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PubMed1976

[Intrauterine contraceptive devices. Mode of action, experiences, complications (author's transl)].

Already in 1909 methods of an intrauterine contraception were indicated in Germany. Their practical use was intiated twenty years later by Ernst Graefenberg. Further development almost exclusively takes place in the USA, whereas the major part of basic investigations has been done. The introduction of copper bearing IUD's undoubtedly increased the safety of intrauterine contraception. Investigations concerning the morphology of the endometrial contact area (f.e. by SEM) and the evaluation of certain biochemical facts associated with the release of copper ions, lead to hypotheses of the mode of action. A randomized comparative study of CuT 200 verus Lippes Loop D demonstrates similar pregnancy rates with both types of IUD, but a moderate advantage of the CuT 200 in regard of the expulsion rate and the removal rates due to bleeding and/or pains. The author stresses that it might be medically indicated to terminate pregnancy when a woman has conceived in spite of a copper bearing IUD in situ. His statement is in correspondence to the recommendations of the Population Council, but nevertheless, this problem as yet is far of being solved unanimously. Most complications associated with the IUD are due to incorrect insertion. It is therefore postulated to insert the IUD menstrually, maintaining strictly sterile conditions, a non-deformed uterus being hooked on a bullet forceps. As already anticipated by Ludwig Fraenkel a careful insertion should be done by experienced doctors only, this fact counteracting the widespread use of this contraceptive method to be in the second place as compared to hormonal contraception.

Abortion, Legal↗
PubMed1976

[Copper-7 intrauterine device (Gravigard). Report of experience].

Within 2 years 258 women aged 16 to 42 years were fitted with a copper-7-IUD (Gravigard, Searle). 45% of these patients were nulliparous women. Follow-up studies were provided in 236 cases in a total of 2717 women-months according to an average time of observation of 11.5 women-months per patient. Altogether there occurred 5 unwanted pregnancies with a Pearl-Index of 2.3. Partial or total expulsion occurred in 27 cases (11%). Fourteen out of 27 expulsions were noticed within the first 2 months after insertion. Removals for medical reasons were requested in 36 cases-in the majority (26 cases) because of bleeding and pain. Thirteen women desired removal of the IUD in order to get either pregnant or sterilized. The continuation rate after 2 years was 73%. The highest number of drop-outs occurred within the first year after insertion (60 cases = 23%) whereas only 4% drop-outs occurred in the 2nd year. It was suggested that the low continuation rate might be partially due to the high number of physicians (19) participating in this study. The most important side effects of the copper-7-IUD in situ were irregular bleeding, intermenstrual pain and discharge. Irregular bleeding and pain decreased markedly after the first year, while slightly prolonged periods persisted in 30 to 50% of all patients. Compared with oral contraceptives copper IUDs hav less severe side effects but less safety at the same time-especially for the younger fertile age group. Therefore they should be offered to young nulliparous women only for a limited period of time.

Abortion, Spontaneous↗
PubMed1998

Managing clinical complexities of long-term contraception.

The 3 methods of long-term contraception (LTC) approved for use in the US are intrauterine devices (IUDs), levonorgestrel subdermal implants, and sustained-release medroxyprogesterone acetate injections. Women who use reversible LTC are likely to receive care from clinicians who did not prescribe the method of contraception originally. Fortunately, most concerns arising from the use of reversible LTC can be managed by clinicians regardless of their specialty. Problems associated with an IUD can include a missing string, partial expulsion of the device, change in menstrual pattern, vaginal discharge, or infection. Headaches, weight gain, dermatologic problems, changes in hair growth, and irregularities in menses are among the problems that clinicians may confront while caring for a woman who has had subdermal hormone implants or has been taking depot injections. Besides the problems caused by or complicating specific methods of LTC, a woman may seek clinical care for a variety of general concerns. These include a desire to terminate LTC in order to become pregnant, and physical changes that are suspected to indicate pregnancy or contraceptive failure. In addition, general health conditions such as concurrent medications, hypertension, and endocrine disorders may need special consideration in a woman using LTC. There are few medical indications for discontinuing or changing LTC, even when intercurrent illnesses arise.

Female↗
PubMed2003

Use of prostate-specific antigen (PSA) to measure semen exposure resulting from male condom failures: implications for contraceptive efficacy and the prevention of sexually transmitted disease.

Accurate measurement of semen exposure resulting from condom failures can refine public health messages and improve predictions of condom efficacy in preventing pregnancy and HIV transmission. Eight hundred and thirty couples enrolled in a condom efficacy study were asked to collect a baseline sample of ejaculate from the inside of the first study condom they used and to collect a postcoital vaginal sample whenever a study condom broke or slipped off during intercourse. All samples were quantitatively tested for prostate-specific antigen (PSA), a substance found only in human semen, using rocket immunoelectrophoresis, and inspected microscopically for presence of sperm. Sixty-eight baseline ejaculate samples collected from the inside of the first study condom by couples who subsequently experienced a condom failure averaged 13.4 microg PSA per swab and 79% of the samples averaged one or more sperm per high power field (hpf). Seventy-nine postcoital vaginal samples obtained after a condom break averaged 5.7 microg PSA per swab and only 38% averaged one or more sperm per hpf. The PSA results indicated a 50% reduction in semen exposure compared to baseline levels (p = 0.0001). Seventeen samples obtained after a condom slip-off averaged 2.5 microg PSA per swab and none of the samples averaged one or more sperm per hpf. The PSA results indicated an 80% reduction in semen exposure compared to baseline levels (p = 0.0001). Our results suggest that even condoms that fail reduce the risk of pregnancy and the transmission of sexually transmitted disease compared to unprotected intercourse. We also used PSA results to adjust a model designed to predict consistent-use pregnancy rates from condom breakage and slippage data.

Coitus↗
PubMed1998

A scenario study of oral contraceptive use in Japan. Toward fewer unintended pregnancies.

A scenario study was conducted to assess the extent to which the unintended pregnancy rate in Japan, where oral contraceptives (OC) have not been legalized for family planning purposes and couples rely mainly on condoms, might change if more women were to use OC. Because current rates of unintended pregnancy and abortion in Japan are not known, data provided by the 1994 Japanese National Survey on Family Planning were used to construct scenarios for national contraceptive use. Annual failure rates of contraceptive methods and nonuse were applied to the contraceptive use scenarios, to obtain estimates of the annual number of contraceptive failure-related pregnancies. Subsequently, contraceptive practice situations assuming higher OC use rates were defined, and the associated change in the number of contraceptive failure-related pregnancies was estimated for each situation. It emerged that OC use rates of 15% decreased the expected number of unintended pregnancies by 13%-17%, whereas use rates of 25% resulted in decreases of 22%-29% and use rates of 50% in decreases of 45%-58%. The findings were reasonably robust to variation in the assumptions that were made. In conclusion, each theoretical percentage increase in the OC use rate in Japan was found to lead to a roughly equivalent percentage decrease in the number of unintended pregnancies.

Adolescent↗
PubMed1981

[The position of the IUD and intrauterine pregnancies].

In 59 women who became pregnant with an IUD the position of the device was controlled by ultrasound. Before the 9th week of pregnancy the device was located in 40 women (78.4%) in the cervix or in the isthmic region of the uterus. In 11 cases the IUD was in correct position. 8 women had a pregnancy of more than 9 weeks and were not included in the study as the gestational sac could have influenced the IUD position. The possibility of regular control of the IUD position by ultrasound is discussed in order to reduce the failure rate of this contraceptive method.

Cervix Uteri↗
PubMed1996

Emergency hormonal contraception usage in genitourinary medicine clinic attenders.

OBJECTIVE: To assess the indications for usage of emergency hormonal contraception amongst a population of London genitourinary medicine clinic attenders. METHODS: In a prospective study, 150 consecutive women receiving emergency hormonal contraception (EHC) were enrolled. The attending doctor completed a questionnaire of patient details and prescribed EHC with prophylactic prochlorperazine. Follow-up was arranged three weeks later, at which time outcomes and side-effects of therapy were recorded. For those women who did not reattended as planned case notes were reviewed at three months. RESULTS: Of 150 women surveyed, 100 (66%) reported contraceptive method failure, 48 (32%) had used no contraception at the time of last sexual intercourse and two requested EHC after sexual assault. Ninety three (62%) reported condom failure, 7 (5%) oral contraceptive pill failure. Seventy five (50%) had used EHC before (range 1-10 times). Seventy one (47%) women reattended within three months. Five (3.3%) of the 150 women were pregnant; none of these cases had experienced nausea or vomiting whilst taking EHC. Side-effects were reported by 22 (31%) of the 71 patients who reattended. Nine (6%) women had been followed-up in the family planning advisory clinic. Of the 71 women who reattended, 39 (55%) reported that their preferred future method of contraception would be condoms. Of the 150 women 19 (13%) underwent tests for sexually transmissible infections within one month of presentation. CONCLUSIONS: EHC usage in this population was associated with a failure rate of at least 3.3% and an overall side effect rate of 31%. Despite requests for emergency contraception because of condom failure many elected to continue using condoms as their preferred method of contraception. The majority of women (53%) did not return for follow-up or family planning advice, and so we believe that future contraceptive plans must be addressed at the time EHC is prescribed.

Adolescent↗
PubMed1996

The missing forgotten intrauterine contraceptive device.

Failure to locate the strings of an intrauterine contraceptive device may mean that the device is within the uterine cavity, was expelled or, worst of all, has perforated the uterine wall. We describe a 36-year-old woman complaining of infertility in whom two missing devices were found within the pelvis after having perforated the uterus. This report demonstrates the need to investigate every case of a missing intrauterine contraceptive device. An algorithm for the proper management of such cases is suggested.

Adult↗