Contraception with intrauterine devices.
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Contraception↗
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Actinomyces in cervical smears of women using the intrauterine device in Singapore.
OBJECTIVES: Reproductive tract actinomyces have been associated with the use of intrauterine contraceptive device (IUCD). Thus, there is a need to evaluate the prevalence of colonization with Actinomyces israelii in a cohort of Singaporean women using an IUCD. Second, the occurrence of actinomycosis in colonized women and the clinical need to remove the IUCD and/or possibly the need to treat asymptomatic carriers with antibiotics were evaluated. METHODS: The study population consisted of 1,108 IUCD users attending the Fertility Control Clinic, National University Hospital, Singapore. RESULTS: In our study, the prevalence of actinomyces-positive cervical smears among IUCD users was 13.7%; the incidence of actinomyces-positive smears was similar with Copper T (34.2%), Multiload (32.9%) and Nova T (32.9%) IUCDs. We found no association with the duration of use of IUCD and actinomyces infection. In our study, 150 out of 152 (98.7%) IUCD users with actinomyces-positive smears were asymptomatic, and only 2 out of 152 (1.3%) who had actinomyces-positive cervical smears developed pelvic inflammatory disease at 6 months. CONCLUSIONS: Our study suggests that removal of the IUCD in asymptomatic women with actinomyces-positive cervical smear is not necessary. Moreover, we suggest that asymptomatic carriers of actinomyces do not require preemptive antibiotic treatment.
Actinomyces↗
[Present and future choices of vaginal drug dosage forms. I. Classical forms].
The anatomy and physiology of vagina play a major role in the formulation of vaginal products. In this review, many classical dosage forms (tablets, suppositories, creams, gels, foams...), used either for local or systemic treatment are described and discussed. Formulation and essay are briefly reviewed. But emphasis is layed on the problems associated with the administration of these dosage forms, their advantages with regard to other vaginal products and the use of these products as contraceptive devices.
Administration, Intravaginal↗
Absence of chorionic gonadotropin in sera of women who use intrauterine devices.
A controlled study was undertaken to determine whether unnoticed pregnancies routinely occur in users of the intrauterine contraceptive device (IUD). Starting on day 10 of the menstrual cycle and continuing through the onset of menstruation or until the diagnosis of pregnancy, we collected daily blood samples from three groups of normally menstruating young women. The study groups were (A) IUD users (n = 30), (B) women with tubal ligation (n = 30), and (C) women trying to become pregnant (n = 15). The sequential serum samples were analyzed by radioimmunoassay for progesterone (P), human luteinizing hormone (hLH), and human chorionic gonadotropin (hCG). No positive hCG assays in luteal phase blood sera of IUD users were observed. The only positive hCG determinations of IUD users coincided with the preovulatory surge of hLH. Two subjects who became pregnant, as judged by progressive increases in hCG and P levels in the luteal phase, belonged to the group planning pregnancy. The finding of two pregnancies in 15 months of exposure is consistent with the assumption of natural fertility. The probability of no pregnancies in 30 months at risk, as observed among the IUD users, is between 1 in 200 and 1 in 100,000, depending on the assumption made for natural fertility. The study demonstrates that IUD users do not retain their natural fertility, and that IUDs do not exert their antifertility effect as abortifacient agents. If a confirmed pregnancy is detected in an IUD user, it may be assumed to represent an isolated case of contraceptive failure.
Adult↗
Effect of intrauterine devices on sperm transport in the human being: preliminary report.
This investigation was designed to determine the effect of the intrauterine contraceptive device (IUD) on the early phase of sperm transport. Previously we have shown that in normal midcyle subjects the maximal number of sperm recovered from the oviducts occurred between ten and 45 minutes after vaginal insemination. Four normal subjects, three of whom had IUD's in situ for at least eight months (copper T, Dalkon shield, and loop) and one a loop for one month, were studied in a similar manner. All subjects were inseminated at midcycle and had bilateral abdominal salpingectomies 15 to 30 minutes after insemination. No sperm were present in the oviducts of any of the subjects. The results of this study indicate that the IUD interferes with sperm transport in the human being. Additional subjects are now being studied at different time intervals after insemination in order to determine the entire effect of the IUD upon sperm transport.
Adult↗
Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T.
In a European randomized multicenter study, the efficacy and safety of an intrauterine contraceptive device releasing 20 microgram levonorgestrel/24 hours (LNG-IUD) have been evaluated and compared to the Nova-T. Because the LNG-IUD has a strongly suppressive effect on the endometrium and in some women affects ovarian function, the return to fertility after removal of the IUD was studied. Two-hundred-nine women (71 in the Nova-T and 138 in the LNG-IUD group), who had their IUDs removed because of planning pregnancy, were followed at least 24 months or until termination of pregnancy. For the Nova-T, the cumulative conception gross rate was 71.2/100 women after 12 months (79.7 after 24 months) and for the LNG-IUD 79.1 (86.6 after 24 months). The difference between the devices is not statistically significant, and in spite of the endometrial suppression during use of LNG-IUD, there is no delay of return to fertility and in both groups 96% of the pregnancies occurred during the first year after removal of the device. Eighty-four % of the pregnancies in the Nova-T group and eighty-six % in the LNG-IUD group ended in live births. The results suggest that the endometrium recovers quickly, normal ovulations are established and the fertility seems to be unaffected after use of an LNG-IUD.
Female↗
Ovarian pregnancy associated with copper-7 intrauterine device.
This report documents the second case of an ovarian pregnancy with a Cu-7 intrauterine contraceptive device. All of Spiegelberg's criteria were satisfied. A summary of the literature is presented, revealing 33 ovarian pregnancies in users of an IUD. The overall frequency of primary ovarian pregnancy is 1:40,000 deliveries. There is a ratio of one ovarian pregnancy to nine ectopic pregnancies among IUD users, compared to 1:150 to 1:200 in the general population.
Adult↗
Menstrual pattern changes following laparoscopic sterilization with different occlusion techniques: a review of 10,004 cases.
A comparison is made of menstrual pattern changes reported by 10,004 women undergoing interval and postabortion sterilization by the laparoscopic occlusive techniques of unipolar electrocoagulation, the tubal ring, the prototype spring-loaded clip, and the Rocket clip. Controlling for prior contraceptive use, the menstrual patterns in these women sterilized by the four techniques were compared with respect to six parameters: cycle regularity, cycle length, menstrual flow duration, amount of flow, dysmenorrhea, and intermenstrual bleeding. The majority of women reported no menstrual changes subsequent to sterilization. When changes were experienced, they occurred in equal proportions in opposite directions. Depending on the parameter, from 15% to 79% of the menstrual pattern changes seen within 6 months after sterilization in women who were using oral contraceptives or intrauterine contraceptive devices at the time of sterilization could be attributed to the discontinuation of those methods of contraception. There were no significant differences between the several occlusion technique groups with respect to the proportion of women who reported changes in their menstrual patterns after sterilization.
Adult↗
The future of hormonal contraception.
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Administration, Cutaneous↗
The effect of copper on spermatozoal motility and viability evaluated objectively with the aid of the multiple-exposure photography method.
The antispermatozoal effect of the copper intrauterine contraceptive device (IUD) was investigated in an attempt to explain one aspect of its contraceptive mechanism. For this purpose, 42 specimens of normal semen were incubated in vitro with the metallic portion of two types of copper IUDs for 24 hours. Periodic determinations of sperm velocity and percentage of motility and viability were performed objectively with the aid of the multiple-exposure photography (MEP) method. No significant effect concerning these parameters was found when specimens were incubated continuously with either type of these IUDs at 23 degrees C. On the contrary, sperm velocity and percentage of motility dropped markedly, and the number of dead spermatozoa increased reciprocally when specimens were incubated with those IUDs at 37 degrees C for 4 hours. However, motility was almost unaffected in specimens that were incubated at 37 degrees C with amounts of copper that exist usually within uterine cavities bearing this sort of IUD. The conclusion was that a copper IUD does not seem to exert its contraceptive effect by inhibiting spermatozoal activity.
Copper↗
Acceptability and clinical performance of a copper-containing frameless IUCD in Hong Kong.
This is the first study conducted in Hong Kong to evaluate the acceptability and clinical performance of a copper-containing frameless intrauterine contraceptive device (IUCD; GyneFix/Ji Ni). Sixty-two women chose to use the frameless IUCD for contraception. A learning curve was demonstrated in the insertion technique of this new device. Pain associated with insertion was acceptable. No pregnancy was reported during the 1-year trial period. Objectively, the amount of menstrual loss did not change and dysmenorrhea improved, but the duration of menstrual flow was slightly prolonged during the use of this device. However, there was a 10.7% request rate for removal of the device because of its side effects. The expulsion rate during the first year was 5.3%, and the continuation rate at the end of the first year was 76.7%. It was found that 85% of the 40 subjects interviewed upon the completion of the 1-year trial period wished to replace the same device after the product expiration date and that 92.5% would recommend this device to their friends. In summary, the clinical performance of the frameless IUCD was comparable to its framed counterparts. The device was considered acceptable to a majority of the women.
Adult↗
Fertility and contraception of 6 patients with ovarian pregnancy.
A series of 6 ovarian pregnancies out of 369 ectopic (1.65/100 tubal) were selected to evaluate the fertility and contraception of patients with this rare condition. Mean patients' age was 28.5 years, mean previous parity was 1.5 children and all but one were using some sort of contraception (four had an IUD inserted and one had a previous laparoscopic tubal ligation). Clinical features on admission were as reported for the ectopic pregnancy and surgical findings at laparotomy showed an otherwise intact tubes. Postoperative further contraception was used by four patients and the two non-users became pregnant easily within an 18 month period. We conclude that ovarian pregnancy is an accident which occurs in a rather fertile population with an intact genital tract and who were using intrauterine contraceptive devices. Postoperative reproduction performance shows a high fertility rate in those patients who were not using any contraceptives at all.
Adult↗
A copper-based intrauterine device with gold or platinum core: in vitro and in vivo studies.
The use of copper intrauterine contraceptive devices is currently limited to 2-3 years, mainly due to wire fragmentation, which was observed as early as after 8 months of use. In the resulting search for a long-lasting device, two new systems of duplex wire, with gold and platinum cores electrolytically coated with copper, were devised and studied. Initially, duplex wires and controls were exposed to physiological solution. Copper dissolution rate, and corrosion morphology were studied by weight-loss measurements and optical metallography. Similar systems were then surgically implanted in rat uteri for varying periods up to 26 weeks. Electron microanalysis of corrosion products in addition to weight-loss measurements and metallography was performed. The results showed that a uniform and ductile copper coating is obtainable by electroplating on gold and platinum wires. The rate of copper dissolution is similar to that of solid copper wire. No dissolution of gold and platinum in the controls or coated wires was detected by weight loss, metallography or atomic absorption measurements. Microanalysis of the deposits and corrosion products on the wires in the uterine environment showed the presence of compounds containing sulphur, chlorine, calcium and copper. The results of this study suggest that supplementing IUDs with copper-coated gold or platinum wires may result in significant prolongation of the life-span of the device by preventing uncontrolled loss of copper caused by wire fragmentation.
Animals↗
Urticaria secondary to a copper intrauterine device.
A 24-year-old woman developed in acute urticarial reaction secondary to a copper intrauterine contraceptive device. Allergy to copper was proven by scratch tests. The condition cleared with removal of the IUD.
Adult↗
Plasma ferritin levels as an index of iron deficiency in women using intrauterine devices.
Forty-seven women were studied before and for one year after insertion of an intrauterine contraceptive device (IUCD). The menstrual blood loss increased in 44 subjects (94 per cent), and this was related to the surface area of the IUCD. Plasma ferritin levels in the iron deficient range (below 16 microgram/l) were present in 9 subjects (19 per cent) before insertion of the IUCD, whereas by the end of one year, 21 subjects (45 per cent) had reached these levels. The incidence of depressed ferritin levels was highest in subjects with a monthly blood loss exceeding 80 ml. The haemoglobin, mean corpuscular haemoglobin and mean corpuscular volume measurements declined progressively, but were less sensitive predictors of iron deficiency. These findings indicate the need to monitor iron status and administer oral iron replacement therapy in subjects with an IUCD.
Female↗
[The migrating intrauterine device. Case report and review of the literature].
We report a case of migration of an intrauterine contraceptive device (IUCD) detected during pregnancy one year after insertion. The advanced gestation of the pregnancy and the absence of symptoms lead to expectant management. There were no complications during the pregnancy or delivery. A CT Scan in the post-partum period suggested that the IUCD was located in the region of the small bowel. Laparoscopy confirmed that the IUCD was superficially embedded in the intestinal wall but with no mucosal lesion. The device was removed with the aid of a mini-laparotomy. The migration of an IUCD into the abdominal cavity is rare. A literature review spanning the past 18 years revealed 165 reported cases. The IUCD was located in the following sites: omentum 45, rectosigmoid 44, peritoneum 41, bladder 23, appendix eight, small bowel two, adnexa one, iliac vein one. The majority of the authors recommend removal of copper containing devices, because of the potential for inflammatory reactions that can cause bowel obstruction and perforation. Initial laparoscopy has mostly superceded laparotomy but conversion may be necessary if difficulties arise.
Adult↗
Retrieval of lost Copper-T from the rectum.
A case of lost Copper-T lying partly in the rectal lumen and its removal through the rectal route is described. This case emphasises the importance of rectal examination in the case of lost intra-uterine contraceptive device (IUCD) and highlights the possibility of safe retrieval of an IUCD through the rectal route even when it is partly embedded in the rectal wall.
Adult↗
Effect of indomethacin incorporation on the retention of silastic intrauterine devices in the rat.
In order to observe the effects of indomethacin upon the retention of silastic intrauterine contraceptive devices, rods containing indomethacin at various loadings were inserted unilaterally into adult rats. In other animals, an unmedicated rod was inserted into one uterine horn whilst an indomethacin-loaded rod was fitted to the other horn. Rods were not secured to the uterine wall and the retention of rods in both groups was determined at weekly intervals. The results show an increased retention for animals fitted with indomethacin-loaded rods over a 4-week period. All unmedicated rods, irrespective of whether a contralateral indomethacin rod was present or not, were expelled by 1 week after insertion.
Animals↗