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PubMed2006

Sperm maturation in the domestic cat.

The epididymis is essential for sperm development and maturation, and, subsequently, the ability of spermatozoa to penetrate and fertilize the female gamete. Functional differences in segments of the long tubule are reflected by histological differences among epididymal regions. The feline epididymis can be divided into six different regions according to their histological differences. A marked increase in sperm concentration occurs between regions 2 and 3, indicating resorption of fluid in region 2, a concept supported by the histological characteristics of the epithelium. At the transition between regions 4 and 5, located between the caput and corpus epididymides, histological characteristics change from being that of a maturation function to being typical of a storage function. Migration of the cytoplasmic droplet and induction of motility occur in this same region. Proteins are secreted from epithelial cells in the feline epididymis by merocrine and apocrine secretion, although the functions of different feline epididymal proteins have not been determined. Hypotaurine, taurine and, probably, alkaline phosphatase are produced by the feline epididymis. During epididymal transit the percentage of immature, unviable and morphologically abnormal spermatozoa decreases, indicating the existence of a mechanism that removes abnormal spermatozoa. In contrast, the percentage of spermatozoa with abnormal tails increases slightly during epididymal transit. Most of the distal droplets present on spermatozoa in the cauda epididymis are lost at or after ejaculation. Additional knowledge of the feline epididymis should be beneficial for developing sperm preservation protocols and advance the prospects for effective male contraceptive methods.

Acrosome↗
PubMed2003

Contraceptive practices of non-HIV-seropositive injecting drug users.

AIMS: To study the sociodemographic characteristics and sexual behaviours in contraception choices of injecting drug users (IDUs) and to compare the contraceptive practices of non-HIV-positive IDUs to those of the general population. DESIGN: Two surveys were used: a sample of IDUs attending 10 drug abuse treatment centres in the Paris region (IDU) and the Parisian subsample of the National French Survey of Sexual Behaviour (ACSF). MEASUREMENTS: Percentages of contraception practices were estimated separately for 81 IDU and 130 ACSF women, and for 175 IDU and 168 ACSF men, aged 25-34, not reporting prostitution or HIV seropositivity. FINDINGS: Most IDU (77%) and ACSF (84%) women, and IDU (73%) and ACSF (75%) men currently used a contraceptive method. Male condoms were more widely used by IDUs than by the general population (64 vs. 10% in women, 75 vs. 14% in men), for all subgroups of educational level, marital status, recent multipartnership status and sexual activity. CONCLUSIONS: Contraceptives are used as often by IDUs as by the general population aged 25-34. However, the methods employed differ, with higher condom use by IDUs, which suggest that IDUs take into account the risk of HIV contamination in their contraceptive practices.

Adult↗
PubMedDate not supplied

Reproductive and sexual health benefits in private health insurance plans in Washington State.

CONTEXT: Although unintended pregnancy and sexually transmitted diseases (STDs) are considerable problems in the United States, private health insurance plans are inconsistent in their coverage of reproductive and sexual health services needed to address these problems. METHODS: A survey administered to a market-representative sample of 12 health insurance carriers in Washington State assessed benefit coverage for gynecologic services, maternity services, contraceptive services, pregnancy termination, infertility services, reproductive cancer screening, STD services, HIV and AIDS services, and sterilization, as well as for the existence of confidentiality policies. "Core" services in each category were defined based on U.S. Preventive Services Task Force and other recommendations. RESULTS: Of the 91 top-selling plans on which data were collected, 8% were indemnity plans, 14% were point-of-service plans, 21% were preferred-provider organization plans and 57% were health maintenance organization (HMO)-type products; they had a combined enrollment of 1.4 million individuals. Coverage of core services varied widely by type of plan. While a high proportion of plans covered core gynecologic, maternity, reproductive cancer screening, STD and HIV and AIDS services, nearly half of plans did not cover any kind of contraceptive method. Approximately 13% of female enrollees did not have core coverage for gyneco!ogic services, 19% for matemity services, 75% for contraception, 37% for sterilization and 53% for pregnancy termination; 98% of women and men were not covered for infertility treatment. Most carriers did not have specific policies for maintaining privacy of sensitive health information. Overall, benefit coverage was lower for indemnity, preferred-provider organization and HMO plans in Washington State than has previously been seen nationally. CONCLUSIONS: A sizable proportion of women and men in Washington State who rely on private-sector health insurance lack comprehensive coverage for key reproductive and sexual health services.

Family Planning Services↗
PubMed1976

Dynamics of contraceptive failures.

The purpose of this study was to explore the vicissitudes of contraceptive efforts and practice, and human behavior contributing to contraceptive failure. A consecutive sample of 481 women, who visited various gynecological out-patient clinics of a New York City municipal hospital between August 1974 and August 1975, served as the study population. There were 181 women with planned pregnancies and 300 women with unplanned pregnancies. The data were gathered in personal interviews. By comparison of both groups it was discovered that the women with unplanned pregnancies, because of their lower frustration tolerance level, had been led by successive difficulties related to contraceptive efforts and practice to episodic, faulty, or nonuse of technically effective contraceptive methods. Thereafter, psychological processes and mechanisms gave rise to a false sense of security, which virtually prevented them from resuming contraceptive practice. These psychological processes and mechanisms also govern other spheres of human behavior and merit systematic investigation.

Adult↗
PubMed1980

Brazil announces family planning programme in 1981.

The Brazilian Minister of Health, Waldyr Arcoverde, announced in December that the government will implement a national family planning program in 1981. O Globo and Jornal do Brasil, the 2 main national newspapers, report that according to the information given by the Minister, the program will offer all contraceptive methods including male and female sterilizations. Sterilizations will be provided free-of-charge by INAMPS, the national hospital system. Contraceptive services are being provided in order to reduce illegal abortions, the practice of which is widespread throughout the country.

Americas↗
PubMed1987

Adolescent contraception.

Many adolescents are at risk for unplanned pregnancy. Health professionals who care for adolescents should be familiar with the various contraceptive methods and their suitability for teenagers. Each method, with its pros and cons, is described in this article. Ultimately, the health care provider is advised to tailor contraception to fit the needs of the individual patient.

Adolescent↗
PubMedDate not supplied

Reproductive health services for adolescents under the State Children's Health Insurance Program.

CONTEXT: The federal government enacted the State Children's Health Insurance Program (CHIP) in 1997 to provide insurance coverage to uninsured, low-income children up to age 19. Individual states' decisions when designing their CHIP efforts will in large part determine the extent to which the program will help the nation's nearly three million low-income uninsured adolescents get needed reproductive health services. METHODS: CHIP administrators in all states and the District of Columbia were sent a survey concerning reproductive health services for adolescents aged 13-18 provided under their state's CHIP effort. The questionnaire asked about services covered, information provided to adolescents, confidentiality, outreach and enrollment activities, managed care and performance measures. RESULTS: Of the 46 respondents to the survey, 29 states and the District of Columbia included a Medicaid component to their CHIP effort, and 28 states included a state-designed component. Overall, states provided relatively comprehensive coverage of reproductive health services, with all 58 CHIP programs covering routine gynecologic care, screening for sexually transmitted diseases and pregnancy testing. Fifty-four covered the full range of the most commonly used prescription contraceptive methods, although only 43 covered emergency contraception. Twenty of 58 CHIP programs required that adolescents be provided with information about coverage for the full range of reproductive health services, and 18 required that information be provided about accessing care. Seventeen programs reported guarantees of confidentiality before and after receipt of reproductive health care. In 26 programs, enrollees in managed care were guaranteed access to contraceptive services through out-of-network providers. Twenty-six states and the District of Columbia reported targeting outreach activities specifically to adolescents, and 41 states and the District of Columbia stated that they provide outreach materials at middle schools, high schools and community-based organizations serving teenagers. CONCLUSIONS: Despite their nearly comprehensive coverage of reproductive health services, programs were inconsistent in guaranteeing the information, confidentiality and flexibility in choosing providers that is critical to adolescents' ability to access care. In addition, many states failed to creatively use strategies to target uninsured adolescents for enrollment, although new initiatives are under way to correct this problem.

Adolescent↗
PubMed1998

Cyclofem/Cyclo-Provera: emerging countries' perspective.

Cyclo-Provera, the original name of the combination of 25 mg medroxyprogesterone acetate and 5 mg estradiol cypionate, later known as Cyclofem and hereafter referred to MPA/E2C, has proven its use-effectiveness (pregnancy rate less than 1%) in routine service delivery conditions. Overall, the life-table discontinuation rates at 1 year ranged from 33.5% to 71.8%. Only a third of total discontinuations were attributable to the injectable contraceptive method, thus raising the importance of service delivery issues related to its continued use. The results of introductory trials in Mexico, Indonesia, Thailand, Tunisia, Jamaica and, more recently, Brazil, Colombia, Chile and Peru have demonstrated that MPA/E2C is a highly effective contraceptive that could be offered as an alternative to current fertility regulation methods for many women around the world. In addition, the results of studies were the basis for the approval of MPA/E2C by local health authorities and its inclusion in the Ministries of Health Family Planning Programs.

Contraceptive Agents, Female↗
PubMedDate not supplied

Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth.

CONTEXT: Half of all pregnancies in the United States are unintended. Of these, half occur to women who were practicing contraception in the month they conceived, and others occur when couples stop use because they find their method difficult or inconvenient to use. METHODS: Data from the 1995 National Survey of Family Growth were used to compute life-table probabilities of contraceptive failure for reversible methods of contraception, discontinuation of use for a method-related reason and resumption of contraceptive use. RESULTS: Within one year of starting to use a reversible method of contraception, 9% of women experience a contraceptive failure--7% of those using the pill, 9% of those relying on the male condom and 19% of those practicing withdrawal. During a lifetime of use of reversible methods, the typical woman will experience 1.8 contraceptive failures. Overall, 31% of women discontinue use of a reversible contraceptive for a method-related reason within six months of starting use, and 44% do so within 12 months; however, 68% resume use of a method within one month and 76% do so within three months. Multivariate analyses show that the risk of contraceptive failure is elevated among low-income women and Hispanic women. Low-income women are also less likely than other women to resume contraceptive use after discontinuation. CONCLUSIONS: The risks of pregnancy during typical use of reversible methods of contraception are considerably higher than risks of failure during clinical trials, reflecting imperfect use of these methods rather than lack of inherent efficacy. High rates of method-related discontinuation probably reflect dissatisfaction with available methods.

Adult↗
PubMed2000

Economic analysis of long-term reversible contraceptives. Focus on Implanon.

OBJECTIVE: To examine the economic impact of a new implantable contraceptive, Implanon, in comparison with other available contraceptive methods. DESIGN: This was a modelling study using cost data derived from national published sources and effectiveness data from either controlled clinical trials (Implanon) or reports in the literature (other contraceptives). In the baseline analysis, Implanon was compared with 2 long term reversible contraceptives, Norplant and Mirena. Further analyses were then carried out comparing Implanon with Depo-Provera and with combined oral contraceptives. SETTING: The study concentrated on the UK, but also made reference to several other European countries. MAIN OUTCOME MEASURES AND RESULTS: The baseline analysis showed that all 3 long term reversible contraceptives produce very good rates of return, with Implanon providing the best rate of return (both average and internal) of the 3 methods. The payback period for Implanon was calculated as 146 days, compared with 339 and 368 days for Norplant and Mirena, respectively. In terms of cost effectiveness, the cost per protected year for Implanon was 95 Pounds, compared with 146 Pounds and 168 Pounds for Norplant and Mirena, respectively. In comparison with Depo-Provera (an injectable contraceptive), Implanon was both less costly and more effective, the cost per protected year for Depo-Provera being 131 Pounds. The threshold beyond which Implanon delivers cost savings compared with combined oral contraceptives was at a failure rate of 4.9% for the combined pill. CONCLUSIONS: Reversible long term approaches to contraception provide an effective and efficient use of healthcare resources and generate an excellent return on public investment. Implanon produces better rates of return than both Norplant and Mirena, and is also more cost effective in terms of cost per pregnancy avoided and cost per protected year than Norplant, Mirena, Depo-Provera and oral contraceptives.

Adult↗
PubMed2004

I got rhythm: Gershwin and birth control in the 1930s.

Gershwin's song 'I Got Rhythm' serves here as a backdrop representing the social context of the inter-war years. On center stage is a particular aspect of the history of birth control--the application of a new theory of ovulation to contraception. Starting in 1928, a series of experiments revealed a biochemical rhythm in the female reproductive cycle, which contradicted the widespread idea that ovulation and pregnancy could occur at any time. This discovery was applied to a new contraceptive method, the rhythm method, which enjoyed significant popularity during the 1930s, especially among Catholics. For a short period, women could join Ethel Merman in the refrain 'I got rhythm, I got my man, who could ask for anything more?' But the rhythm method has not lived to its promise, and the play goes on em leader

Contraception↗
PubMed1997

Minimizing the problem of poor compliance in adolescents. Clinical experience with a modern low-dose gestodene-containing oral contraceptive.

Adolescents represent a particularly difficult group with respect to compliance. Not only is incorrect pill intake a common problem, but unnecessary discontinuation also occurs regularly. Reasons for poor compliance are varied, but inadequate information and problems with cycle control and weight gain are particularly important. Choosing a well-tolerated oral contraceptive can help to improve compliance, and clinical experience from a large, multicenter trial suggests that monophasic gestodene (75 micrograms gestodene/30 micrograms ethinylestradiol) is a suitable preparation for this group of women. An investigation of 5,602 adolescents with an average age of 16.4 years found good contraceptive reliability and excellent cycle control. The incidence of spotting and breakthrough bleeding was low and declined during the course of the study. The preparation was tolerated well, and the incidence of adverse events was low, with only 4.4% of women withdrawing from the study due to adverse events. An increase in body weight was uncommon. At the end of the study, 85.0% of adolescents rated monophasic gestodene as good and 9.6% as satisfactory.

Adolescent↗
PubMed1997

An overview on the effectiveness of natural family planning.

Recent years have witnessed important developments in natural family planning (NFP), which is based on the observation of fertile and infertile periods of the menstrual cycle, so that the couple is able to know when sexual intercourse may lead to a pregnancy. A review of the main studies regarding the effectiveness of NFP showed a decrease in the Pearl Index and life table values from the early 1980s to date, indicating that progress both in the teaching and in the application of these contraception, methods has been achieved. The main cause of lack of success seems to be the misapplication of NFP rules, whereas the errors due to the method itself are few. Furthermore, it seems that the symptothermal method might give better results than the ovulation method, even though no comparative study has been carried out, and that the first studies on the lactational amenorrhea method show encouraging results. Finally, it seems that NFP is best suited for 'spacers' of pregnancies, rather than for 'limiters'. Indeed, the former are more likely to show good compliance, since the sexual abstinence periods are limited and an unwanted pregnancy is not regarded as a completely negative event.

Clinical Trials as Topic↗
PubMed1993

Prevention of sexually transmitted infections. Physical and chemical barrier methods.

Barrier contraceptives, including mechanical methods, chemical methods, and combinations thereof, have the potential to decrease the spread of STDs, are inexpensive, and do not have any systemic effects. Currently, the concerns that the efficacy of latex condoms is limited because they are not consistently used, they can break, may cause allergies, and have a limited shelf-life has led to the development of condoms made of other materials such as polyurethane. Spermicides using nonoxynol-9 as their active ingredient have been shown to be effective in preventing the transmission of some STDs such as gonorrhea and chlamydia. In the absence of well-controlled studies of nonoxynol-9 efficacy against HIV, questions have been raised that some formulations, high doses, or frequent use may be associated with genital tract irritation, and possibly, enhancement of HIV transmission. Because heterosexual transmission will continue to be the major route of HIV transmission worldwide, the development and consistent use of a chemical or mechanical barrier during intercourse may be the best way to decrease the spread of HIV.

Condoms↗
PubMed1985

Chromosomal abnormalities in the Kaiser-Permanente Birth Defects Study, with special reference to contraceptive use around the time of conception.

Chromosomal abnormalities were studied in 33,551 abortions and births to women whose contraceptive histories had been recorded at their first antenatal visit in 1975-1977. Chromosome examinations were performed exclusively on clinical grounds. There were 45 de novo abnormalities detected (1.34/1,000); three of them were detected at amniocentesis. Trisomy 21 was observed in 27 cases (0.80/1,000), trisomy 18 in nine (0.27), other trisomies in three (0.09), and translocations or deletions in five (0.15). One case of triploidy and six cases of inherited abnormalities were detected. There were no significant racial variations. No increase in risk for chromosomal abnormalities was found among women who had used oral contraceptives prior to becoming pregnant or among women who experienced oral contraceptive breakthrough pregnancies. Two cases of trisomy 18 were observed among the 814 deliveries following oral contraceptive breakthrough conceptions (2.46/1,000), two cases of trisomy 21 occurred in 338 births following failures of rhythm contraception (5.92/1,000), and no cases of trisomy 21 or 18 among the 1,569 women using spermicides at the time of conception.

Abnormalities, Drug-Induced↗