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The wife of a vasectomized man became pregnant by her husband. He was examined and a supernumerary testis with intact vas and with normal histology and normal spermatogenesis were discovered.
AIMS: To document the main reasons for condom failure in women presenting for first trimester termination of pregnancy. METHODS: From 1990-97 an audit was carried out, on the 3283 cases personally operated on by the author, using the information routinely obtained during pre-operative counselling. RESULTS: Two sets of figures were obtained. The first (minimum figures) were restricted to those who used condoms on every occasion of coitus (746 or 22.7% of all women seen). The second (maximum figures) included all of these plus those who did not use condoms on every occasion or who used condoms in conjunction with another method (1494 or 45.5% of all women seen). In this expanded group, there was no obvious cause for the failure in 446 (29.9% of condom users). The main reason for failure was not using condoms every time (736 or 49.3% of condom failures). Leakage of semen occurred in 321 cases (21.5% of condom failures) and 104 of these had used emergency contraception which had also failed (7.0% of condom failures). Condoms failed more often in women under 25 years of age. CONCLUSIONS: There is a need for better education on correct condom use and improved availability of emergency contraception. There is also a need for greater standardisation in reporting contraceptive failure.
Doxycycline and other antibiotics have been implicated in oral contraceptive (OC) failure, but information is sparse and studies of a doxycycline-OC interaction are nonexistent. Because an interaction between doxycycline and OCs, especially those containing low-dose estrogen, could result in an unplanned and unwanted pregnancy, a controlled clinical trial of the effects of doxycycline on OC hormone concentrations was performed. Twenty-four women aged 18-35 years were recruited as volunteers from among the patients seen in a University-based family planning clinic. While they were on a steady dose of the OC Ortho-Novum 1/35, serum concentrations of ethinyl estradiol, norethindrone, and endogenous progesterone were measured on days 18, 19, and 20 of the menstrual cycle (control phase). These measurements were repeated on days 18, 19, and 20 of the following menstrual cycle while the patient was taking doxycycline, 100 mg twice daily (treatment phase). No statistically significant differences in serum levels of ethinyl estradiol, norethindrone, or endogenous progesterone were seen between the control and treatment phases. However, there was large inter-patient and intra-patient variability in ethinyl estradiol and norethindrone levels. No elevations of endogenous progesterone occurred to suggest ovulation during antibiotic administration in either phase. It is not known what effects longer or earlier administration of doxycycline during the OC cycle would have on serum hormone concentrations or ovulation. Pregnancies attributed to failure of OCs because of tetracycline use could in fact be due to other causes or could represent a true interaction that only manifests itself in a small proportion of women at risk.
OBJECTIVE: To assess the recent incidence of ectopic pregnancy (EP) in France (1992-1997) and to relate this incidence to trends in risk factors and use of contraception. DESIGN: Population register-based study. SETTING: Auvergne EP register (central France). PATIENT(S): Women aged 15-44 years with EP in the Auvergne region. MAIN OUTCOME MEASURE(S): Rates of EP, frequencies of exposure to risk factors, and sales of contraceptive methods in 1992-1997. RESULT(S): The overall EP rate decreased 13.7%, from 96.4 per 100,000 women aged 15-44 in 1992 to 83.2 per 100,000 in 1997. The rate of EP associated with reproductive failure remained stable, but the rate of EP associated with contraceptive failure (mostly intrauterine device failure) decreased 26.6%. The trends in the prevalence of the main risk factors for EP and sales of contraceptive methods are concordant with the changes in EP rates: Risk factor prevalence did not change over time, but intrauterine device sales in the area declined in parallel. CONCLUSION(S): The rates of EP as the result of contraceptive failure and as a result of reproductive failure evolve differently in the population and should not be confused in epidemiologic studies. This finding, along with published evidence that the two types of EP have different risk factors, location, prognosis, and perception by women, indicates that they are two distinct clinical entities possibly requiring different management.
OBJECTIVES: The purpose of this article is to determine the knowledge status of women concerning postcoital contraception when they turn to curettage in order to terminate an undesired pregnancy. METHODS: This defining study has been carried out at a maternity hospital in Izmir on pregnant women admitted for curettage. We interviewed 150 pregnant cases using an improbability sampling method. RESULTS: We discovered that 48.7% of women had avoided pregnancy before curettage by withdrawal before ejaculation. When we investigated the method used after uncontrolled coitus, 27.3% of cases reported vaginal douche while 12.7% indicated curettage. After having an unprotected coitus or failure in contraceptive methods 99.3% of the women indicated they would report to health institutes to utilize postcoital methods if they were familiar with them. CONCLUSIONS: Postcoital contraception may be a solution for undesired pregnancies.
Between 1968 and 1973, 2122 women were sterilised, 52.2% were by laparotomy, 46.3% by laparoscopy. Sterilisation was performed after abortion in 38.5%, after delivery in 22.5%, and as an interval procedure in 38.5% of cases. Laparoscopy had a lower incidence of side effects than laparotomy, and sterilisation as an interval procedure was safer than after delivery or abortion. A five-year follow-up of patients revealed a low incidence of late side effects; only 34 patients required hysterectomy and in 18 this was not due to the sterilisation. Failure of sterilisation (0.5%) was evenly distributed between the various methods; operative trauma was low 0.6% for laparoscopy and 0.2% for laparotomy. There were 4 maternal deaths, only 2 were related to the procedure.
Female sterilization by laparoscopy has become widely accepted throughout the United States and Europe. The failure rate of this procedure is still speculative. In the course of 4200 operative sterilization, 32 failures have been identified and 31 of these have been subsequently evaluated. The most common finding was inadequate or superficial fulguration and resection. Operative errors such as round ligament fulguration were also more common than expected.
OBJECTIVE: Nonuniformity in suppression of spermatogenesis induced by various hormones or hormone combinations has impeded the development of an effective hormonal male contraceptive. The basis for this heterogeneity in response remained unresolved to date; however, the presence of ethnic differences points to an involvement of genetic factors. PATIENTS AND MEASUREMENTS: In a retrospective analysis we investigated the impact of a CAG repeat polymorphism in the androgen receptor and polymorphic sites in the oestrogen and FSH receptor genes on spermatogenic suppression in 85 Caucasian men treated with different regimens of hormonal contraception. RESULTS: Failure to reduce sperm concentrations below 3 million/ml was significantly associated with insufficient suppression of gonadotrophins. The extent of gonadotrophin suppression was not explained by any polymorphism but was primarily pharmacological, resulting from addition of gestagens to testosterone. When LH and FSH suppression was rapid and persistent none of the polymorphisms studied explained why some men failed to achieve azoospermia. In cases with incomplete gonadotrophin suppression the chances of becoming azoospermic were 2.5 times higher in men having more than 22 CAG repeats. CONCLUSIONS: In summary, our analysis shows that in a subset of men, effective hormonal male contraception can be achieved even in the absence of complete gonadotrophin suppression.
Between 1890 and 1945 the number of induced (criminal) abortions increased in Amsterdam; from 1945 up until the 1960s the number decreased slightly. In 1965 the number of induced abortions that took place in Amsterdam was estimated at more than 2000. Complications were frequent and included infections, septicaemia, damage caused by injected soap and sometimes air embolism. Women in Amsterdam often used primitive methods of contraception, but effective methods, such as condoms and diaphragms, were also used to some degree. Oral contraception was introduced in The Netherlands in 1962. Its use increased rapidly and consequently many doctors were confronted with problems surrounding contraception, including failures and abortion requests. After a television programme on abortion in 1967, requests for abortion surged. Hospitals set up multidisciplinary abortion committees to assess the requests, but soon it became evident that the women themselves were better able to judge whether they should undergo the procedure. Abortion clinics were established outside hospitals. Support from the feminist movement played a role after changes were already underway. The nationwide number of abortions increased to 21,000 in 1972 and to about 25,000 in the 1990s. The number remained stable, even among teenagers, because caregivers placed a great deal of emphasis on adequate contraception.
Family planning groups and a lawmaker accused a US drug company yesterday of profiteering on Norplant, the implantable, 5-year contraceptive. The company said its $365 product is cheaper than birth-control pills. But Rep. Ron Wyden said Norplant was developed with extensive government support and sells for $23 in some Third World countries. He said its cost to Wyeth-Ayerst laboratories may be as little as $16. About 875,000 US women have had 6 match-sized hormone-dispensing rubber capsules implanted in their upper arms since 1990. Dr. Amy Pollack of the Association of Reproductive Health Professionals said 56% of the 6 million pregnancies in the US each year are unwanted. She said 1.7 million pregnancies occur among women using contraceptives. The failure rate is less than 4 per 10,000 with Norplant compared with 3 per 100 women on the pill, she said. Dr. Marc W. Deitch, Wyeth's medical director, said the company made a risky decision to bring Norplant to market in collaboration with the nonprofit Population Council. The implant costs women 20 cents a day over its 5-year life, said Dr. Deitch. The $365 cost is significantly less than the $1481 they would pay over 5 years for birth-control pills, $762 for a diaphragm and $590 for shots of Depo Provera, he said. Male condoms cost $312 and an IUD $176. Family planning advocates challenged Dr. Deitch's math. Judith DeSarno, president of the National Family Planning and Reproductive Health Association, said federally funded clinics pay only $60 for a 5-year supply of oral contraceptives. Women also must pay doctor fees--usually from $150 to $200--for inserting Norplant and eventually removing it from their upper arms.
The operative, postoperative and subsequent course of 86 patients who underwent cesarean hysterectomy (C.H.) during the years 1970-1979 are compared to an equal number of cesarean sections with tubal ligation (C.S.L.). Both groups are similar regarding age, gravidity, parity, number of living children and indications for abdominal delivery. Operative and postpartum complications of both groups were all minor, although significantly (p less than 0.05) more frequent in the C.S.L. group. More patients of the C.H. group required blood transfusions than the C.S.L. group (p less than 0.01). The mean period of hospitalization was similar in both groups. Two pregnancies occurred after tubal sterilization, a failure rate of 1:43. During the follow-up period, 49 surgical gynecological procedures were performed in the C.S.L. group compared to 1 in the C.H. group. Ten patients of the C.S.L. group subsequently underwent abdominal hysterectomy. Hysterectomy is the procedure of choice for permanent sterilization and prevention of many subsequent gynecological problems. Consideration must be given to coexisting gynecological conditions while considering sterilization at elective C.S. and C.H. should be offered to those patients.
PROBLEM: Reduction of excess numbers of white-tailed deer (Odocoileus virginianus) is an example of a potential use for immunocontraception as a means of wildlife population management. METHOD OF STUDY: A 4 year multifaceted study was conducted to determine the long term effects of gonadotropin releasing hormone (GnRH) contraceptive vaccine on the fertility and behavior of female and male white-tailed deer. Deer were monitored for breeding behavior, hormone levels, pregnancy, fawning and GnRH specific antibody levels. RESULTS: Treatment lead to reduced fawning rates, altered estrus behavior, reduced concentrations of progesterone, contraception and failure to maintain pregnancy following conception. GnRH immunized does bred to untreated bucks had an 88% reduction in fawning caused by either immunocontraception or immunocontragestion. The vaccine effect is reversible, directly related to the antibody titer. Infertility lasted up to two years without boosting. GnRH immunized bucks demonstrated no interest in sexual activity when paired with control females. Depending on the immunization schedule, antlers either dropped early or remained in velvet. CONCLUSIONS: The results of this study demonstrate that GnRH vaccine is effective in inducing a reversible infertility in white-tailed deer, the infertility lasting up to two years without boosting.
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A total of 104 couples participated in a randomized crossover trial to compare a new baggy condom with a straight-shaft condom produced by the same manufacturer. Participants completed a coital log after using each condom. All couples used five condoms of each type. Among 102 couples who did not report major deviations from the protocol, the breakage rate was eight of 510 (1.6%) for the baggy condom, and six of 510 (1.2%) for the standard condom (rate difference, RD = 0. 4%, 95% confidence interval of the RD, CI = -1.0%; +1.8%). Slippage was reported in 50 baggy condom logs and in 58 standard condom logs; the slippage rate was 50 of 510 (9.8%) for the baggy condom, and 58 of 510 (11.4%) for the standard condom (RD = -1.6%, 95% CI = -5.4%; +2.2%). Slippage was most often partial (<1 inch) and may not indicate condom failure. Severe slippage rates were 11 of 510 (2.2%) for the baggy condom, and 18 of 510 (3.5%) for the standard condom (RD = -1.4%, 95% CI = -3.4%; +0.7%). The findings support the conclusion that the two condoms are equivalent with respect to breakage and slippage. The participants appeared to prefer the baggy condom, suggesting that the new product may be more acceptable to the public than the traditional straight-shaft condoms, and may be easier to use consistently over long time periods.
Forty women participated in three clinic visits during which they were exposed to their partner's semen (10 microL, 100 microL, and 1 mL). At each visit they took vaginal fluid samples before exposure to their partner's semen, immediately after, and at 1, 24, and 48 h after exposure. PSA was measured with an enzyme-linked immunoassay. The mean PSA level for preexposure swabs ranged between 0.43 and 0.88 ng/mL. The mean PSA levels were 193 immediately after exposure to 10 microL, 472 after 100 microL, and 19,098 after 1 mL. The PSA levels declined within 1 h, and returned to background at 48 h. The findings confirm that our procedure is a sensitive and specific method for detecting recent semen exposure, and indicate that PSA levels depend on exposure intensity and time since exposure. Application of this method in condom efficacy studies provides objective evidence of condom failure that enhances the interpretation of self-report.
In September 1972, clinical trials of a spring-loaded clip for laparoscopic sterilization were begun and extended to a number of centers in the United States and overseas. As of March 1974, more than 1000 patients had undergone the procedure, usually performed under local anesthesia in an outpatient setting, with no fixed contraindications. Complications and pregnancy rates based on a preliminary 6-month follow-up are presented. Complications due to application of the clip appeared to be limited to postoperative cramps lasting 24 to 48 hours (26% of the patients). No ectopic pregnancies were reported. Pregnancies, when corrected for unsuspected pregnancies and misapplication of the clip, occurred in 2 of these first 1000 patients. The difficulties and relative contraindications learned from this unselected series and the advantages over electrocagulation techniques are discussed.
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