Conception Rates In Women Research Articles

O-149 The Endometriosis Longitudinal Fertility Study (ELFS): Outcomes for women with moderate or severe endometriosis who are trying to conceive

Abstract Study question What are the pregnancy outcomes for women with moderate or severe endometriosis who are trying to conceive? Summary answer Preliminary pregnancy rates in women with moderate/severe endometriosis are 11% for natural conception cycles and 22% for ART cycles. This is consistent with previous literature. What is known already Endometriosis is associated with reduced pregnancy rates in women attempting both spontaneous and assisted conception. Monthly fecundity is approximately half that of women without endometriosis and reduces further with increasing severity of disease. At present, the effect of surgery on the fertility outcomes of women with moderate or severe endometriosis remains unanswered. Treatment decisions are complex, particularly in those without pain symptoms seeking to optimise fertility outcomes. Study design, size, duration ELFS is a prospective multi-site longitudinal cohort study being conducted over 5-years. This interim report summarises data from August 2021-January 2024 in participants <38 years with evidence of in-situ moderate or severe endometriosis desiring fertility immediately or in the future. ELFS prospectively measures and compares monthly clinical pregnancy and live birth rates in women having either surgical or conservative management of endometriosis. This report assesses outcomes for those trying to conceive naturally or with ART. Participants/materials, setting, methods Following consent and baseline questionnaire completion, participants install the purpose-built ELFS App to their mobile phone or use a web-based option to complete cyclical surveys. The timing of surveys is dependent on a learned logic within the App and based on menstrual cycle length and pregnancy status. Participants report attempted conception cycles and any ART treatments undertaken with IVF or intrauterine insemination (IUI). Pregnancy outcomes are recorded as well as surgery during the study period. Main results and the role of chance There are 124 participants enrolled in ELFS, 86 (69%) are in the surgical cohort and 38 (31%) in the conservative cohort. There are 45 participants (36%) who have indicated they are actively trying to conceive during the study and a total of 171 cycles have been recorded from these participants. Of those trying to conceive, 24 (53%) have elected to have surgery during the study period, compared to 23 (29%) who were not trying to conceive. The study has captured 126 cycles with attempted conception. Of these, 42 cycles (33%) utilised ART compared to 84 cycles (67%) of natural conception attempts. Of the ART cycles, 27 (75%) involved IVF with fresh or frozen embryo transfer and there were 9 (15%) IUI cycles. To date, there are 25 reported pregnancies. The pregnancy rate for ART cycles was 22% (8/36) compared to 11% (9/87) in the natural conception cycles. Of those who conceived following surgery, 47% (8/17) of pregnancies were following ART and 53% (9/17) were natural conceptions. There are 2 live births recorded, both from the cohort who had surgery during the study. A total of 5 miscarriages (20%) have been reported, 4 (80%) from the surgical cohort. Limitations, reasons for caution In the absence of data to guide management in this area, clinician scope of practice and concurrent pain symptoms are likely to influence recommendations for ART or surgery in those trying to conceive with moderate or severe endometriosis. Wider implications of the findings This preliminary data is consistent with the current literature showing reduced natural and assisted conception rates in women with moderate or severe endometriosis. Long-term data will be required to determine if fertility and pregnancy outcomes are influenced by surgical management of endometriosis. Trial registration number ACTRN12621000431820 (ANZCTR)

The impact of metabolic surgery on natural conception rates in women with infertility, obesity and polycystic ovary syndrome: a retrospective study.

Women with obesity and polycystic ovary syndrome (OPOS) are at high risk for infertility. However, the reproductive effects of metabolic surgery on women with infertility and OPOS have not been fully elucidated. We investigated the natural conception rates after metabolic surgery, and the variables associated with infertility in women with OPOS. Shanghai Sixth People's Hospital, Shanghai, China. This study included 72 women with infertility and OPOS who underwent metabolic surgery and were followed up for 4 years after surgery. Finally, 54 patients completed the study. Reproductive outcomes were assessed, along with changes in anthropometric parameters and metabolic indices before and 1year after surgery (prepregnancy). Logistic regression analysis was used to identify variables influencing natural conception and delivery outcomes. After metabolic surgery, 35 patients (64.8%) became pregnant naturally, while 16 were still unable to conceive naturally. Preoperative body mass index (BMI) tended to be lower in the natural conception group than in the no natural conception group (38.9 ± 6.9 versus 43.6 ± 11.0 kg/m2, P = .070) and there were no significant differences in weight loss between the 2 groups after surgery. Logistic regression analysis showed that the BMI 1year after surgery (prepregnancy) was an independent predictor of natural conception, and receiver operating characteristic analysis showed that a BMI of 27.0 kg/m2 was the optimal cutoff for predicting successful natural conception after surgery. Metabolic surgery can improve fertility in women with OPOS. Patients with a BMI < 27.0 kg/m2 1year after surgery (prepregnancy) are more likely to become pregnant naturally and give birth.

Predictors of Spontaneous Conception Following Myomectomy among Women with Infertility at Federal Medical Centre Yenagoa, Nigeria

&#x0D; Background: Uterine fibroid or leiomyoma (myoma) is the commonest uterine neoplasm in women, and it has been associated with infertility. Though it’s not regarded as a direct cause, surgical removal (myomectomy) has been reported to increase the spontaneous conception rate in women with infertility.&#x0D; Objective: The objective of this study was to determine the factors associated with conception after myomectomy in women with infertility. It would determine the pregnancy rate, demographic, and surgical factors (pre and postoperative factors).&#x0D; Materials and Methods: This was a retrospective observational study of 107 women who had myomectomy during the study period, out of these, 68 were done for infertility. The case notes of these women were retrieved, and information related to demographic factors obtained was: maternal age, parity, address, tribe, educational level, and occupation. The preoperative surgical factors obtained were previous history of myomectomy, indication for myomectomy, the size, number and location of myomas, and the caliber of the surgeon. Postoperative surgical data collected include conception, interval between myomectomy and conception, pregnancy outcome, mode of delivery, and fetal sex and birth weight. Categorical variables were compared with chi square and odds ratio, and the degree of association for quantitative variables was determined using Pearson’s correlation coefficient. Predictor variables were determined using simple logistic regression, and multivariate analysis.&#x0D; Results: The infertility rate among the women who had myomectomy was 63.6%, the conception rate was 14.7%, and the mean myomectomy to pregnancy interval was 9.20 ± 1.24 months. The factors that favor conception were: younger women P = 0.003, uterine size ≤ 16 weeks odds ratio = 3.50(0.14, 84.20), high parity (p = 0.002), solitary fibroid odd ratio = 2.65(0.44, 16.04), tertiary education P = 0.0001 and surgery by consultants P = 0.004. Others were absence of submucous myomas, and pelvic pathology at laparotomy. Using multivariate analysis, the most significant predictors for conception were age and parity, accounting for 10.7%, and all the factors put together could only explain 36.5%.&#x0D; Conclusion: The conception rate following myomectomy in Yenagoa was relatively low, and the most important predictors were maternal age and parity. The bulk of the factors (65.5%) that determine conception are outside the scope of our study; these could be male factor infertility, factors within the tubal lumen, unidentified uterine synechia, and ovarian failure.&#x0D;

A Pharmacoepidemiologic Approach to Evaluate Real-world Effectiveness of Hormonal Contraceptives in the Presence of Drug-drug Interactions.

Background:Accurate estimation of conception is critical in the assessment of the effects of drugs used during pregnancy or to prevent pregnancy. In a novel application, we studied the effectiveness of oral contraceptives (OCs), where misclassification of conception relative to OC exposure may obscure effect estimates.Methods:We studied OC failure, in a large claims database, among women who used antiepileptic drugs with metabolizing enzyme-inducing properties (carbamazepine or oxcarbazepine), which reduce OC’s effectiveness or enzyme-neutral properties (lamotrigine or levetiracetam), with no expected impact on OC effectiveness. We compared conception rates in women 12–48 years of age concomitantly using OCs and enzyme-inducing drugs with rates in concomitant users of OCs and enzyme-neutral drugs. We measured conception with a validated algorithm that estimates gestational age based on pregnancy endpoints. We estimated relative and attributable risk using generalized estimating equation models after standardized mortality ratio weighting.Results:We identified 89,777 concomitant use episodes with adjusted contraceptive failure rates of 1.6 (95% confidence interval (CI) = 1.4, 1.8) per 100 person–years among users of enzyme-neutral drugs and 18,964 episodes with a rate of 2.3 (1.9, 2.8) among users of enzyme-inducing drugs. The relative risk of conception for enzyme-inducing group was 1.4 (1.1, 1.8), and the rate difference was 0.7 (0.2, 1.2).Conclusions:OCs in combination with antiepileptic drugs that interact with metabolic enzymes were associated with increased contraceptive failure rates. Measurement of conception in claims data had adequate accuracy to uncover a strong drug–drug interaction, offering promise for broader application in comparative effectiveness studies on hormonal contraceptives to inform clinical and regulatory decisionmaking.

Estrogen therapy before hysteroscopic adhesiolysis improves the fertility outcome in patients with intrauterine adhesions.

To describe the fertility outcomes after hysteroscopic adhesiolysis combined with preoperative hormone treatment in women with intrauterine adhesion (IUA). This study is a retrospective cohort study. A total of 230 patients with IUA underwent hysteroscopic adhesiolysis combined with hormone treatment from Jan 2012 to Jun 2018. 148 patients who received preoperative estrogen treatment were enrolled into group A and 82 patients without preoperative estrogen treatment were enrolled into group B. All the patients underwent hysteroscopic adhesiolysis and received postoperative estrogen therapy, intrauterine indwelling device. Second or third look was performed after 2-3months. 90.87% (209/230) patients complete the study. The AFS scores at baseline were higher in the group A than group B. After the preoperative E2 treatment, group A achieved the comparable AFS score to group B before the surgery. The cumulative fertility rate in group A was comparable in group B, both in the ITT analysis (49.32% vs. 52.44%, p = 0.651) and the PP analysis (54.07% vs.58.10%, p = 0.575).The mean conception time was also similar in group A and group B (8.30 ± 6.47 vs. 8.54 ± 5.68months, p = 0.837). Besides, the surgery times in group A were less than group B. There was no difference in the rate of adverse events between two groups. Hysteroscopic adhesiolysis combined with preoperative oestrogen could reduce the preoperative AFS scores and the times of surgery which yield a similar conception rate in women with less severe intrauterine adhesions.

Conception rates and contraceptive use after bariatric surgery among women with infertility: Evidence from a prospective multicenter cohort study

BackgroundLack of prospective trials have resulted in a dearth of information regarding postbariatric surgery conception rates in women with a preoperative history of infertility. ObjectiveTo examine associations between preoperative history of infertility and postbariatric surgery conception. SettingA multicenter cohort study at 10 United States hospitals (2006–2009). MethodsParticipants completed a preoperative reproductive health questionnaire, with annual postoperative assessments for up to 7 years until January 2015. This report was restricted to women 18- to 44-years old with no history of menopause, hysterectomy, or hormone replacement therapy. The primary outcomes were postoperative (0 to <90 mo) conception rate, early conception rate (0 < 18 mo), and postoperative unprotected intercourse with a male partner while not trying to conceive. ResultsOf 740 eligible women, 650 (87.8%) provided required responses. Median interquartile range (IQR) preoperative age was 34 (30–39) years and follow-up was 6.5 (5.9–7.0) years. Nulliparous women with a preoperative history of infertility represented 8.0% (52/650) of the total cohort, 63.5% (33/52) of whom had never conceived. Compared with women without this history, these women had a higher postoperative conception rate (121.2 [95% confidence interval (CI), 102.3–143.5]/1000 versus 47.0 [95%CI, 34.2–62.9]/1000 woman-yr; P < .001), early conception rate (115.4 [95%CI, 96.1–138.5]/1000 versus 33.9 [95%CI, 23.6–47.1]/1,000 woman-yr; P < .01), and a higher risk of unprotected intercourse (ARR 1.48 [95% CI, 1.14-1.90], P = 0.003). ConclusionAfter bariatric surgery, preoperative history of infertility and nulliparity was associated higher conception rates and unprotected intercourse.

Effect of exposure to second-hand smoke from husbands on biochemical hyperandrogenism, metabolic syndrome and conception rates in women with polycystic ovary syndrome undergoing ovulation induction.

Does second-hand smoke (SHS) exposure from husbands have adverse effects on sex hormones, metabolic profiles, clinical phenotypes and fertility outcomes in women with polycystic ovary syndrome (PCOS) undergoing ovulation induction? SHS exposure is associated with worsened biochemical hyperandrogenism, higher incidence of metabolic syndrome and reduced conception rates in women with PCOS. Smoking in women impairs fecundity at some stages of the reproductive process including folliculogenesis, embryo transport, endometrial angiogenesis and uterine blood flow. Yet little is known about the hazard of SHS exposure in women with PCOS. This study was a secondary analysis of the Polycystic Ovary Syndrome Acupuncture and Clomiphene Trial (PCOSAct), a large randomized controlled trial conducted at 27 hospitals from 2012 to 2015 in mainland China. Out of 1000 women with PCOS, SHS exposure status were available in 500 women, of whom 271 women were non-exposed and 229 exposed to cigarette smoke (170 women ≤10 cigarettes per day as low-SHS exposed and 59 women >10 cigarettes per day as high-SHS exposed). We compared circulating sex steroids, glucose and lipid metabolism, metabolic syndrome and phenotypes, fertility and obstetric outcomes between non-exposed and exposed women. Women exposed to SHS, compared to non-exposed women, had a higher serum total testosterone (1.7 vs 1.5 nmol/L, P = 0.01), free androgen index (5.7 vs 4.0, P = 0.001) and lower sex hormone binding globulin (30.1 vs 35.6 nmol/L, P = 0.03). Metabolic syndrome, but not other phenotypes, was more frequent in exposed women as compared to non-exposed women (21.8 vs 13.3%, adjusted odds ratio (OR)=1.66; 95% CI, 1.02-2.71, P = 0.04). Ovulation rates between exposed and non-exposed groups were not significantly different (76.9 vs 82.9%, adjusted OR=0.72; 95% CI, 0.45-1.15, P = 0.17). Conception rates were significant lower in the exposed group (26.6 vs 36.9%; adjusted OR=0.61; 95% CI, 0.41-0.91; P = 0.01), while clinical pregnancy and live birth rates showed a similar trend that was not statistically significant. Gestational age, birth weight and other obstetric outcomes were not affected by SHS exposure. Data on SHS exposure were missing in 50% of the women. We did not assay serum nicotine or cotinine levels to quantify the SHS exposure status. These data suggest that smoking partners of infertile women with PCOS who seek treatment should be advised to quit smoking. Funding was provided by the National Public Welfare Projects for Chinese Medicine (201107005 and 200807002) and the National Clinical Trial Base in Chinese Medicine Special Projects (JDZX2012036 and 2015B009). There are no conflicts of interest. ClinicalTrial.gov number: NCT01573858 and chictr.org.cn number: ChiCTR-TRC-12002081.

Clinical characteristics and reproductive outcome following hysteroscopic adhesiolysis of patients with intrauterine adhesion - a retrospective study

The authors performed a retrospective clinical analysis of 153 patients with intrauterine ashesion (IUA) who underwent hysteroscopic adhesiolysis. A follow-up office hysteroscopy was performed in all cases after three months. On follow-up hysteroscopy, 22 patients showed reformation of adhesions and required a repeat procedure. The primary risk factor for IUA was uterine curettage associated with pregnancy termination. The follow-up study revealed that the rate of pregnancy after IUA treatment was 51%. The conception rate in women who had reformation of IUA was significantly lower than that of women who had a normal cavity following adhesiolysis. Therefore the authors conclude that prevention is more important than therapy in IUA. Increasing education about avoiding curettage is necessary to reduce the incidence of IUA. Outreach is particularly important for older women with less education. However, hysteroscopic adhesiolysis for IUA is a safe and effective method of choice for restoring menstrual function and fertility.

Reproductive risk: its role in maternal mental health

For many women, pregnancy and childbirth are not without substantial risk in terms of new-onset, recurrent or existing mental disorder. This has consequences not only in terms of poor maternal mental health but also in terms of increased pregnancy- and delivery-related morbidity and can have a significant negative impact on the well-being of the fetus or neonate. New-onset disorders such as postnatal depression and puerperal psychosis have been recognised for some considerable time but it is also becoming apparent that, with the exception of anorexia nervosa, severe intellectual disability and possibly schizophrenia, conception rates among women with all types of mental disorder are the same as those in the general population. In high-income countries, the widespread use of atypical antipsychotics, most of which do not impair reproductive function, may lead to increased conception rates in women with schizophrenia. In addition, pregnancy and childbirth are multifactorial stressors which may render women with previous mental disorders vulnerable to a recurrence. Hence it is no surprise that studies in urban, low-income and ethnically diverse populations in the USA estimate that around a third of pregnant women are suffering from a mental disorder when substance misuse is included (e.g. Kim et al, 2006).

Factors affecting reproductive outcome of hysteroscopic adhesiolysis for Asherman's syndrome

To evaluate the outcome of hysteroscopic adhesiolysis in women with Asherman's syndrome. Retrospective clinical study. Hysteroscopic center of Fuxing Hospital in Beijing, China. Patients with Asherman's syndrome who presented with a history of infertility or recurrent pregnancy loss were included in the study. The adhesions were divided hysteroscopically by electrode needle or loop under direct vision. A second look hysteroscopy was performed after 3 months. The menstrual pattern, the time interval to conceive, and the reproductive outcome were recorded. A total of 109 operative procedures were performed in 85 cases. Uterine perforation occurred on one occasion (0.9%). After hysteroscopic adhesiolysis, the chances of conception in women who remained amenorrheic (2 out of 11; 18.2%) were significantly lower than those who continued to have menses (37 out of 74; 50%). At second look hysteroscopy, the conception rate in women who had reformation of intrauterine adhesions (2 out of 17; 11.8%) was significantly lower than that of women who had a normal cavity (26 out of 44; 59.1%). The outcome of hysteroscopic adhesiolysis for Asherman's syndrome is significantly affected by recurrence of intrauterine adhesions. Further research in Asherman's syndrome should be directed toward reduction of adhesion reformation with a view to improving outcome.

The Oxford Conception Study design and recruitment experience

The Oxford Conception Study is a randomised controlled trial that aims to determine whether or not information about potential fertility from a device that monitors urinary hormones will increase the conception rate in women wishing to conceive. Three modified versions of a fertility monitor have been developed for the study. The monitor measures the levels of urinary oestrone-3-glucuronide (E3G) and luteinising hormone (LH), and the display indicates high or low fertility. The monitor requests all women to test their urine from day 6 to day 25 of the menstrual cycle inclusive. One-third of women are randomised to receive information from the fertility monitor about the early fertile time (from the first rise in E3G until the LH surge is detected), one-third receive information about the late fertile time (the onset of the LH surge and the following 2 days), and a third do not receive any information (control group). All the women are followed up for 6 months or until they are pregnant. A total of 1453 women have been recruited into the study, reaching the study recruitment goal for 80% power to detect a 10% difference in three-cycle pregnancy rate between the Late Fertile Time group (50%) and the Control group (40%), allowing for a 15% non-pregnancy drop-out rate. Follow-up of the women is currently ongoing. The primary analysis will compare the cumulative three-cycle pregnancy rate between each of the study arms. Time-specific conception probabilities will be estimated from coitus information recorded in 12-h intervals. The data from this study will also allow many additional questions to be addressed, including changes in intercourse patterns with feedback about the fertile days and other questions in relation to menstrual cycle function, sexual intercourse, stress, exposures to tobacco products, alcohol, caffeine and medications, fertility and pregnancy outcomes. In addition to presenting the study design, we review the recruitment experience for the Oxford Conception Study. We have achieved sustained and effective recruitment over time by primary use of recruiting via the Internet.

Assisted reproduction in the treatment of polycystic ovarian syndrome

Treatment of patients with polycystic ovary syndrome (PCOS) with assisted reproductive techniques is a great challenge for the infertility specialist. Patients with PCOS demonstrate many problems, such as excessive body weight and hyperinsulinaemia, that render management more complex. Prior to treatment with IVF, the PCOS patient should be thoroughly evaluated for disclosure of endometrial neoplasia, hyperinsulinaemia, and other general health related problems. Ovarian stimulation for IVF carries the risks of overstimulation and severe hyperstimulation, which should be avoidable in most cases with preventive measures. The outcome in terms of pregnancy and implantation rates is similar for patients with PCOS when compared with patients undergoing IVF for other indications. There are some questions regarding oocyte and embryo quality in women with PCOS. This manifests itself in lower fertilization rate and decreased embryo quality in some studies. However, increased numbers of oocytes available for insemination or ICSI compensate for decreased fertilization rates and embryo quality. More recent studies suggest higher cumulative conception rates in women with PCOS when compared with controls. In-vitro maturation (IVM) of oocytes retrieved from non-stimulated or minimally stimulated cycles represents a viable option that should be considered seriously when assisted conception is attempted. Results of IVM, however, should be improved further and generalized before the technique can be advocated as the initial treatment approach in these patients.

Fertility after a randomised trial of spontaneous abortion managed by surgical evacuation or expectant treatment

present in the follow-up group and both had given birth to children; and in five of the women originally managed surgically, three were followed up and two had given birth to children. 14 of the 76 women who attempted to become pregnant, most of whom were managed by expectant management, underwent operative evacuation at a later date due to retained products. The cumulative conception rates in women managed expectantly who later required surgical evacuation for retained products, expectantly only, and primary evacuation were 93%, 91%, and 88%, respectively. This follow-up study shows that expectant management of spontaneous abortion does not affect future fertility.

Impact of age on reproductive outcome in women with recurrent spontaneous abortions and infertility of immune etiology.

The objective of this paper is to determine whether age has any impact on conception rate, pregnancy outcome, or autoimmune status in women with recurrent spontaneous abortions (RSA) and infertility of immune etiology. One hundred twenty-four women with 3 or more RSA and 36 women with unexplained infertility were prospectively studied. Maternal antipaternal lymphocyte antibodies and autoantibodies to phospholipids and nuclear antigens were tested. All achieved an adequate alloimmune recognition after lymphocyte immunization and followed for 1 year with optimal preconception autoimmune treatment. Conception rate and pregnancy outcome were prospectively studied. 1) 10.1% of women with RSA and 30.6% of women with infertility failed to achieve a pregnancy after 1 year of trial (P = 0.0084); 2) in women with RSA, the number of previous fetal death after 28 weeks of gestation was significantly higher in women who failed to achieve a pregnancy within 1 year when compared to women who became pregnant (P = 0.0296). Conception rate was not different with advancing age; 3) women with infertility demonstrated significantly higher incidence of anti-phosphatidylethanolamine antibody when compared to women with RSA (P = 0.052); 4) in women with infertility, those who failed to achieve a pregnancy were significantly older (P = 0.0012) and demonstrated a higher incidence of autoantibodies to phosphatidic acid than women with infertility who became pregnant (P = 0.0339); 5) the subsequent spontaneous abortion rate while on optimal immune therapy was the same in the women with RSA (39.3%) and women with infertility (32%). Spontaneous abortion rate of women with RSA or infertility was not different among four age groups; 6) the presence of anticardiolipin antibody (P = 0.0055) and higher gravidity (P = 0.0354) correlated significantly with pregnancy failure in women with a history of infertility. The prevalence of auto-antibodies to phospholipids and nuclear components was not different among four age groups in women with RSA or infertility. Age does not affect pregnancy outcome or conception rate in women with RSA. In women with infertility of immune etiology, conception rate was significantly reduced over age 40 although pregnancy outcome was no different with advanced age.

Return of fertility following discontinuation of norplant R-II subdermal implants : ICMR task force on hormonal contraception

A total of 627 women who had discontinued the use of the Norplant-II implants for various reasons and were exposed to the risk of pregnancy were followed-up for two years for return of fertility. The cumulative conception rates in women who had discontinued due to planning pregnancy were 80.3 per 100 women at one year and 88.3 per 100 women at two years. The majority of women who did conceive (90 percent), had full-term normal liver births; about 4 percent of women had spontaneous abortions, the remaining 6 percent decided on elective termination of pregnancy (ETP). The cumulative conception rates in women who discontinued due to bleeding irregularities and 'other reasons' were 64.5 and 55.8 per 100 women at one year and 77.9 and 75.1 per 100 women at two years, respectively. These rates were significantly lower as compared to those observed in women who discontinued due to planning pregnancy. A large proportion, about 40 percent, of women who conceived after discontinuation of the method due to bleeding irregularities and “other reasons,” opted for ETP indicating that many women in these two groups did not desire another child and that such women need to be counselled for adopting another method of contraception. The spontaneous abortion rates observed in ex-users of Norplant-II implants (1.7 to 4.4% pregnancies) were comparable to the spontaneous abortion rates prior to Norplant-II implant use (3.6% pregnancies) indicating that ex-users of Norplant-II implants were not at a higher risk of spontaneous abortion. There was no association between the pregnancy rates and either duration of Norplant-II implants use or bleeding patterns during the three months prior to discontinuation of the method in this sample. However, there was a delay in return of fertility in women aged more than 30 years as compared to those who were below the age of 30 years. The study indicates that the return of fertility was not impaired in ex-Norplant-II implant users who were planning pregnancy. In addition, those women who continued with the pregnancy until term delivered full-term normal babies in all the study groups.

Acceptability of Norplant®-2 rods as a method of family planning

The Norplant®-2 rod system consists of two silastic rods in which levonogestrel has been incorporated with the polymer. The continuation rate at the end of five year was 62%. No accidental pregnancies occurred throughout the five years of use. The post-removal conception rate in women desiring pregnancy was 70.8% at the end of two years. The majority of acceptors were happy with the rods and 86.8% expressed the desire to have another set of implants inserted following removal of the first set. The study shows the Norplant®-2 rod system to be a well accepted method of family planning.

Acceptability of norplant R implants for fertility regulation in singapore

The continuation rate at the end of this five-year clinical study was 60% with no accidental pregnancy occurring throughout the five years. The post-removal conception rate in women desiring pregnancy was 92% at the end of two years. The majority of acceptors described the overall experience with the implants as favourable. In fact, 75% of the women planning to use contraception after removal of the implants were going to use implants again.

A three-year clinical evaluation of Norplant-2 rods in Singapore

A three-year clinical evaluation of Norplant-2 rods in Singapore shows that no pregnancy occurred during the three years of use. The continuation rate at the end of three years was 74%. Desire for planned pregnancy was the main reason for removal during the three years. The post-removal conception rate in women desiring planned pregnancy was 50.0% at the end of one year. This low rate could be attributed to the four women deciding against a pregnancy after removal. However, despite this apparent reason one needs to monitor the post-removal return of fertility closely in the years to come.

A three-year clinical evaluation of Norplant in Singaporean acceptors

A three-year clinical evaluation of Norplant implants in Singaporean acceptors shows that no pregnancy occurred during the first three years of use. The continuation rate at the end of three years was 69%. Desire for planned pregnancy and disruption of menstrual rhythm were the two main reasons for implant removal during the three years. The post-removal conception rate in women desiring pregnancy was 94.1% at the end of one year. It thus appears that Norplant offers a highly effective, safe, acceptable and reversible method of contraception.

NorplantR-2 rods contraceptive subdermal implants: two-year experience in Singapore

Norplant-2 contraceptive implants consist of two Silastic rods in which levonorgestrel has been incorporated with the polymer. This on-going study describes our two-year experience with 100 acceptors of Norplant-2 rods in Singapore. No pregnancies occurred during the first two years of use. Desire for planned pregnancy and menstrual irregularities accounted for 86.4% of the removals during this period. The continuation rate at the end of two years was 78%. The post-removal conception rate in women desiring planned pregnancy was 54.5% at the end of one year. Apart from this apparent slow return of fertility requiring future close surveillance, it appears that the Norplant-2 rod system offers a highly effective and convenient means of contraception.