The use of intrauterine contraceptive devices in diabetics.
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A study was begun to develop a contraceptive delivery system that would free the user from precoital or daily administration and utilize a nonhormonal agent as the active ingredient. Testing of such a system in rabbits has led to the development of a device that will release a controlled level of an acrosin and hyaluronidase inhibitor into the vagina. This toroidal device is composed of a core of tetradecyl sodium sulfate (TDSS) incorporated in polyurethane surrounded by a rate-limiting membrane of polyurethane. Such devices had a sustained in vitro TDSS release rate of greater than or equal to 400 micrograms/day for over 30 days. These devices had a complete contraceptive effect in 15 rabbits bred weekly for 4 weeks. The contraceptive effect is due to release of the TDSS into the vagina and the subsequent binding of the TDSS to spermatozoa in the female reproductive tract. TDSS has a very low toxicity profile in the rat, dog, and rabbit.
A study of the United States acceptors of the Copper T, model TCu 380A, initiated in 1972, was carried to the completion of 4 years of observation. The 1051 receptors, whose median age was 22.3 years, accumulated a total of 1927 years of use. At the end of 4 years, the cumulative net pregnancy rate was 1.9 per 100 women, and the gross rate was 2.8 per 100. The annual continuation rate over the 4-year interval averaged 77 per 100. The TCu 380A intrauterine device (IUD) has provided extremely effective and undiminishing protection against pregnancy through 4 years of use in a group of young women. This degree of protection has not as yet been equaled when randomized comparative trials have been carried out with other copper-bearing IUDs.
An implantable miniature biogalvanic cell was developed to kill the spermatozoa in the vas deferens by an electric current. Experiments in vitro and in vivo showed that a combination of aluminum/silver electrodes connected with platinum wires with the vas deferens fluid as n electrolyte is effective in killing spermatozoa. Female rats paired with males having biogalvanic devices in the vas deferens, which remained patent, did not produce any young.
OBJECTIVES: The aim of the study was to compare the incidence of pre-malignant and malignant cervical conditions during a period of 10 years of use of inert (Szontagh) and copper-bearing IUCDs. METHODS: Candidates were parous women requesting intrauterine contraception regardless of the previous IUCD use and having no contraindications. Follow-ups were scheduled at 1, 6, and 12 months after insertion, and annually thereafter. Colposcopy and cytological evaluation were performed at insertion and at yearly follow-ups. For comparison of the two groups and the different follow-up periods (at the end of each ordinal year), net and gross cumulative lifetable rates were calculated. Statistical differences were measured by chi-squared test, and were regarded as significant at P <or= 0.05. RESULTS: The total number of insertions was 3536 and 13,518 for inert and copper devices, respectively, and the maximum cumulative woman months of use (CWMU) at 10 years for the two groups were 163,567 and 492,836, respectively. There were no statistically significant differences in the life table rates of terminations for suspected cervical pre-malignant and malignant conditions between the groups at the end of each ordinal year. CONCLUSION: The copper-bearing intrauterine contraceptive devices are not associated with a significantly higher risk of cervical cancer compared to the inert IUCDs.
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Reviews of the safety of intrauterine contraception usually are based on studies that do not reflect changes in clinical practice that have occurred over time, and that include many types of IUDs that are no longer used. Studies of insertions of the Multiload 375 and Copper T 380 performed since 1980, which more accurately reflect current clinical practice, show that these IUDs provide a high level of protection against pregnancy and are associated with low rates of complications. Current clinical opinion regarding the safety of IUDs needs to be reassessed in light of the positive safety record of these IUDs.
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OBJECTIVES: Norplant implants have been used for long-lasting contraception in Senegal since 1986. The purpose of this work was to assess tolerance and acceptability of the method among Senegalese women. MATERIAL AND METHODS: A prospective non-comparative study including 300 women was undertaken in the Obstetrics and Gynecology Clinic at the University Teaching Hospital A Le Dantec of Dakar between December 1986 and July 1991. Women meeting inclusion criteria were seen at 1 month, 3 months, and 6 months after insertion then every 6-month until device removal. RESULTS: The mean age of women was 31.3+/-5.45 years and mean parity was 4.7+/-2.45. Almost half of the women no longer desired pregnancy and 67.6% of the women who had not used contraceptive method the month before admission decided to use Norplant. During follow-up visits, 45.2% had menstrual side effects mainly amenorrhea 23.4% and irregular bleeding 12.5%. Non-menstrual side effects were local reactions at the implant site (19.9%). The other side effects were dizziness, asthenia, insomnia, anemia, and high blood pressure and weight change. Overall, 58.8% of the women kept their implants and had them removed after 5 years of use. The failure rate was 3.3+/-1.25. At the end of five years of use, satisfaction was 84.8% and nearly two-thirds of the women decided to recommend Norplant to a friend or relative or to use it again. CONCLUSION: Norplant is a method of choice among the range of contraceptive methods available in Senegal. Because of its advantages and its ease of use, Norplant could be a widely used method in Senegal.
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Insertion of a copper wire into the vas deferens of male rats released 4 micrograms of copper in themid portion of the vas deferens in two days time. In urethral and epidymal segments of the vas deferens copper released was less than one microgram. The present study demonstrates that the in vivo effects of 4 microgram of copper in 2 days time in the vas deferens are enough to induce antifertility in rats.
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This study was undertaken to investigate the role of cytokines in intrauterine contraception. Cervical mucus samples were obtained from 20 women with proven fertility 7, 14, 30, and 120 days after insertion of copper-T380 intrauterine devices (IUDs) for the determination of interleukin-2 (IL-2) soluble receptor (IL-2SR) and granulocyte macrophage colony stimulating factor (GM-CSF) concentrations. Both levels of IL-2SR and GM-CSF were significantly elevated after insertion of copper-releasing IUDs. This elevation remained significant through 6 months post-insertion. The mean-fold rise of GM-CSF compared to pre-insertion mean values amounted to 12.4, 11.8, 2.1, and 1.5 at 7, 14, 30, and 120 days post-insertion, respectively. The corresponding values for IL-2SR were 10.4, 8.8, 2.6, and 2.5, respectively. These results demonstrate enhanced local cytokines production in IUD users indicating local inflammatory reaction in the endometrium. This inflammatory reaction together with the cytotoxic effects of these cytokines may produce an environment which adversely affect embryo pre-implantation. This may explain the antifertility effect of copper IUDs.