Non-surgical female sterilization with quinacrine: an update

Abstract

The intrauterine installation of quinacrine represents a simple, inexpensive, effective, and seemingly safe method of non-surgical female sterilization. Existing clinical data on its use are very encouraging: Results of a large study conducted in Vietnam with an overall sample of over 30,000 women showed high effectiveness; in addition, when a retrospective study was conducted in these women, cumulative 5-year pregnancy rates were estimated to be 13% in women younger than 35 years and 6.8% in the women older than 35. Overall, failure rates with quinacrine have been estimated, at 10 years, to be between 1.9 and 4 times higher than those obtainable with conventional surgical procedures of tubal interruption. Unfortunately, existing toxicology for topical use of quinacrine pellets is incomplete. This prompted an expert group convened by WHO, to comment, in 1994, that the toxicology of locally applied quinacrine is inadequate. To counter this statement the proponents of the method argue that it is unfair to apply the stringent pre-clinical requirements that are mandatory in the industrialized world, to methods utilized in countries plagued by both high fertility and high maternal mortality. This controversy will soon be resolved since conventional toxicological evaluation is now underway. In conclusion, the future of quinacrine for non-surgical female sterilization will depend on the results of long-term animal studies, as well as the retrospective human studies now being carried out.