. The data suggest that women at age 30 in Canada are in the best economic circumstances when they remain single or when they marry at age 20 or older and either remain childless or begin their childbearing at age 25 or older. The implications of these findings are discussed.

Adolescent↗
PubMed1995

Retained common bile duct stones after endoscopic sphincterotomy: temporary and longterm treatment with biliary stenting.

Basket extraction after endoscopic sphincterotomy failed to clear the bile ducts immediately in 85 (30%) of 283 consecutive patients with common bile duct stones. Temporary biliary drainage was established by the insertion of a single 7 Fr double pigtail stent before further planned endoscopic attempts at stone removal. In 84 patients (21 male: 63 female, mean age 77 years) this measure relieved biliary obstruction, mean serum bilirubin falling from 101 to 18 umol/l by the time of the second endoscopic retrograde cholangiopancreatography. Six patients died from non-biliary causes with temporary stents in situ. Common bile duct stone extraction was achieved endoscopically in 50 of the remaining 79 patients after a mean of 4.3 months (range 1-12), 34 (68%) requiring only one further procedure. Three patients were referred for biliary surgery. Single stents were also effective for longterm biliary drainage in the remaining 26 elderly patients with unextractable stones. The main biliary complication of stenting was 13 episodes of cholangitis but all except one responded to medical treatment and early stent exchange. If common bile duct stones remain after endoscopic sphincterotomy, a single 7 Fr double pigtail stent is effective and safe for temporary biliary drainage before further endoscopic attempts at duct clearance and for longterm biliary drainage especially in the old and frail.

Adult↗
PubMed1980

Clinical evaluation of long-term treatment with levo-norgestrel and testosterone enanthate in normal men.

Thirteen healthy men (25-35 years) with proven fertility were scheduled for long-term treatment (> 12 months) with levo-norgestrel (500 micrograms daily) and testosterone enanthate (200 mg monthly). The volunteers were regularly investigated prior to, during and after treatment. Seven volunteers withdrew from medication after 1 to 12 months of treatment; three due to psychological side effects, one because of stiffness of a finger joint, two for personal reasons and one for unspecified reasons. Sperm counts were significantly decreased during treatment and in 7 volunteers the sperm counts were < 5 x 10(6)/ml. However, two of these volunteers exhibited a breakthrough in sperm counts after 12 and 13 months of a 16-month treatment period. Serum testosterone, serum LH and serum FSH were significantly decreased during treatment, but returned, as did sperm counts, to normal levels after withdrawal of treatment. No rebound effect was seen. Potency and libido remained unchanged. No toxicological side effects were observed and finally no consistent changes were seen in blood coagulation parameters.

Adult↗
PubMed1997

Is vasectomy harmful to health?

Since the late 1960s, vasectomy has been a popular and widely used form of contraceptive in Britain for couples who do not want to have any more children. However, throughout the past decade there has been considerable concern about the safety of this procedure. This paper reviews the current opinion on the possible health considerations associated with this operation and shows that the latest news is mostly reassuring.

Cardiovascular Diseases↗
PubMed1991

Prostaglandin production in human endometrium following continuous exposure to low-dose levonorgestrel released from a vaginal ring.

Arachidonic acid metabolites produced by primary cultures of human endometrial cells derived from biopsies obtained before and after exposure to 20 micrograms/day levonorgestrel for 84 +/- 1 days were analysed by reverse phase HPLC. This revealed a significant increase in PGF1 alpha and an epoxide metabolite upon levonorgestrel stimulation. The proportion of epoxide metabolite, PGF1 alpha and PGE2 were positively correlated with serum levonorgestrel levels while HETES, PGE2 and epoxide were similarly correlated with serum oestradiol. The extent of intermenstrual bleeding during exposure to levonorgestrel was correlated with the proportion of epoxide and HETES products in vitro which is discussed in relation to their physiological function.

6-Ketoprostaglandin F1 alpha↗