Contraceptive Techniques Research Articles

Sperm Ion Channels: Molecular Targets for the Next Generation of Contraceptive Medicines?

Sperm Ion Channels: Molecular Targets for the Next Generation of Contraceptive Medicines?

A vasectomy technique for Egyptian fruit bats (Rousettus aegyptiacus).

Bats in captivity reproduce well and contraceptive techniques are needed. In initial attempts at vasectomy using a prescrotal approach, it was difficult to identify the mesoductus deferens. The technique described here uses a scrotal approach with exteriorization of the testis, followed by identification and ligation of the mesoductus deferens. Nine Egyptian fruit bats (Rousettus aegyptiacus) underwent vasectomy for this study. No postoperative complications were seen (n = 18 testes), but some of the testes (5/18, 27%), which previously moved freely from the scrotum to the abdominal cavity, were still adhered to the scrotal sac 14 mo postoperatively. This technique appears safe, is fast, and is relatively easy to perform.

Politics, Population, and Family Planning in Guatemala: Ch'orti' Maya Experiences

The Guatemalan population has increased from 3 million to over 11 million since 1950. A close look at the Guatemalan population boom, especially among Mayas, reveals several interrelated factors at play, including 1) a lifestyle based on manual labor and cooperation of kin, 2) inadequate indigenous contraceptive techniques, 3) poverty and marginality from public services, 4) ethnic distrust, 5) religion, 6) gender inequality, and, ultimately, 7) inadequate international and state assistance for family planning. Despite the myriad challenges to family planning in Guatemala, the physical and cultural accessibility to contraceptives can be enhanced by a holistic family planning program.

Sociodemographic attributes of Iranian wives who reported unwanted pregnancies.

In a 1989 Family Planning Study in Iran, 40 percent of the married women of reproductive age reported that their last or current pregnancies were unwanted and unintended. This finding is consistent with the results obtained from a number of studies undertaken in the countries of North Africa and the Middle East. Although the phenomenon of unwanted pregnancy is a significant topic in the population studies, it has received very little attention. This paper shows the differences between two groups: group A, those married women who reported that their last or current pregnancies were wanted, and group B, those married women who reported that their last or current pregnancies were unwanted. The findings of this study clearly show significant differences between these two groups in regard to some key sociodemographic attributes: wife/husband's education, actual and desired fertility, wife's current age, past and present practice of contraceptive methods, and extent of satisfaction with family planning services are among the attributes differentiating these two groups. Our examination of these variables suggests that group B had higher parity, fertility, less desire for more children, less use of contraceptive techniques, and less satisfaction with the efficiency of the contraceptive techniques than group A. The relationship between education and wanted/unwanted pregnancies is mixed. The urban women who wanted pregnancies and were 25 years old or older were more educated than those who did not want pregnancies. On the contrary, the rural women whose pregnancies were not wanted were more educated than those who wanted pregnancies regardless of age, parity, and locality differences. Furthermore, the urban/rural women with different levels of parities who did not want to be pregnant were more educated than the urban/rural women who wanted pregnancies. Finally, the standardized regression coefficients, obtained in logistic regression, reveal that among urban women the desire for more children and parity are the first and second most significant independent variables differentiating between group A and group B. Among rural women, living children and the desire for more children were the first and second most important variables differentiating between group A and group B.

Farmed deer: new domestic animals defined by controlled breeding.

The domestication of plants and animals is recognized as pivotal in mankind's social evolution. Yet, surprisingly few species have actually been farmed, prompting speculation as to which attributes are needed for successful domestication. Although red deer were the staple source of meat throughout Europe in the mesolithic, they have not been widely domesticated, leading many ethologists to argue that they are behaviourally unsuitable. Recently, the most widely accepted criterion of domestication, the ability of farmers to control the breeding of a species, has been fulfilled in red and other species of deer with the widespread adoption of even the most technologically advanced methods of artificial breeding. Simultaneously and conversely, the population growth of wild deer in many temperate parts of the world has stimulated a search for contraceptive techniques.

Suburban residents’ criteria for evaluating contraception and other deer management techniques

Contraception has been advocated increasingly by residents of urban and suburban areas as an appropriate technique for managing local deer herds. Although knowledge about the technical aspects of contraception is increasing among professionals, little study of citizens’ attitudes toward and beliefs about contraception has occurred to date. We explored residents’ attitudes toward contraception in Irondequoit, New York. We identified the criteria residents used to evaluate deer management techniques and how they applied these criteria in evaluating the suitability of contraception. Criteria used to evaluate the suitability of deer management techniques varied among citizens preferring different types of management techniques. Knowledge about contraception was low among citizens, even those who supported it as a management alternative. Further citizen education about contraception and other management techniques is needed in suburban areas with ongoing deer management efforts. Information needs may vary among citizens, however, based on which criteria citizens use to evaluate deer management options. Information about technical feasibility (e.g. effectiveness, speed, etc.) may have little influence on the attitudes of citizens most concerned with issues such as humaneness or effects on nontarget animals.

Canadian Pioneers in Family Planning

Contraceptive techniques have been used in many cultures over hundreds and sometimes thousands of years. As the practice grew, so negative environments and legislation rose to restrict the use of contraceptives.In Canada, it was a criminal offense to advertise or offer a contraceptive product for sale until 1969.The United States had repressive legislation in place around the turn of this century, and in the United Kingdom, it was illegal at one time to distribute contraceptive material.This article provides a brief overview of the significant contributions made by a select number of individuals who challenged the Canadian legislation in a variety of ways, and helped to bring about the eventual reversal of the Criminal Code as it applied to contraception.

Emergency contraception: Lack of awareness among patients presenting for pregnancy termination

Study Objective Emergency contraception, otherwise known as postcoital contraception, refers to a group of birth control modalities that, when used after unprotected intercourse within defined time constraints, can markedly reduce the risk of a resultant unintended pregnancy. The English literature, using British and American awareness data, consistently claims that these contraceptive options are underutilized in the United States because of a lack of patient and physician awareness of their existence. The objective of this study was to determine the level of awareness of postcoital contraceptive techniques in a population of American women who were presenting for pregnancy termination. The secondary goal was to calculate (theoretically) how many of these surgical terminations could have been prevented through the use of postcoital contraception. Methods A questionnaire was administered to patients presenting to an abortion clinic. It was intended to anonymously identify patient demographics and knowledge of the various emergency contraceptive options and, in hindsight, to determine what percentage of these women would have been willing candidates for one of these medical modalities. On completing the questionnaire, all patients received an emergency contraceptive information sheet for future consideration. Results Eighty-three patients completed the study. They ranged in age from 15 to 44 years (mean, 24 years). Forty-six percent of the patients were 21 years of age or younger. A total of 71% of all patients had no real knowledge of the existence of emergency contraceptive options; 26% had some limited knowledge, and only 3% had somewhat complete and valuable information. Fifty-one percent of the patients would have been appropriate, realistic, and willing candidates for at least the emergency contraceptive pill. Assuming at least a 75% effectiveness rate for the emergency contraceptive pill, 38% of the surgical pregnancy terminations performed on this population of women could have been avoided. Conclusion Our data confirm that emergency contraceptive options are underutilized because of a lack of patient awareness. Contraception education, especially directed toward adolescents, should include disseminating enhanced information about postcoital contraception options.

Regulation of the Human Menstrual Cycle

Our understanding of the regulation of the menstrual cycle has recently improved with the development of various tools of investigation. The cycle is now thought to be determined mainly by the ovary itself, which sends various signals to the pituitary and the hypothalamus. The aim of the cycle is to produce a single mature oocyte each month from puberty to menopause. However, the most common evolution of a follicle is atresia, a consequence of the genetically controlled, ovarian apotosis (or “programmed cell death”). Follicular growth and maturation are mostly independent of gonadotropins, from the stage of primordial follicles to antral follicles. A complete intraovarian paracrine system is implied in this gonadotropin-independent follicular growth, and in the modulation of the actions of the gonadotropins in the ovary. FSH allows the rescue of a minority of follicles from atresia and is indispensable to only the final maturation of the preovulatory follicle. The cyclical variations of the gonadotropins are under the control of ovarian steroids (estradiol and progesterone) and peptides (inhibin). The cycle length is determined by follicular growth and by the fixed life span of the corpus luteum. The mechanism of action of gonadotropins is much better understood since the gonadotropins and their receptor cDNA have been cloned. The recent description of naturally occurring mutations has lead to a better understanding of the role of each gonadotropin, demonstrating the crucial role of FSH in the terminal maturation of the follicles. The ovarian cycle can also be monitored at the level of target tissues of steroids such as the endometrium. The cellular mechanisms of endometrial maturation, under the control of estradiol and progesterone, are better understood. The endometrial maturation is synchronized to follicular development and allows implantation of the conceptus. The genes implied in the implantation of the embryo are being identified (e.g., integrins). Last but not least, the mechanisms of endometrial shedding are being elucidated, especially the role of metalloproteases and angiogenic factors. These concepts will allow the development of new treatments for infertility, the design of new contraceptive techniques, and a better tolerance of treatments using sex steroids, particularly progestin-only pill.

The endometrial approach in contraception.

Contraceptive techniques that selectively impair endometrium receptivity have the potential to reduce the risk of cardiovascular complications associated with hormonal methods. However, further research is needed to provide better treatment when oral estrogen is contraindicated, to improve tolerance of progestin-only contraceptives, and identify alternative techniques that will not interfere with the endocrine events of the cycle. This article presents an overview of the endometrial approach to contraception. Discussed are endometrium physiology and the mechanisms of hormonal contraception, endometrial modifications following hormonal contraceptive use, emergency contraception, and intrauterine steroid administration. Outstanding research issues include the mechanisms of endometrial bleeding, definition of molecular and cellular targets for an endometrial approach to contraception, progesterone action, integrins, placental protein 14, insulin growth factor binding protein-1, and plasminogen activators. Short-term developments in this area are expected to include the intrauterine administration of steroids and continuous administration of antiprogestins at doses that do not interfere with secretion. Long-term development will focus on defining new targets for a pharmacological approach in a tissue-specific manner.

Improving adolescent sexual behavior: a tool for better fertility outcome and safe motherhood

The consequences of increased adolescent sexuality worldwide include: an increased rate of adolescent pregnancies and abortions; a high prevalence of sexually transmitted diseases; and a significant number of psychosocial problems. Improvement of adolescent sexual behavior should be one of the primary goals of the 21st century. This includes development of new contraception techniques, providing protection from sexually transmitted diseases, improvement of contraception compliance and the correct use of mass media. As adolescents seek advice on sexual matters, it is our responsibility to provide them with accurate consultation as well as free family planning services in well organized adolescent units, where they may be counselled on the prevention of unwanted pregnancy, and sexually transmitted diseases. This will assist in a better fertility outcome and a safe motherhood.

Female condoms

Early versions of a female condom were available in the 1920s and 1960s, but they were little used and soon forgotten. It took the arrival of AIDS, and the urgent need for a wider range of female-controlled barrier techniques, to rekindle scientific interest in this method. In the 1980s, three groups in Europe and the USA began development of new female condom designs, comprising 'Femidom (Reality)', the 'Bikini Condom', and 'Women's Choice'. Apart from differences in their physical design, Femidom differs from the others in that it is made of a polyurethane membrane, which has several advantages over latex. Of the three, Femidom is the most advanced in terms of development and clinical testing, and it is the only one to have reached the marketing stage. Laboratory studies and clinical trials suggest that its contraceptive efficacy is similar to that documented for the male condom, though a direct comparison is not possible because no comparative clinical trials have, as yet, been undertaken. Reported 'typical-use' pregnancy rates range from 12.4 to 22.2% at 6 months of use in the USA and Latin America, respectively, while a study in the UK observed a rate of 15% at 12 months. As with all barrier methods, most failures appear to be associated with poor compliance or incorrect use. 'Perfect-use' pregnancy rates were substantially lower, indicating that Femidom can be very effective, if used consistently and correctly.Evidence for Femidom's effectiveness to protect against transmission of sexual disease-causing organisms, including HIV, is still very limited and based largely on laboratory studies. Whilst, in theory, the condom should confer reliable protection, its efficacy in clinical use will depend upon correct and consistent use and upon the product's ability to maintain an effective physical barrier throughout penetrative intercourse. In this respect, the results of recent and ongoing clinical studies are expected with much interest.How valuable Femidom will prove to be, in terms of sexual health and contraception, will also depend largely on its long-term user-acceptability. As is generally the case with new methods, initial public interest in Femidom is expected to be high, as was documented in numerous surveys, and there undoubtedly exists a sub-group of women who view the product as their most appropriate contraceptive/sexually transmitted disease prevention option. However, more information on the product's acceptability, based on continuation rates, as is usually applied to other contraceptive techniques, is urgently needed to permit a more reliable assessment of Femidom's position among current methods.The arrival of a female condom represents a welcome addition to the range of female-controlled barrier contraceptives and, because of its numerous potential advantages over the male condom, may play an important role in the prevention of unwanted pregnancy and sexually transmitted diseases.

Emergency contraception: Lack of awareness among patients presenting for pregnancy termination

Background Emergency contraception, otherwise know as postcoital contraception, refers to a group of birth control modalities, which, when used after unprotected intercourse, within defined time constraints, can markedly reduce the risk of a resultant unintended pregnancy. The English literature, using British awareness data, consistently claims that these contraceptive options are underutilized in the USA because of a lack of patient (and physician) awareness of their existence. The objective of this study was to determine the level of awareness of postcoital contraceptive techniques in a population of U.S. women who were presenting for pregnancy termination. Our secondary objective was to calculate (theoretically) how many of these surgical terminations could have been prevented. Methods A questionnaire was administered to patients presenting to an abortion clinic. It was intended to identify anonymous patient demographics, knowledge of the various emergency contraceptive options, and in hindsight, to determine what percentage of these women would have been willing candidates for one of these medical modalities. Upon completing the questionnaire all patients received an Emergency contraceptive information sheet for future consideration. Results Seventy patients completed the study. They ranged in age fran 15 to 44 years with a mean of 24. Forty-one percent of the patients were 21 years or younger. Seventy-one percent of all patients had no real knowledge of the existence of emergency contraceptive options, 26% had limited but not necessarily useful knowledge, and only 3% had somewhat complete and valuable information. Fifty-three percent of the patients would have been appropriate, realistic and willing candidates for at least the emergency contraceptive pill. Conclusions Our data confirm that Emergency contraceptive options are underutilized. Assuming at least a 75% effectiveness rate for the Emergency contraceptive Pill, 40% of the surgical pregnancy terminations performed on this population of women could have been avoided with improved Awareness and Availability. contraception education, especially directed towards adolescents, s houId include d isseminat ing enhanced informat ion about postcoital contraception options. Emergency contraception, otherwise know as postcoital contraception, refers to a group of birth control modalities, which, when used after unprotected intercourse, within defined time constraints, can markedly reduce the risk of a resultant unintended pregnancy. The English literature, using British awareness data, consistently claims that these contraceptive options are underutilized in the USA because of a lack of patient (and physician) awareness of their existence. The objective of this study was to determine the level of awareness of postcoital contraceptive techniques in a population of U.S. women who were presenting for pregnancy termination. Our secondary objective was to calculate (theoretically) how many of these surgical terminations could have been prevented. A questionnaire was administered to patients presenting to an abortion clinic. It was intended to identify anonymous patient demographics, knowledge of the various emergency contraceptive options, and in hindsight, to determine what percentage of these women would have been willing candidates for one of these medical modalities. Upon completing the questionnaire all patients received an Emergency contraceptive information sheet for future consideration. Seventy patients completed the study. They ranged in age fran 15 to 44 years with a mean of 24. Forty-one percent of the patients were 21 years or younger. Seventy-one percent of all patients had no real knowledge of the existence of emergency contraceptive options, 26% had limited but not necessarily useful knowledge, and only 3% had somewhat complete and valuable information. Fifty-three percent of the patients would have been appropriate, realistic and willing candidates for at least the emergency contraceptive pill. Our data confirm that Emergency contraceptive options are underutilized. Assuming at least a 75% effectiveness rate for the Emergency contraceptive Pill, 40% of the surgical pregnancy terminations performed on this population of women could have been avoided with improved Awareness and Availability. contraception education, especially directed towards adolescents, s houId include d isseminat ing enhanced informat ion about postcoital contraception options.

A comparison of contraceptive habits and pregnancy outcome at 19 years of age in two cohorts of Swedish women born 1962 and 1972

The prevalence of contraception and pregnancy outcome intwo representative samples of 19-year-old women resident in the city of Göteborg, born in 1962 (n = 596) and 1972 (n = 641), respectively, was assessed and compared using a postal questionnaire technique. The prevalence of different contraceptive techniques was as follows (62/72): Oral contraception (OC) alone 44%135%, (p<0.001); OC + condom 1%112%, p<0.001; intrauterine device 4%/1%, p<0.001; condom only 11%/14%; depot gestagen 0%/0.3%; no contraception 40%/38%. The median duration of OC use was 15 and 14 months, respectively. Fear of OCs was the commonest reason given for cessation of OC in the 62 cohort and that contraception was no longer required in the 72 cohort. The proportion of women who gave the latter explanation for cessation of OC had increased (p<0.001) from 10% in 1981 to 57% in 1991, indicating that young women in Sweden now tend not to continue with OCs when a relationship ends. Although the prevalence of cigarette smoking was reduced (p<0.05 in the 72 cohort compared to the 62 cohort), there was still an over-representation of smokers in both cohorts among contractraceptive users (p<0.001) and in women who had been pregnant (p<0.001) or undergone an abortion (p<0.001). Pregnancies were reported by 11 % of the women from the 62 cohort and by 13% from the 72 cohort. A greater proportion (p<0.001) of pregnancies terminated in legal abortion in the 72 cohort (61 %) compared to the 62 cohort (50%). The medical complication rate following legal abortion was lower (p<0.05) in the 72 cohort compared to the 62 cohort.

A comparison of contraceptive habits and pregnancy outcome at 19 years of age in two cohorts of swedish women born 1962 and 1972

<h2>Abstract</h2> The prevalence of contraception and pregnancy outcome intwo representative samples of 19-year-old women resident in the city of Göteborg, born in 1962 (n = 596) and 1972 (n = 641), respectively, was assessed and compared using a postal questionnaire technique. The prevalence of different contraceptive techniques was as follows (62/72): Oral contraception (OC) alone 44%135%, (p<0.001); OC + condom 1%112%, p<0.001; intrauterine device 4%/1%, p<0.001; condom only 11%/14%; depot gestagen 0%/0.3%; no contraception 40%/38%. The median duration of OC use was 15 and 14 months, respectively. Fear of OCs was the commonest reason given for cessation of OC in the 62 cohort and that contraception was no longer required in the 72 cohort. The proportion of women who gave the latter explanation for cessation of OC had increased (p<0.001) from 10% in 1981 to 57% in 1991, indicating that young women in Sweden now tend not to continue with OCs when a relationship ends. Although the prevalence of cigarette smoking was reduced (p<0.05 in the 72 cohort compared to the 62 cohort), there was still an over-representation of smokers in both cohorts among contractraceptive users (p<0.001) and in women who had been pregnant (p<0.001) or undergone an abortion (p<0.001). Pregnancies were reported by 11 % of the women from the 62 cohort and by 13% from the 72 cohort. A greater proportion (p<0.001) of pregnancies terminated in legal abortion in the 72 cohort (61 %) compared to the 62 cohort (50%). The medical complication rate following legal abortion was lower (p<0.05) in the 72 cohort compared to the 62 cohort.

New contraceptives in the 1990s.

This article reviews the contraceptive methods levonorgestrel implants and depot medroxyprogesterone acetate. These methods provide effective and safe contraception for adolescents and adults. This review focuses on the use of these contraceptive techniques in the adolescent population, discussing patient selection, side effects, and controversies concerning the methods. Future hormonal contraceptive methods are also discussed.

Adult involvement in teenage childbearing and STD

Many of the proposed counter measures to US teenage pregnancy, childbearing, and sexually transmitted diseases center on sex and abstinence education. A tabulation by the California Center for Health Statistics of 46,511 marital and unwed births among school-age girls in 1993 showed that only 29% were fathered by school-age peers 10-18 years old; 71%, or over 33,000, were fathered by adult post high-school men whose mean age was 22.6 years. Even among junior high school mothers 15 and younger, most births are fathered by adult men 6-7 years their senior. Studies of 535 pregnant and parenting teenagers (mostly Whites) by researchers in Washington state and of 445 teenage mothers (most nonWhites) in Chicago found that large majorities had histories of rapes and sexual abuse before age 12, inflicted mainly by adults who were at least 5-10 years older than their early adolescent girlfriends. 40% of US girls live near or below poverty income levels, and this low-income population accounts for 6 out of 7 teenage births. US teenage pregnancy rates are 3-10 times higher than those found among industrial nations of western Europe, but poverty rates among US youth are also higher by a similar magnitude. The sexual abuse and rape of young girls, pregnancy during adolescent years, and abandonment of women to raise or support children are, overwhelmingly, adult male behavior problems exacerbated by poverty. The claim that superficial pregnancy prevention programs emphasizing abstinence and contraceptive techniques can persuade young teenagers to enforce abstinence or contraception on their older adult partners is dubious. US prevention campaigns are likely to succeed only when they limit the emphasis on youth-targeted campaigns, condescending attitudes, and punitive approaches, and forcefully confront the excessive economic attrition inflicted on US youth, and the thoroughly integrated nature of sexual behaviors among adolescents and adults.

Possible physiological bases for contraceptive techniques in the male.

Aspects of the physiology of the testis and epididymis are discussed which might be relevant to future methods of contraception in the male. These include the blood-testis barriers, both at the tubular and vascular level, testicular and scrotal thermoregulation and maturation of spermatozoa in the epididymis. Possible adverse consequences of interfering with spermatogenesis are also considered, such as reduced endocrine responsiveness of the testis, increased incidence of genetic abnormalities and abnormal development of embryos produced by sub-fertile males.

Possible physiological bases for contraceptive techniques in the male

Aspects of the physiology of the testis and epididymis are discussed which might be relevant to future methods of contraception in the male. These include the blood-testis barriers, both at the tubular and vascular level, testicular and scrotal thermoregulation and maturation of spermatozoa in the epididymis. Possible adverse consequences of interfering with spermatogenesis are also considered, such as reduced endocrine responsiveness of the testis, increased incidence of genetic abnormalities and abnormal development of embryos produced by sub-fertile males.The perfect male contraceptive would block either the production or maturation of spermatozoa without affecting hormone secretion by the testes, thereby not diminishing libido or secondary sex characteristics. Reduction of gonadotropin secretion to that point which decreases sperm production is an obvious route to suppress sperm production. The barrier between the blood stream and the seminiferous tubules, which does not appear until after puberty, plays a key role in regulating access of hormones, metabolites, and antibodies to the germinal cells and protecting the immunologically foreign haploid cells from a immune response. Contraceptive researchers have identified it as a target for male contraception. Basic research of the barrier has been limited to animals. Some research suggests that movement of substances across the endothelial lining of the testicular blood vessels may determine the response of the testis to a hormonal challenge. Thus, if researchers could identify those factors regulating this movement and could greatly modify them, they might discover a way to interfere with spermatogenesis. Another physiological basis for contraceptive techniques in the male is that short-term heating of testes to or slightly above body temperature disrupts spermatogenesis. Severe or prolonged heating of the testis completely suppresses spermatogenesis. Inhibition of sperm maturation in the epididymis is another possible route. Yet, we do not yet know the importance of blood, lymph, and rete testis fluid in transporting active substances to the epididymis, or how the epididymis brings about changes in spermatozoa. Possible risks of induced suppression of spermatogenesis are so far limited to thermal treatment and include increased concentrations of luteinizing hormone in the blood, genetic abnormalities, and abnormal development of embryos in females.

Immediate postplacental insertion of the intrauterine device: a review of Chinese and the world's experiences.

The postpartum period is an ideal time to begin contraception, as women are more highly motivated to adopt contraception at this time and it is convenient for both patients and service providers. For intrauterine device (IUD) contraception, this period offers other advantages, such as ease of insertion and minimal adverse impacts on breastfeeding. Among early studies, most postpartum insertions were performed anywhere from a few hours to seven days or more after delivery, and retention of the IUD in the uterus was poor. Since the 1970s, immediate postplacental insertion (IPPI), i.e., IUD insertion performed within 10 minutes after placental delivery, has been advocated, and fairly, low expulsion rates have been reported. Up to now, IPPI has not been widely accepted in clinics because its expulsion rate still appears to be higher than that of interval insertion. In order to further study IPPI and perfect this contraceptive technique, it is essential to comprehensively review IPPI results and compare the Chinese experience with that of the rest of the world.