SOME CLINICAL EXPERIENCE IN THE ORAL CONTROL OF CONCEPTION

Abstract

The results of a study designed to determine how norsteroids control conception and to observe side effects that might result are reported. 17-ethinyl-19-nortestosterone acetate (norethisterone acetate) was selected. Treatments were begun in 1958. 2 patients were given 2 mg/day from Day 5 of the cycle for 20 days for 8 cycles. Breakthrough bleeding occurred in all 8 cycles. In the next series 5 mg was given to 7 patients for 22 cycles. Breakthrough bleeding occurred in 4 cycles. In 2 cycles there was no withdrawal bleeding. In a 3rd series 10 mg was given to 27 patients for 207 cycles. Breakthrough bleeding occurred in 12 cycles no withdrawal bleeding occurred in 14. In 1 patient an ectopic pregnancy occurred; this patient admitted forgetting to take the pills at times. In a 4th series the dose was 4 mg plus ethinyl estradiol .05 mg (Anovlar). There were 53 patients and 282 cycles. Breakthrough bleeding occurred in 14 cycles. There was no withdrawal bleeding in 9 cycles. A constant elevation of temperature coinciding with the treated days of the cycle was noted. Actively migrating sperm were found high in the cervical mucus. Viscosity of the cervical mucus did not appear to be sufficiently changed to prevent sperm penetration. Endometrial biopsies showed suppression of glandular secretory activity and enhancement of stromal predecidual reaction but no true decidua. All appeared abnormal. Cytological changes in vaginal smears showed a premature luteal effect suggesting hormonal imbalance. Regardless of the effect on ovulation the endometrium was not considered suitable to support a conception.