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PubMed1989

Measuring the quality and duration of contraceptive use: an overview of new approaches.

This paper provides an overview of recently developed approaches to the measurement of contraceptive continuation and failure rates, using retrospective survey data rather than the data from clinical trials or program statistics which are more traditionally used. The approaches fall into 2 categories, 1 relying on retrospective contraceptive histories and the other on current status information. The 1st section of the paper discusses the need for new methodologies; conventional applications using clinic and acceptor data are described, some recent results from developed countries presented, and their limitations illustrated. In the 2nd section, each new approach is presented in terms of its data requirements, methods of calculation, and empirical applications. Finally, potential sources of bias and the ability of the approaches to accommodate them are discussed.

Bias↗
PubMed1988

Non-availability of the IUD and contraceptive choice.

The Copper 7 and Lippes Loop IUD are no longer distributed in the United States, and the cost of the Progestasert precludes usage in many family planning clinics. The impact of the loss of this widely used contraceptive method was assessed in a pilot study at the UCLA Family Planning Clinic. The clients who would have selected an IUD at the time of their clinic visit between March and December of 1986 instead chose oral contraceptive pills (55%) or barrier methods (45%) but their level of dissatisfaction with the methods they received was significantly greater than that of all other contraceptors, and this led to their subsequent selection of another method which, in the majority (66%), was of lower efficacy than the IUD. There were two unplanned conceptions amongst twenty women who would have chosen an IUD, both due to non-compliance with oral contraceptive pills; and at the time of survey in March 1987, no clients had opted for sterilization. Women who no longer have their choice of the IUD represent a high risk for contraceptive dissatisfaction and failure, but have not made precipitous decisions to undergo permanent sterilization.

Adolescent↗
PubMed1983

Propranolol as a novel, effective spermicide: preliminary findings.

The efficacy and tolerability of 80 mg propranolol tablets as a vaginal contraceptive were studied in 198 fertile women for 11 months. The calculated one year life table pregnancy rate was 3.4/100 women and the Pearl index was 3.9/100 women years. No major adverse effects were encountered. The findings suggested that propranolol is an effective vaginal contraceptive whose failure rate compares favourably with that of other methods of contraception. Further study of propranolol and similar compounds is warranted.

Adolescent↗
PubMed1989

Pregnancies in reliable pill takers.

This study is an extension of a previous study on oral contraceptive pill method failure in reliable pill takers. It documents 137 cases which presented during the 3 year period from December 1985 to December 1988. The most important new finding is that smoking is a significant risk factor in failure on the combined pill (67% were smokers, n = 118), but not on the progestagen-only pill, although the numbers in the latter group were small (n = 19). Diarrhoea and/or vomiting (46%) and drug interactions (33%) are confirmed as important predisposing factors. Systemic illness and/or severe psychological stress may also affect pill utilisation and such factors were found in 47%. Menstrual disturbances were found in 32% of women on the combined pill and 68% of these were smokers. Multiple factors were present in most cases (79%). Repeat failures occurred in 25%.

Adolescent↗
PubMed1979

Do anticonvulsants reduce the efficacy of oral contraceptives?

Women in our area with epilepsy who were also taking oral contraceptives were identified. Of 82 patients taking oral contraceptives, 41 had used both anticonvulsants and oral contraceptives for a total of 955 months. Three documented oral contraceptive (pill) failures occurred during this period, whereas the expected number of 0.12 (relative risk, 25; 95% confience interval, 5 to 73). No pill failures were observed in 2,278 months among women with epilepsy who were taking oral contraceptives but who were not taking anticonvulsants at this time. Thus our data support the suggestion that there is an increased rate of pill failure among women taking anticonvulsants. In view of this diminished effectiveness, the advisability of using oral contraceptives rather than one of the other forms of contraception when anticonvulsant medication is being used concurrently may need to be reevaluated.

Anticonvulsants↗
PubMed1988

Female sterilization using tubal coagulation.

3 different techniques have been described for laparoscopic sterilization using using tubal coagulation. Our experience using all 3 different techniques with a 3-year follow-up is evaluated. Unipolar electrocoagulation (UPE) was used in only 17 cases and subsequently replaced. 1 ectopic pregnancy was encountered (5.88%). There was no pregnancy when bipolar electrocautery (BPE) was applied to 94 women. Endothermic coagulation (EC) was used in 166 patients. 9 pregnancies (5.42%) were noted. An analysis of the possible causes of such high pregnancy rate did not answer our questions. 200 patients were followed by hysterosalpingography (HSG) after tubal coagulation. 4 if them (2%) showed radiologic signs of tubal patency. 1/2 of the clinical pregnancies had a negative HSG performed. BPE is the method of choice for tubal coagulation. EC has a high failure rate. UPE should be abandoned. HSG is not a reliable method for control after sterilization.

Biology↗
PubMed2003

Recent research on vasectomy techniques.

Vasectomy is a commonly used, highly effective method for the control of fertility in the human male. It is almost always performed as an outpatient procedure, is safer than tubal occlusion and has few side effects. The number of people relying on vasectomy as a method of contraception varies widely from country to country. Though vasectomy is highly effective, failures may occur due to re-canalization of the vas, surgical error, anatomical variants or failure of contraception during the post-operative waiting period. One of the disadvantages of this technique is that sperm are present in the posterior end of the vas following surgery and hence patients have to use alternative methods of contraception for a waiting period of 12 weeks to 15 weeks before relying on a vasectomy for contraception. This review summarizes recent research on vasectomy conducted by Family Health International, USA.

Adult↗
PubMed1992

Update on oral contraceptive pills and postcoital contraception.

Modern oral contraceptive pills are safe for the majority of American women. The most important contraindications to oral contraceptive pill use are a history of thrombophlebitis or thromboembolism while on the pill or during pregnancy, smoking over 15 cigarettes daily if over 35 years of age, active liver disease, hypertension, diabetes, a lipid disorder, or breast cancer. A history of gestational diabetes is not an absolute contraindication to oral contraceptive pill use, but women with such a history must be encouraged to exercise and eat properly to reduce the high risk of developing overt diabetes. Couples should be encouraged to use condoms to reduce the risk of sexually transmitted diseases. Most antibiotics do not decrease the effectiveness of the pill. Nonuse of contraception among adolescents and older couples is the most common reason for failure. Postcoital contraceptive pills are available but are not completely effective. The use of modern contraceptives is almost always safer than nonuse.

Anti-Bacterial Agents↗
PubMed1994

Contraception in women with intercurrent disease.

Prescribing a contraceptive method for women with intercurrent disease poses a difficult clinical management problem for physicians. The contraceptive chosen may adversely affect the underlying disease of the patient. Conversely, failure of contraception could result in pregnancy, which could also adversely affect the patient's underlying disease. These factors must be taken into consideration in selecting appropriate and effective contraceptive agents to avoid complications and undesired pharmacologic interactions.

Blood Coagulation Disorders↗
PubMed1981

A prospective multicentre trial of the ovulation method of natural family planning. II. The effectiveness phase.

A five-country prospective study was undertaken to determine the effectiveness of the ovulation method of natural family planning. After successful completion of a teaching phase of three cycles, 725 subjects entered a 13-cycle effectiveness phase and contributed 7514 cycles of observation. The overall cumulative net probability of discontinuation for the effectiveness study after 13 cycles was 35.6%, 19.6% due to pregnancy. Pregnancy rates per 100 woman-years calculated using the modified Pearl index were as follows: conscious departure from the rules of the method, 15.4; inaccurate application of instructions, 3.5; method failure, 2.8; inadequate teaching, 0.4; and uncertain, 0.5.

Adult↗
PubMed2002

Unwanted pregnancies involving young women and men in a New Zealand birth cohort.

AIMS: To examine the circumstances of wanted and unwanted pregnancies before age 25 years for both women and men, and compare the circumstances of the most undesired pregnancies with all others. METHODS: Cross-sectional study within a birth cohort using a computer-presented questionnaire. RESULTS: Of the 477 women, 173 (36%) had been pregnant before age 25 years, and experienced 289 pregnancies of which 173 (60%) were unwanted. Of the 489 men, 142 (29%) reported 225 pregnancies before age 25, of which 165 (73%) were unwanted. By age 25 about a quarter of the study members (27% of women and 24% of men), had been involved in at least one unwanted pregnancy. Wantedness increased with age and length of relationship with the other parent; both factors remained significant in multivariate analysis for men, but not age for women. For women unwanted pregnancies were more likely to be due to non-use of contraception than failure. For both women and men the commonest single reason for not using contraception was not thinking about it, followed by alcohol use. CONCLUSIONS: An environment has emerged for men and women in their twenties in New Zealand where most are sexually active but do not want a pregnancy to occur. To delay pregnancy for a prolonged period requires dedication and commitment to effective contraception. While more attention needs to be paid to promotion of effective use of contraception, more understanding is called for over the difficulties of avoiding pregnancy with long-term reversible contraception. A further approach to the problem of unwanted pregnancies which should be investigated is to encourage committed sexual relationships.

Adolescent↗
PubMed1999

Correlates of condom failure in a sexually active cohort of men who have sex with men.

Condom failure (slippage or breakage) has been shown to be associated with HIV seroconversion among men who have sex with men (MSM), but predictors of failure have been poorly elucidated. Of 2592 HIV-seronegative MSM participants in the HIV Network for Prevention Trials (HIVNET) multisite Vaccine Preparedness Study who reported condom use for anal sex in the 6 months before enrollment, condom failure was reported by 16.6%, with failure rates of 2.1/100 episodes of condom usage (2.5 failures/100 episodes for receptive anal sex and 1.9/100 episodes for insertive anal sex). In separate multivariate models evaluating predictors of condom failure reported by the insertive and receptive partners, more frequent condom use was associated with a decreased per-condom failure rate and amphetamine and heavy alcohol use with increased rates in both models. Being employed, having private medical insurance, and using lubricants for >80% of anal sex acts were significantly associated with decreased failure rates in the insertive model. Safer sex counseling should particularly target men of lower socioeconomic status, promote proper and consistent use of condoms with appropriate lubricants, and address the impact of drug use, especially amphetamines and alcohol, on condom failure.

Adult↗