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PubMed1999

Oral contraception: current use and attitudes.

Oral contraception (OC) has been available for almost four decades. During this time, changes in contraceptive use in general and OC in particular have occurred. Knowledge and attitudes about OC may not always reflect trends in use. Contraceptive use data from 1965-1995 show that OC continue to be the method chosen consistently by more than one-quarter of women contraceptors. Probably even more women would use the pill if they had more accurate information regarding the higher failure rates with barrier methods (especially the condom), if misperceptions about OC safety were put to rest, and if greater awareness of the noncontraceptive health benefits of OC could be achieved. Increased education and awareness of women as well as their healthcare providers has the potential to positively affect future contraceptive use.

Breast Neoplasms↗
PubMed2000

Semen analysis after vasectomy: when and how many?

OBJECTIVE: To assess patient compliance for semen analysis after vasectomy, and to determine the timing and number of semen analyses required to confirm sterility. PATIENTS AND METHODS: The study included 1321 men who underwent vasectomy between October 1995 and June 1998. They were followed up in two groups; in group 1 (one-test method) 961 consecutive patients were asked to provide a semen sample for analysis 4 months after vasectomy. Sterility was defined as the absence of sperm in one sample. If sperm were present in the sample, the test was repeated at monthly intervals until there were no sperm. In group 2 (two-test method) 360 consecutive patients were advised to provide semen samples 3 and 4 months after vasectomy. The absence of sperm in two consecutive samples was defined as the criterion to declare the man azoospermic. The presence of sperm in one sample required further samples every month until two consecutive azoospermic samples were produced. RESULTS: In group 1, 810 patients provided semen samples, of which 783 (97%) had no sperm and the men were thus declared azoospermic. The remaining 27 (3%) samples contained sperm; six men withdrew from follow-up at various times but 21 patients produced a negative sample at some time within 7 months and were declared azoospermic. At the end of the follow-up, 804 (84%) patients had been declared azoospermic. In group 2, 294 (82%) patients provided a semen sample after 3 months but only 259 (72%) did so after 4 months. Of the patients providing the first sample, 287 (98%) were azoospermic, and after the second 252 (97%) were azoospermic. At the end of the follow-up 255 (71%) patients were declared azoospermic. There was no reported paternity in any of the men. CONCLUSION: These results suggest that compliance was better in group 1; when the patients in group 2 were asked to provide a second sample the compliance decreased significantly. The percentage of patients producing an azoospermic sample was similar for semen provided after 3 and 4 months. Thus, provided that the patient is adequately warned about the risk of failure of the vasectomy at any time during his life, a single semen analysis after 3 months is sufficient grounds for discontinuing other contraceptive precautions.

Follow-Up Studies↗
PubMed1985

Long term effects of cyclophosphamide on testicular function.

Thirty men treated in childhood with cyclophosphamide for a mean of 280 days were assessed at a mean of 12.8 years after treatment for hormone concentrations and spermatogenesis. Four were azoospermic, nine oligospermic, and 17 normospermic. There was a significant inverse correlation of sperm density with cyclophosphamide dosage and duration of treatment. After a further mean follow up of 7.2 years three patients who were previously oligospermic and one who was azoospermic had normal sperm counts. All patients had normal sexual characteristics and libido. Serum androgen and prolactin concentrations did not differ significantly between patients and controls. Raised basal and stimulated follicle stimulating hormone concentrations were in keeping with impaired spermatogenesis. All patients had significantly raised luteinising hormone responses on stimulation with luteinising hormone releasing hormone. The results suggest compensated Leydig cell failure, and patients with this condition require long term evaluation of testicular function. Potential recovery of spermatogenesis with time requires appropriate counselling and contraceptive advice.

Adult↗
PubMed1988

Clinical evaluation of a monophasic ethinylestradiol/desogestrel-containing oral contraceptive.

A multicenter trial was conducted in 267 centers in Italy to evaluate the efficacy, acceptability and safety of a monophasic oral contraceptive containing 30 micrograms ethinyl estradiol and 150 micrograms desogestrel (Marvelon) 13,290 women were followed up for a total of 74,967 cycles. No pregnancies due to method failure were reported and only three because of patient failure. Cycle control was good. There was a decrease in the occurrence of irregular cycles and in the duration and amount of menstrual bleeding; the incidence of breakthrough bleeding and spotting was low. No severe side-effects occurred and the incidence of minor complaints was generally lower during treatment than in the pre-treatment cycle. Body weight and blood pressure were not significantly altered.

Adult↗
PubMed1990

Pharmacokinetic drug interactions with oral contraceptives.

Oral contraceptive steroids are used by an estimated 60 to 70 million women world-wide. Over the past 20 years there have been both case reports and clinical studies on the topic of drug interactions with these agents. Some of the interactions are of definite therapeutic relevance, whereas others can be discounted as being of no clinical significance. Pharmacological interactions between oral contraceptive steroids and other compounds may be of 2 kinds: (a) drugs may impair the efficacy of oral contraceptive steroids, leading to breakthrough bleeding and pregnancy (in a few cases, the activity of the contraceptive is enhanced); (b) oral contraceptive steroids may interfere with the metabolism of other drugs. A number of anticonvulsants (phenobarbital, phenytoin, carbamazepine) are enzyme-inducing agents and thereby increase the clearance of the oral contraceptive steroids. Valproic acid has no enzyme-inducing properties, and thus women on this anticonvulsant can rely on their low dose oral contraceptive steroids for contraceptive protection. Researchers are now beginning to unravel the molecular basis of this interaction, with evidence of specific forms of cytochrome P450 (P450IIC and IIIA gene families) being induced by phenobarbital. Rifampicin, the antituberculous drug, also induces a cytochrome P450 which is a product of the P450IIIA gene subfamily. This isozyme is one of the major forms involved in 2-hydroxylation of ethinylestradiol. Broad spectrum antibiotics have been implicated in causing pill failure; case reports document the interaction, and general practitioners are convinced that it is real. The problem remains that there is still no firm clinical pharmacokinetic evidence which indicates that blood concentrations of oral contraceptive steroids are altered by antibiotics. However, perhaps this should not be a surprise, given that the incidence of the interaction may be very low. It is suggested that an individual at risk will have a low bioavailability of ethinylestradiol, a large enterohepatic recirculation and gut flora particularly susceptible to the antibiotic being used. Two drugs, ascorbic acid (vitamin C) and paracetamol (acetaminophen), give rise to increased blood concentrations of ethinylestradiol due to competition for sulphation. The interactions could have some significance to women on oral contraceptive steroids who regularly take high doses of either drug. Although on theoretical grounds adsorbents (e.g. magnesium trisilicate, aLuminium hydroxide, activated charcoal and kaolin) could be expected to interfere with oral contraceptive efficacy, there is no firm evidence that this is the case. Similarly, there is no evidence that smoking alters the pharmacokinetics of oral contraceptive steroids. These agents are now well documented as being able to alter the pharmacokinetics of other concomitantly administered drugs.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed1996

Applications of pig zona pellucida immunocontraception to wildlife fertility control.

A unique application of pig zona pellucida (PZP) immunocontraception is the control of wildlife populations. A native PZP vaccine has been successfully applied to wild horse and donkey populations. A single annual booster inoculation was capable of maintaining contraception. Seven consecutive years of PZP treatment in wild mares resulted in no detectable debilitating side effects, and reversibility of contraception has been documented among mares treated for up to 4 consecutive years. Long-term treatment (5-7 years) is associated with some ovulation failure and depressed urinary oestrogen concentrations. Complex social behaviours in horses were unaffected by treatment. PZP immunocontraception has also been successfully applied to white-tailed deer, with no detectable changes in ovarian histology after 2 years of treatment. Seventy-four species of captive zoo animals have been treated with the PZP vaccine, with documented success in 27 species, including members of the orders Perissodactyla (Equidae), Artiodactyla (Cervidae, Capridae, Giraffidae, Bovidae), and Carnivora (Ursidae, Mustelidae, Felidae). Immunocytochemistry studies have demonstrated a high degree of crossreactivity between anti-PZP antibodies and African elephant zona pellucida. The need for a one-inoculation form of the vaccine has led to the incorporation of PZP into lactide-glycolide microspheres, which cause a delayed release of the PZP. PZP immunocontraception of wildlife has potential because of (1) > 90% effectiveness, (2) the ability for remote delivery, via darts, (3) reversibility after short-term use, (4) a wide breadth of effectiveness across many species, (5) a lack of debilitating side-effects even after long-term treatment, and (6) minimal effects upon social behaviours.

Animals↗
PubMed1995

Clinical pharmacokinetics of lansoprazole.

Lansoprazole, a benzimidazole derivative with antisecretory and antiulcer activities, inhibits the acid pump activity at the final stage of the enzyme process and therefore reduces the acid secretion of parietal cells. Lansoprazole is converted to active metabolites in the acid environment of these cells. It is rapidly absorbed from a gastric acid-resistant formulation and is approximately 97% bound in human plasma. Single dose pharmacokinetics of lansoprazole appear to be linear over the range from 15 to 60mg. Food and time of dose influence absorption after single doses, but do not modify the antisecretory effect of multiple doses. Lansoprazole is extensively metabolised following oral administration into sulphone and 5-hydroxylated metabolites by the cytochrome P450 enzymes CYP3A4 and CYP2C18. Two other metabolites have been identified in plasma: sulphide and hydroxylated sulphone. Mean plasma elimination half-life (t1/2) is between 1.3 and 2.1 hours in healthy volunteers. 15 to 23% of the total dose is found in urine as free and conjugated hydroxylated metabolites, while unchanged lansoprazole is not detected. The pharmacokinetic profile of the drug is not modified by multiple administration. In healthy elderly volunteers, area under the plasma concentration-time curve (AUC) and t1/2 are significantly greater after single administration occurs to the same extent as in young volunteers. Renal failure has no influence on the pharmacokinetics of lansoprazole, but severe hepatic failure causes a significant decrease in clearance and an increase in the AUC and t1/2 of lansoprazole. This is accompanied by modifications in the AUC of metabolites, but severe hepatic failure has minimal effect on accumulation of the drug after multiple administration. The pharmacokinetics of lansoprazole in patients with acid-related disorders do not differ from those in healthy volunteers. Studies of interactions of lansoprazole with warfarin, prednisone, theophylline, phenazone (antipyrine), diazepam, phenytoin and oral contraceptives suggest minimal risk of any clinically significant interaction.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2003

Factors associated with oral contraceptive discontinuation in rural Bangladesh.

Oral contraceptives (OCs) account for half of all modern contraceptive methods used in Bangladesh, however, discontinuation remains fairly high in OC use. This paper identifies factors associated with discontinuation of OC use, where discontinuation refers to cessation of OC use in the 6 months prior to the survey. The data for this study were drawn from a survey on OC compliance in rural Bangladesh. A total of 1600 OC users, current or past, aged 15 to 49 years were interviewed; of these, 36% discontinued OC use. Of the women who discontinued, 47% reported the experience of side-effects as the main reason for OC discontinuation. Multivariate analysis identified lack of fieldworker's visit as the strongest predictor of OC discontinuation; women who were not visited by fieldworkers had a four-fold risk of discontinuing OC use. Discontinuation of OC use decreased with increased duration of use and number of living children. OC discontinuation was associated with side-effect experiences, lack of husband's support in OC use and failure to purchase OCs. Of great concern is that about 70% of the women who were at risk of unintended pregnancy were not using any method of contraception following OC discontinuation. Husband's education was positively associated with the substitution of OCs with another contraceptive method. Effective OC use should be advocated through adequate counselling about how to take it correctly, the possibility of side-effects and their proper management and, more importantly, the possible alternative contraceptive method should OCs prove unsatisfactory or unsuitable. Better provider-client interactions along with improved access to the newly established community clinics could be instrumental in the continued and effective use of OCs.

Adolescent↗
PubMed1979

Individual neurophysin concentrations in the pituitary and circulation of humans.

Specific, homologous human neurophysin I and II radioimmunoassays were established and used to measure the individual, immunoreactive neurophysin concentrations in human plasma. Circulating levels of human neurophysin I in normal individuals were less than 1 ng/ml and neurophysin II levels were 1-2 ng/ml. During dehydration, there was a significant rise in plasma neurophysin I, together with an increase in neurophysin II. Haemorrhage also was associated with a rise in plasma neurophysin I and II, but the percent increase was greater for I than II. In two subjects in whom nicotine inhalation caused a rise in plasma neurophysin I, there was no detectable increase in plasma neurophysin II. These stimuli which have been reported to release vasopressin from the posterior pituitary also are associated with the differential release of neurophysin I. Plasma neurophysin II levels could more clearly be shown to rise independently of plasma neurophysin I during events thought to be related to oxytocin release. Plasma neurophysin II levels were significantly elevated in women taking oral contraceptives. Similarly during pregnancy there was a progressive rise in plasma neurophysin II concentration which was proportional to the period of gestation. Plasma neurophysin II concentrations in seven of fifteen nursing women rose significantly during suckling. There was no detectable change in plasma neurophysin I concentrations during any of these events. Plasma neurophysin I and II levels were both significantly elevated in fourteen patients with chronic renal failure and rose over haemodialysis, suggesting that the kidney may be the major route of clearance of the neurophysins. In humans the independent release of neurophysin II was associated with stimuli thought to release oxytocin, but neurophysin I showed only a differential release compared to neurophysin II in vasopressin stimulated events.

Contraceptives, Oral↗
PubMedDate not supplied

Lp(a) levels: effects of progressive chronic renal failure and dietary manipulation.

Patients with chronic renal failure (CRF) have an increased risk of cardiovascular disease (CVD). Elevated lipoprotein(a) (LP(a)) levels have been shown to be an important risk factor for CVD. This study examined Lp(a) changes during the progression of renal disease in patients following different dietary regimens. Fifty-seven patients with CRF of different etiology and degree (mean age 58 +/- 10 yrs) were divided into four groups according to their serum creatinine (sCr) levels. The first group had sCr 1.5-3; the second 3-6; the third > 6, all on a conventional low-protein diet (CLPD), and the fourth had sCr > 6 on a supplemented vegetarian diet (SVD). Lp(a), apoproteins AI, B, E, CII, CIII, CII/CIII, Apo A/Apo B ratios and the lipid pattern (total cholesterol (TC) and its fractions LDL, HDL, HDL3 and triglycerides) were investigated. Patients with diabetes, proteinuria > 1.5 g/24 h, hepatic disease or taking contraceptives or lipid lowering drugs were excluded. Results were compared with a reference group (N = 12) with sCcr < 1. Lp(a) concentrations increased with the progression of renal failure, and a significant correlation was observed with sCr. Despite the elevated sCr levels, patients on the SVD had an almost normal Lp(a) concentration. Only 15% of the reference group had Lp(a) levels > 30 mg/dl, compared to 33%, 50% and 78% of the 1st, 2nd and 3rd groups and 38% of the 4th group. No relationship was found between Lp(a), lipids or apoproteins. Our results indicate that renal function influences Lp(a) levels and suggest a SVD helps to lower them. This might be ascribed to some antioxidant factors in the SVD.

Adult↗
PubMedDate not supplied

The demand for fertility control in sub-Saharan Africa.

Recent fertility surveys in Africa reveal that a striking majority of women want more children, even among those who practice modern contraception, and that modern contraceptive prevalence is still low for women most motivated to avert pregnancy. This analysis suggests that whereas there is, as yet, little indication of change in conditions anticipated to shift the underlying demand for children, uncertainties attached to successful childraising due to risks of infertility, failure to thrive, disability, and divorce strongly favor traditional forms of fertility regulation. The two major means of fertility regulation in Africa--avoidance of next pregnancy in reference to the last born child's survival and rearrangement of the timing and tempo of childrearing through fostering--are not equivalent to modern contraception in purpose or practice. Against these general observations, particular demand for fertility control is identified for groups of women who demonstrate interest in nontraditional forms of fertility regulation at specific lifecycle points. A range of focused family planning activities is proposed to address this demand.

Abortion, Induced↗
PubMed2000

In vitro assessment of the structural integrity of the female condom after multiple wash, dry, and re-lubrication cycles.

Since the introduction of the female condom in the early 90s, there have been numerous reports of reuse of the device. In response to these reports, studies were undertaken to evaluate the safety of female condom reuse. If reuse were shown to be safe, then programmatic costs of introduction of the female condom would be reduced allowing it to be more widely available. This article outlines the results of in vitro structural integrity testing of the female condom after multiple wash, dry, and re-lubrication cycles. Devices were tested up to 10 washes using water leakage, burst, and tensile seam testing. All results were compared to the United States Food and Drug Administration (US FDA) standards for an unused female condom. The results of the structural integrity tests for all 6 washing procedures examined in this study were above the FDA minimum standards for seam strength and burst tests. For the water leakage test, 3 of 6 washing procedures tested passed the required FDA minimum standards (no holes detected). From the results of the study, it seems that washing, drying, and re-lubricating the female condom up to 10 times leads to some deterioration in the structural integrity of the device for specified washing procedures. Further studies are currently being conducted to establish the safety of female condom reuse with respect to microbial retention, structural integrity after in vivo use, and viral permeability.

Single-Use Internal Condom↗
PubMed1986

What is the relationship between postpartum withdrawal from school and repeat pregnancy among adolescent mothers?

An association between the failure of teenage mothers to return to school postpartum and rapid repeat pregnancy (recidivism) has been described. We report the postpartum education pursuits and contraceptive practices of 29 teenage mothers. Our data, together with the literature, suggest that with close postpartum follow-up, young mothers who are not motivated to return to school following delivery can effectively postpone pregnancy.

Adolescent↗
PubMed1986

[Report on 3,186 laparoscopic tubal sterilizations].

Between 1976 and 1984, 3,186 laparoscopic tubal sterilisations were performed in the Department of Gynaecology of the City Hospital at München-Harlaching. No death was registered. One severe late complication was observed, but its connection with the laparoscopic intervention is doubtful. 71 minor complications were analysed statistically. During the subsequent observation period of 8 1/2 years, 12 pregnancies were registered, representing a failure rate of 3.8 per thousand. 11 out of these 12 pregnancies were tubal pregnancies. We think that laparoscopic tubal sterilisation is an important contraceptive method, comparable, in terms of safety and mortality risk, to taking the pill. Its application is suitable after family planning has been finalised. The mean age of our patients was 36.5 years.

Adult↗
PubMed2004

Acute disorders of mesenteric circulations: the etiology, risk factors and incidence of lesions.

Acute disorder of mesenteric circulation (ADMC) is an emergency pathology of the abdominal organs. It occurs in 0.2% of general surgery patients. A total of 346 patients with verified (before, during operation and/or on autopsy) diagnosis of ADMC were analyzed retrospectively. There were 217 (62.7%) women and 129 (37.3%) men. The mean age of the patients was 68.4+/-3.6 years. In 50.7% of patients, ADMC was induced by thrombosis of the unpaired visceral branches of the abdominal aorta, in 29.1% -- by embolism of the superior mesenteric artery (SMA), in 7.8% -- by thrombosis of the portomesenteric bed, in 7.5% -- by non-occlusion mesenteric ischemia (NOMI), and in 4.9% by diseases of the parietal vessels of the bowel. The most prevalent risk factors of ADMC were: atherosclerosis of the aorta and its branches, previous reconstructions for occlusion-stenotic arterial lesions, episodes of arterial embolism in the anamnesis, congenital and acquired hemostatic disorders, oral contraception, thromboses of the deep veins and/or pulmonary embolism in the anamnesis, operations on the abdominal organs, different types of acute end chronic heart failure. In SMA thrombosis, occlusion most frequently affects the orifice (93.5%) and initial segment of the great vessel, In embolism it occurs before or at the level of the middle colic artery (in 57.9%). Disseminated bowel necroses are more frequently encountered in occlusions of the arterial bed (87.7% in thromboses and 83.3% emdolism) than in the venous system (8.3%).

Acute Disease↗