IUD Group Research Articles

Comparing the efficacy and pregnancy outcome of intrauterine balloon and intrauterine contraceptive device in the prevention of adhesion reformation after hysteroscopic adhesiolysis in infertile women: a prospective, randomized, controlled trial study

Study objectiveTo evaluate the efficacy and pregnancy outcomes of intrauterine balloon and intrauterine contraceptive devices in the prevention of adhesion reformation following hysteroscopic adhesiolysis in infertile women with moderate to severe intrauterine adhesion.DesignA prospective, randomized, controlled trial study.SettingA tertiary university hospital.PatientsA total of 130 patients with moderate (American Fertility Society [AFS] score of 5–8) and severe (AFS score of 9–12) intrauterine adhesions were recruited.Interventions86 patients were evenly allocated to group treated with an IUD for 1 month and group treated with an IUD for 2 months. 44 patients were allocated to group treated with a Foley catheter balloon.(IUD: Yuangong IUD).Measurements and main resultsThe primary outcome measures were the AFS score, endometrial thickness, and pregnancy outcome. After hysteroscopy, the AFS score was significantly decreased(P<0.05), whereas endometrial thickness was significantly increased across the three groups(P<0.001). Notably, the decline in the AFS score in the balloon group was greater than that in the IUD-1-month group and IUD-2-month group(P<0.01), with no significant difference between the IUD groups(P = 0.298). Lastly, In addition, the extent of the increase in endometrial thickness(P = 0.502) and the pregnancy outcomes(P = 0.803) in the three groups were not significantly different.ConclusionInserting a balloon or placing an IUD for one or two months can effectively lower the risk of adhesion recurrence and restore the shape of the uterine cavity. While the therapeutic effect of the balloon was superior to that of the IUD, no significant differences were observed in the one-month and two-month IUD groups.Trial registrationThis research was registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/enIndex.aspx); Clinical trial registry identification number: ChiCTR-IOR-17,011,943 (http://www.chictr.org.cn/showprojen.aspx?proj=17979). Date of trial registration: July 11, 2017.

SAT463 Hormonal Contraceptive Use and Hypothyroidism Risk

Abstract Disclosure: S. Gloe: None. T.B. Carroll: Consulting Fee; Self; Corcept Therapeutics. Research Investigator; Self; Corcept Therapeutics, Novartis Pharmaceuticals. Introduction: Thyroid dysfunction is one of the most common endocrine disorders, with an estimated 4.3% of the US affected by subclinical hypothyroidism and 0.3% affected by overt hypothyroidism. Chronic autoimmune thyroiditis is the most common cause of hypothyroidism in the US and is estimated to affect 5-10x more women than men. Given this higher incidence in women, it is possible that hormonal difference or hormonal medications may play a role in thyroid dysfunction. Nearly 15% of women aged 15-49 use oral contraceptive pills (OCP) and 10.4% use other long-acting reversible hormonal contraceptives. A recent study showed a 25% increased prevalence of hypothyroidism in women with prior OCP use and in women with more than 10 years of OCP use the risk of developing hypothyroidism was nearly 4 times as high. Methods: Using the TriNetX database, four distinct groups of women aged 18-45 were identified using data from 1/1/2010 -1/1/2020. The four groups were EPC (n=5849), POC (n=5052), IUD (n=1000), and controls without prior hormonal contraception use (n = 6677). Demographic data, date of diagnosis of hypothyroidism, alcohol use, tobacco use, and BMI was obtained for each subject. Exclusion criteria included thyroidectomy (partial or total), lack of sufficient medication data, and a hypothyroidism diagnosis prior to or within 90 days of the first contraceptive medication order. A logistic model was then created accounting for known risk factors for the development of hypothyroidism (race/ethnicity, alcohol use, smoking, and BMI).Results: Initial comparison of treatment groups to controls demonstrated an no difference in risk of developing hypothyroidism for the EPC group (OR=1.18, p=0.2), but the POC and IUD groups had decreased risk of hypothyroidism (OR=0.39, p=&amp;lt;0.001 and OR=0.45, p=0.029, respectively). Using the logistic model, all groups demonstrated a decreased risk of hypothyroidism as compared to the control group (EPC: OR=0.3, p=&amp;lt;0.001, POC: OR=0.14, p=&amp;lt;0.001, IUD: OR=0.12, p=&amp;lt;0.001). Additionally, individuals identifying as Black/African Americans were less likely to develop hypothyroidism when compared to white/Caucasian subjects (OR=0.25, p=&amp;lt;0.001). Finally, BMI showed a fairly weak but significant association with development of hypothyroidism (OR=1.04, p=&amp;lt; 0.0001). Conclusion: Contrary to prior research, our data suggests a potential protective effect against the development of hypothyroidism for EPC, POC, and IUD use. The data also confirms prior studies showing a lower incidence of hypothyroidism in individuals who identify as Black/African American and perhaps those with lower BMI. Presentation Date: Saturday, June 17, 2023

Effects of intrauterine devices on female sexual function: a cross-sectional study

Objectives: To examine the differences in sexual functions between women using copper intrauterine device (Cu-IUD) and levonorgestrel intrauterine system (LND-IUS). Methods: A total of 125 women between the ages of 20 and 40 were included in the study. The demographic data of all participants were recorded. Female Sexual Function Index (FSFI) was performed to all participants. Study participants were divided into 3 groups; 42 Cu-IUD users, 42 LND-IUS users, and 41 control (not use contraceptive) group, then compared. Women with a total score lower than ≤ 26.5 were considered as having sexual dysfunction. Results: The prevalence of female sexual dysfunction (FSD) was 56.8% among the participants. The total FSFI scores of Cu-IUD and LNG-IUS groups were similar. Moreover, the FSFI score of both IUD users was lower than the control group, and the difference was statistically significant (p &amp;lt; 0.001). The presence of Cu-IUD affected arousal more than pain, satisfaction, lubrication and orgasm scores (p = 0.016). Pain score was similar among IUD groups and significantly lower than controls (p &amp;lt; 0.001). Moreover, orgasm and satisfaction scores were found to be significantly higher in the control group than in the both IUD groups (p &amp;lt; 0.001). All of three groups were also similar about desire and lubrication domains of FSFI. Conclusions: In conclusion, this study found that Cu-IUD and LNG-IUS users did not differ in terms of sexual function according to scores calculated by FSFI.

COMPARATIVE COPPER PHARMACOKINETIC PROPERTIES OF A NOVEL LOW-DOSE NITINOL FRAME COPPER INTRAUTERINE DEVICE (IUD) AND THE COPPER T380A IUD: A RANDOMIZED CONTROLLED TRIAL

We compared the pharmacokinetics and bioavailability of serum copper in women receiving either a novel low-dose nitinol frame copper IUD or the copper T380A IUD through the first 57 days of use. Two sites participated in this parallel -single-blind study that randomized reproductive age women 1:1 to an investigational low-dose copper IUD (with 175 mm2 of exposed copper) or the approved copper T380A (Paragard, 380 mm2) IUD. Participants provided two baseline total serum copper samples at least 24 hours apart within 28 days prior to IUD placement followed by seven samples following randomization on days 1, 3, 8, 15, 22, 29, and 57. We used a noncompartmental mixed-effects linear analysis of variance (ANOVA) model with treatment as a fixed effect and subject as a random effect to calculate uncorrected PK parameters Cmax, Cmean, and AUC0-56 days. We compared relative bioavailability between the two groups by geometric mean ratios and 90% confidence intervals. We hypothesized that the relative bioavailability of total serum copper for the low-dose device would not exceed established normal (490 to 1840 ng/ml) or levels seen in users of the copper T380A. Of the 41 participants enrolled, 39 had successful IUD placements (20 in the low-dose group and 19 in the T380A group) with 36 of those subjects completing the treatment comparison phase of the study (19 low-dose and 17 T380A). Participants reported a mean age of 28.4 years. The baseline mean serum copper concentrations for the low-dose group were 1220 ng/ml standard deviation (SD) ± 285 ng/ml vs. 1250 ng/ml ± 276 ng/ml for the T380A group. Observed copper concentrations in both groups remained in the normal range; with the relative mean Cmax, Cmean, and AUC 0-56 days of 1210 ng/ml, 1070 ng/ml, and 59,700 for the low-dose IUD group vs. 1300, 1150, and 63,600 for the T380A group. Post IUD placement values for both the low-dose group and the copper T380A group were slightly lower than baseline values over the seven timepoints from 0-56 days. Respective baseline-corrected mean values for the low-dose group were 7.8 to 29.8 ng/ml and for the T380A group were 14.9 to 34.3 ng/ml lower than baseline. Relative bioavailability by geometric mean copper exposure for all parameters ranged from 0.93-0.94 (90% CI for all values 0.85-1.02) with all mean values for the low-dose IUD lower than the T380A. Serum copper concentrations for the two IUDs remained within the normal range and trended toward lower values for participants assigned to the low-dose copper IUD relative to the T380A. Neither IUD generated clinically meaningful changes in total serum copper concentrations during the first 56 days after IUD placement.

Liquid-based cervical cytology and microbiological analyses in women using cooper intrauterine device and levonorgestrel-releasing intrauterine system

ObjectiveTo assess the influence of the copper IUD and LNG-IUS on liquid-based cytology results (cellular atypia, reactive alterations, and microbiology). Study DesignThis cross-sectional study was performed between January 2012 and December 2017 in the Northeast of Brazil. Three study groups, the LNG-IUS group (n = 1179), copper IUD group (n = 519), and a control group of women not using contraception (n = 14,616) were compared. To facilitate this analysis, the LNG-IUS and IUD groups were further divided into less and more than two years of use. ResultsThe mean age of the LNG-IUS and IUD groups was around 36 years and the control group was about 35 years (p = ns). The meantime between dispositive placement and examination was 19 ± 16 months for the LNG-IUS and 17 ± 15 months for the IUD. The frequency of epithelial atypia revealed upon cytological analysis did not differ between the groups. However, inflammatory infiltrates were significantly more frequent in the LNG-IUS and IUD (OR IUD = 1.32; OR LNG-IUS = 1.79) groups relative to control. Candida and cytolysis were more frequent in the LNG-IUS group (OR = 4.73 and 2.41, respectively) compared to both other groups. Bacterial vaginosis andActinomyces sp occurred more frequently in the IUD group (OR = 1.39 and 3352.55, respectively) compared to both other groups. Bacterial vaginosis was more common when using an IUD for more than two years than for less than two years (OR = 2.55). The Actinomyces morphotype was also observed at greater frequency after two years of IUD use than before (OR = 5.35). ConclusionsThe LNG-IUS and copper IUD do not affect the incidence of cellular atypia but do interfere with the microbiota over time. Specifically, the copper IUD is associated with bacterial vaginosis andActinomyces sp infection while the LNG-IUS is associated with candidiasis and cytolysis.

The effect of the copper intrauterine device (Cu-IUD) and the injectable depo-medroxyprogesterone acetate (DMPA) use on women’s sexual satisfaction and depression

Background &amp; Aim: Intrauterine device and depo-medroxyprogesterone acetate are among the most effective reversible contraception in the world, still few consensuses exist about sexual and mood changes of these two conventional methods. The present study has compared the sexual satisfaction and depression level in these two methods. Methods &amp; Materials: A cross-sectional study was conducted between August 2017 and January 2018, in 300 married women aged 19-50 year, in Tehran, Iran. One hundred and fifty IUD users and 150 DMPA consumers, 12-18 months after starting the current method, recruited to the study from 34 health centers of Tehran University of Medical Sciences by convenience sampling. Two standard questionnaires of Index of sexual satisfaction (ISS) and Patient Health Questionnaire (PHQ) were used for assessing sexual satisfaction and depression, respectively. Chi-square and independent t-test were used for the homogeneity of the two groups. The linear logistic regression analysis was conducted to estimate the strength of associations. Results: There was not any significant difference between two groups in demographic characteristics such as age, marriage duration, education level, number of children and breastfeeding condition (P&gt;0.05). Significantly higher sexual satisfaction (P&lt;0.001) and lower depression level (P&lt;0.001) reported in IUD users than DMPA consumers in the t-test. A multivariate regression confirmed that sexual satisfaction increased 6.4 scores in the IUD group in comparison to DMPA users (P= 0.003, B= -6.4), and with increase 1 year to duration of the marriage, sexual satisfaction increase 0.33 score. For depression, the only significant variable was the contraceptive methods, and depression level increase 1.24 scores in DMPA users than IUD consumers. (P=0.006, B= - 1.24). Although in univariate analysis, some variables showed effects on sexual satisfaction and depression, multivariate regression results did not confirm any significant relationships. Conclusion: Both sexual satisfaction and mood level was higher among IUD users. This paper reconfirmed that IUD is a preferable method in women who are eligible to use both methods.

Influence of intrauterine dispositive in human papillomavirus clearance

Introduction: An important inverse relation between IUD use and risk of cervical cancer has been proved. Women who used IUD had half the risk of developing cervical cancer. The mechanism how IUD is a protector factor is still unknown. Could be improving the clearance of HPV infection or stopping progression to cancer from preneoplasic lesion.The aim of the study is to check if IUD increases HPV clearance, that is, checking if after 1 year HPV infection disappears in more patients using IUD than those not using it.Study design: This is a cohort case-control prospective study, carried out in Universitary Hospital La Zarzuela in Madrid, Spain, performed between October 2015 and April 2018.No pregnant women between 25–50 years old, with HPV cervical infection were enrolled. We separated the participants into two groups: an IUD group, with women starting using IUD and non IUD group, with women using any other contraceptive method or none. HPV genotyping of cervical cytology samples were performed initially on enrolment day and one year after.Results: 254 participants were enrolled at the beginning of the study, 85 in the IUD group and 169 in the control group (non IUD). 179 participants completed the study, 54 (31%) in IUD group and 120 participants in non IUD group (69%).38 women from IUD group cleared HPV infection (69.5%) and 65 women from control group cleared it (54.2%) (p = 0.044).An association in logistic regression was observed in HPV clearance with different factors. Firstly, higher percentage of patients with IUD clear the HPV infection than those in control group significantly associated (OR = 0.698, CI 95%; 0.251–0.998, p = 0.046). Clearance was higher in patients with low-risk HPV infection comparing with high risk HPV (OR = 1.078, CI 95%; 1.126–4.6.281, p = 0.026) and in patients with only one HPV type than those with more than one (OR = 0.194, CI 95%; 0.084–0.403, p < 0.001).Conclusions: In Spanish women with HPV infection, the HPV clearance between IUD and non IUD groups show results with statistical significance, patients with IUD have higher clearance rates. There were differences also between suffering one HPV type or more than one, and having low-risk HPV or high-risk HPV infection.

Comparison of expulsions following intracesarean placement of an innovative frameless copper-releasing IUD (Gyn-CS®) versus the TCu380A: A randomized trial

ObjectiveThe intent of this study (primary outcome measure) is to assess the expulsion rate of a newly developed copper releasing frameless intrauterine IUD GyneFix® Cesarean Section (Gyn-CS®) at 3 months' follow-up, compared to the TCu-380A IUD, inserted immediately postplacental expulsion following cesarean section delivery. Study designThis is a randomized trial from one hospital research center in Istanbul, Turkey. Eligible pregnant women, the majority undergoing elective cesarean delivery (n=106), and the remaining emergency cesarean section cases (n=34), received intracesarean insertion of Gyn-CS or TCu380A insertion. Follow-up ended with a 3 month-visit. The Zeynep Kamil University Hospital Ethics Committee approved this study. ResultsThe study explores the retention of 140 insertions, 70 Gyn-CS and 70 TCu380A. There were two follow-up visits after discharge from hospital at 6 weeks and 3 months. A single Gyn-CS expulsion occurred after approximately 6 weeks likely a consequence of improper anchoring. Expulsion was more common in the TCu380 A IUD group (11.4% vs 1.4%, p=.039). There were 4 removals for medical reasons in the Gyn-CS patients and 4 in the TCu380A patients, respectively, with 4 non-medical removals occurred, 2 in each group. No serious adverse events (e.g., PID, perforation) were reported. At the study conclusion of 3 months, 61 Gyn-CS (88%) and 54 TCu380A (79%) IUDs remain in place. ConclusionThis immediate postplacental study in cesarean section patients suggests that the anchoring technique employed resulted in the excellent retention of Gyn-CS. Insertion was easy, safe and quick requiring minimal physician training. The possibility of direct visualization of the anchor by ultrasound at insertion and follow-up allows the surgeon to verify the position of the IUD serving to enhance provider and patient confidence and assurance. ImplicationsThe frameless anchored intrauterine IUD is effective in minimizing displacement and expulsion. The results of this study suggest that the Gyn-CS IUD is appropriate for wider intracesarean use.

Short-term copper intrauterine device placement improves the implantation and pregnancy rates in women with repeated implantation failure

To study if hysteroscopy and short-term copper intrauterine device placement (Cu-IUD) improves the pregnancy rates of women with repeated implantation failure (RIF) undergoing frozen-thawed embryo transfer (FET). Retrospective study. Medical university hospital. Infertile women with at least two implantation failures with the use of at least one good-quality embryo. All patients received operative hysteroscopy in the follicular cycle, and if endometrial polyps, polypoid endometrium, or intrauterine adhesions were found they were removed. In some patients, a Cu-IUD was inserted immediately after hysteroscopy and removed after two menstrual periods before embryo implantation. All patients underwent invitro fertilization or intracytoplasmic sperm injection and FET. Clinical pregnancy and implantation rates. A total of 440 women with a mean age of 33.42 ± 4.45years (range 23-47y) were included. There were 382 patients (554 cycles) in the IUD group and 58 patients (87 cycles) in the non-IUD group. The two groups were similar regarding age, body mass index, and infertility factors. The IUD group had a significantly higher implantation rate (29.29% vs. 16.56%), chemical pregnancy rate (53.25 vs. 41.38%), and clinical pregnancy rate (45.13% vs. 26.44%) than the non-IUD group. Multivariable regression analysis indicated that the odds of a chemical pregnancy was significantly increased with IUD usage. Cu-IUD placement for two menstrual cycles at the time of hysteroscopy can improve the implantation and pregnancy rates in women with RIF.

Body composition, resting energy expenditure and inflammatory markers: impact in users of depot medroxyprogesterone acetate after 12 months follow-up.

The aim of this study was to evaluate for 12 months the changes of body weight using Depot Medroxyprogesterone Acetate (DMPA) and if these changes are related to inflammatory markers. Twenty women of childbearing age who chose the DMPA, without previous use of this method, BMI < 30 kg/m2, and 17 women using IUD TCu 380A, participated in the study. At the baseline and after one year, changes in weight gain, body composition by the bioimpedance electric method, resting energy expenditure (REE) by the indirect calorimetry method, inflammatory markers and HOMA-IR were assessed. After 12 months of evaluation, we could observe a significant increase in the DMPA group in weight (3,01 kg) and BMI, while the IUD group's only significant increase was observed in the BMI. Relative to REE there was an increase of basal metabolic rate (BMR) in both groups after one year. The sub-group DMPA that gained < 3 kg had increased significant weight, BMI and body surface (BS) with respiratory quotient (RQ) reduction, while the sub-group that gained ≥ 3 kg had a significant increase in weight, BMI, BS, fat-free mass, fat mass, BMR, Leptin, HOMA-IR and waist circumference, with RQ significantly reduced. Our study found significant changes in weight, body composition and metabolic profile of the population studied in the first 12 months of contraceptive use. These changes mainly increased body weight, leptin levels and HOMA-IR which can contribute to the development of some chronic complications, including obesity, insulin resistance and diabetes mellitus.

Choice of Emergency Contraceptive and Decision Making Regarding Subsequent Unintended Pregnancy.

To prospectively evaluate (1) pregnancy desirability, (2) stated intentions should pregnancy occur among emergency contraception (EC) users, and (3) explore differences between women selecting the copper T380 intrauterine device (Cu IUD) or oral levonorgestrel (LNG) regarding hypothetical pregnancy plans and actual pregnancy actions during subsequent unintended pregnancies. In this prospective observational trial, women received the Cu IUD or oral LNG for EC without cost barriers. At baseline, participants completed a visual analogue scale measuring pregnancy desirability (anchors: 0, "trying hard not to get pregnant"; 10, "trying hard to get pregnant") and self-reported plans (abortion, adoption, parenting, and unsure) if the pregnancy test were to come back positive. Pregnancies were tracked for 12 months, and actions regarding unintended pregnancies were compared between EC method groups. Of 548 enrolled women, 218 chose the Cu IUD and 330 the oral LNG for EC. Pregnancy desirability at baseline was low, with no difference between EC groups (IUD group: 0.51, SD ± 1.60; LNG group: 0.68, SD ± 1.74). Fifty-four (10%) women experienced unintended pregnancies. Pregnancy plans from baseline changed for 27 (50%) women when they became pregnant. EC groups did not differ in hypothetical pregnancy intention (p = 0.15) or in agreement of hypothetical pregnancy intention with actual pregnancy action (p = 0.80). Women presenting for EC state high desire to prevent pregnancy regardless of method selected. When considering a hypothetical pregnancy, half of women had a plan for how they would respond to that situation, but when confronting an actual unintended pregnancy, half altered their plan. Clinicaltrials.gov identifier NCT00966771.

The clinical effect comparison of three types of intrauterine devices

Objective To compare the clinical effect of three types of intrauterine devices and their adverse events. Methods From June 2012 to June 2013,683 women of reproductive age underwent the insertion of Gyne Fix-IN IUD, Mcu IUD and HCu280 IUD in Family-Planning Service Outlet of Yi-shan District in Zaozhuang City were collected in this study. The patients were followed up for 1year. The clinical effect and adverse events of three types of intrauterine devices were compared. Results The expulsion rate of Gyne FixIN IUD(0.88%)group was lower than those in the Mcu IUD(3.95%)and HCu280 IUD(4.41%)group(χ2＝4.565,5.514,all P＜0.05). And the removal rate for medical reasons of Mcu IUD group(5.26%)was higher than those in the FixIN IUD(1.75%)and HCu280 IUD(1.32%)group(χ2＝4.145,5.543,all P＜0.05). The continuation rate of Mcu IUD(90.35%)group was higher than those in the FixIN IUD(96.93%)and HCu280 IUD(95.59%)group(χ2＝8.286,4.784,all P＜0.05). The pregnancy rate of three groups were no significant difference(P＞0.05). Conclusion The three kinds of IUDs could be used as the first menstrual period returns after vaginal delivery. HCu280 IUD has good clinical effect. The effective contraception rate is high while adverse events are low. It is worthy of clinical use. Key words: Female（female）sex; Birth control device; Contraception，artificial; Adverse reactions

Combined hormonal versus nonhormonal versus progestin-only contraception in lactation

Postpartum contraception improves the health of mothers and children by lengthening birth intervals. For lactating women, contraception choices are limited by concerns about hormonal effects on milk quality and quantity and passage of hormones to the infant. Ideally, the contraceptive chosen should not interfere with lactation or infant growth. Timing of contraception initiation is also important. Immediately postpartum, most women have contact with a health professional, but many do not return for follow-up contraceptive counseling. However, immediate initiation of hormonal methods may disrupt the onset of milk production. To determine the effects of hormonal contraceptives on lactation and infant growth We searched for eligible trials until 2 March 2015. Sources included the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, POPLINE, Web of Science, LILACS, ClinicalTrials.gov, and ICTRP. We also examined review articles and contacted investigators. We sought randomized controlled trials in any language that compared hormonal contraception versus another form of hormonal contraception, nonhormonal contraception, or placebo during lactation. Hormonal contraception includes combined or progestin-only oral contraceptives, injectable contraceptives, implants, and intrauterine devices.Trials had to have one of our primary outcomes: breast milk quantity or biochemical composition; lactation initiation, maintenance, or duration; infant growth; or timing of contraception initiation and effect on lactation. Secondary outcomes included contraceptive efficacy while breastfeeding and birth interval. For continuous variables, we calculated the mean difference (MD) with 95% confidence interval (CI). For dichotomous outcomes, we computed the Mantel-Haenszel odds ratio (OR) with 95% CI. Due to differing interventions and outcome measures, we did not aggregate the data in a meta-analysis. In 2014, we added seven trials for a new total of 11. Five reports were published before 1985 and six from 2005 to 2014. They included 1482 women. Four trials examined combined oral contraceptives (COCs), and three studied a levonorgestrel-releasing intrauterine system (LNG-IUS). We found two trials of progestin-only pills (POPs) and two of the etonogestrel-releasing implant. Older studies often lacked quantified results. Most trials did not report significant differences between the study arms in breastfeeding duration, breast milk composition, or infant growth. Exceptions were seen mainly in older studies with limited information.For breastfeeding duration, two of eight trials indicated a negative effect on lactation. A COC study reported a negative effect on lactation duration compared to placebo but did not quantify results. Another trial showed a lower percentage of the LNG-IUS group breastfeeding at 75 days versus the nonhormonal IUD group (reported P < 0.05) but no significant difference at one year.For breast milk volume, two older studies indicated lower volume for the COC group versus the placebo group. One trial did not quantify results. The other showed lower means (mL) for the COC group, e.g. at 16 weeks (MD -24.00, 95% CI -34.53 to -13.47) and at 24 weeks (MD -24.90, 95% CI -36.01 to -13.79). Another four trials did not report any significant difference between the study groups in milk volume or composition with two POPs, a COC, or the etonogestrel implant.Seven trials studied infant growth; one showed greater weight gain (grams) for the etonogestrel implant versus no method for six weeks (MD 426.00, 95% CI 58.94 to 793.06) but less compared with depot medroxyprogesterone acetate (DMPA) from 6 to 12 weeks (MD -271.00, 95% CI -355.10 to -186.90). The others studied POPs, COCs versus POPs, or an LNG-IUS. Results were not consistent across the 11 trials. The evidence was limited for any particular hormonal method. The quality of evidence was moderate overall and low for three of four placebo-controlled trials of COCs or POPs. The sensitivity analysis included six trials with moderate quality evidence and sufficient outcome data. Five trials indicated no significant difference between groups in breastfeeding duration (etonogestrel implant insertion times, COC versus POP, and LNG-IUS). For breast milk volume or composition, a COC study showed a negative effect, while an implant trial showed no significant difference. Of four trials that assessed infant growth, three indicated no significant difference between groups. One showed greater weight gain in the etonogestrel implant group versus no method but less versus DMPA.

Acceptability and Satisfaction towards Copper T 380A versus Single Dose Levonorgestrel as Emergency Contraception among Egyptian women

Objective: To assess acceptability & satisfaction towards Cu-T 380A(IUD) versus levonorgestrel (contra plan II) as EC among Egyptian womenas primary outcome, and the efficacy, side effects as secondary outcomes.Method: 336 women fulfill the inclusion & exclusion criteria completedthe study distributed as 162 women chose to use levonorgestrel and 174women chose to use IUD. Patients were followed up for index cycle. Patients were assessed for acceptance of LNG and IUD, side effects, failurerate and resumption of menses.Results: Acceptability and satisfaction of IUD as EC method were 51.8 %and 98.3%vs. 48.2% and 96.3% of LNG group. 59.3% and 62.1% of LNGand IUD group respectively have resumed their menses within expectedtime. LNG showed tolerated side effects. The most common side effectamong LNG group was heavy bleeding (9.3%) and nausea (7.4%). IUDwas left in place as long-term contraception in most of cases (67.2%).Only one woman of IUD group and 2 women of LNG group had pregnancy. Most of participants have been satisfied with their method.Conclusion: both methods are highly effective methods of contraceptionafter unprotected intercourse and IUDs are cost-effective when left inplace as ongoing contraception.

Body composition and weight gain in new users of the three-monthly injectable contraceptive, depot-medroxyprogesterone acetate, after 12 months of follow-up

Objectives To evaluate weight gain and body composition (BC) in new users of depot-medroxyprogesterone acetate (DMPA) as a contraceptive.Methods This cohort study followed up 20 DMPA users and 20 copper intrauterine device (TCu380A IUD) users, paired for age (± 1 year) and body mass index (BMI ± 1 kg/m2), during 12-months. Healthy, non-obese women aged 18 to 40 years, unaffected by conditions that could influence their body weight, were enrolled. Socio-demographic variables, habits, weight, BMI, BC using dual-energy X-ray absorptiometry, circumferences, skinfold thickness, body fat percentage and waist-to-hip ratio were evaluated. All participants were encouraged to adopt healthy habits.Results At baseline, median age was 29 and 30.5 years, and mean BMI was 24.8 and 24.5 kg/m2 in the DMPA and IUD groups, respectively. At 12 months, an increase was observed in waist and hip circumference in the DMPA users and 8/20 of them had a weight gain ≥ 5% (mean 4.6 kg) with accumulation of fat centrally.Conclusions There were no differences in weight gain or in BC measurements between the groups; nevertheless 40% of women in the DMPA group had larger weight gain and accumulation of fat centrally. The duration of follow-up may have been insufficient to detect differences between the groups.Chinese 摘要 目的 研究应用长效甲羟孕酮避孕对体重和身体成分的影响方法 分别选取20名妇女开始使用长效甲羟孕酮避孕（DMPA组）以及20名开始使用含铜宫内节育器避孕（IUD组）进行队列研究，并按照年龄( ±1 岁)、体重指数（BMI± 1 kg/m2 ）进行配对。40名18-40岁的健康、体重适宜、没有其他可能影响体重因素的妇女入选。记录研究对象的社会人口学特征、生活习惯、体重、体重指数、应用X线骨密度仪测量身体成分、手臂、腰、臀以及大腿的周径、皮肤褶皱的厚度、体脂的百分比以及腰臀比的数据。鼓励所有的研究对象选取健康的生活方式及饮食习惯。结果 入选时两组妇女的平均年龄分别为29岁及30.5岁，体重指数分别为24.8kg/m2以及24.5 kg/m2。12个月后DMPA组的妇女有腰围和臀围的增加，8/20的妇女体重增加≥5%（平均4.6kg）伴有中央性脂肪蓄积的特点。结论 使用DMPA以及使用含铜IUD12个月后的两组妇女在体重增加以及身体成分上的变化没有差异，但是DMPA组有40%的妇女有更多的体重增加以及体脂的中央性蓄积。研究可能需要更长的随访时间来发现两组的差异。

Progestin-only contraceptives: effects on weight.

Progestin-only contraceptives (POCs) are appropriate for many women who cannot or should not take estrogen. Many POCs are long-acting, cost-effective methods of preventing pregnancy. However, concern about weight gain can deter the initiation of contraceptives and cause early discontinuation among users. The primary objective was to evaluate the association between progestin-only contraceptive use and changes in body weight. Through May 2013, we searched MEDLINE, CENTRAL, POPLINE, LILACS, ClinicalTrials.gov, and ICTRP. The 2010 search also included EMBASE. For the initial review, we contacted investigators to identify other trials. All comparative studies were eligible that examined a POC versus another contraceptive method or no contraceptive. The primary outcome was mean change in body weight or mean change in body composition. We also considered the dichotomous outcome of loss or gain of a specified amount of weight. Two authors extracted the data. We computed the mean difference (MD) with 95% confidence interval (CI) for continuous variables. For dichotomous outcomes, the Mantel-Haenszel odds ratio (OR) with 95% CI was calculated. We found 16 studies; one examined progestin-only pills, one studied the levonorgestrel-releasing intrauterine system (LNG-IUS), four examined an implant, and 10 focused on depot medroxyprogesterone acetate (DMPA). Outcomes examined were changes in body weight only (14 studies), changes in both body weight and body composition (1 study), and changes in body composition only (1 study). We did not conduct meta-analysis due to the various contraceptive methods and weight change measures.Comparison groups did not differ significantly for weight change in 12 studies. However, three studies showed weight change differences for POC users compared to women not using a hormonal method. In one study, weight gain (kg) was greater for the DMPA group than the group using a non-hormonal IUD in years one through three [(MD 2.28; 95% CI 1.79 to 2.77), (MD 2.71, 95% CI 2.12 to 3.30), and (MD 3.17; 95% CI 2.51 to 3.83), respectively]. The differences were notable within the normal weight and overweight subgroups. Two implant studies also showed differences in weight change. The implant group (six-capsule) had greater weight gain (kg) compared to the group using a non-hormonal IUD in both studies [(MD 0.47 (95% CI 0.29 to 0.65); (MD 1.10; 95% CI 0.36 to 1.84)]. In one of those studies, the implant group also had greater weight gain than a group using a barrier method or no contraceptive (MD 0.74; 95% CI 0.52 to 0.96).The two studies that assessed body composition change showed differences between POC users and women not using a hormonal method. Adolescents using DMPA had a greater increase in body fat (%) compared to a group not using a hormonal method (MD 11.00; 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (MD -4.00; 95% CI -6.93 to -1.07). The other study reported differences between an LNG-IUS group and a non-hormonal IUD group in percent change in body fat mass (2.5% versus -1.3%, respectively; reported P value = 0.029) and percent change in lean body mass (-1.4% versus 1.0%, respectively; reported P value = 0.027). The overall quality of evidence was moderate to low, given that the studies were evenly divided across the evidence quality groups (high, moderate, low, or very low quality). We found limited evidence of weight gain when using POCs. Mean gain was less than 2 kg for most studies up to 12 months. Weight change for the POC group generally did not differ significantly from that of the comparison group using another contraceptive. Two studies that assessed body composition showed that POC users had greater increases in body fat and decreases in lean body mass compared to users of non-hormonal methods. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.

Evaluation of Placenta in Foetal Demise and Foetal Growth Restriction

The study objective was to evaluate the pathological changes of the placenta in foetal death and foetal growth restriction and to find correlation of the findings with clinical causes. Prospective study at a tertiary care hospital. Gross and histopathological examinations of the placentae were carried out in pregnancies with foetal demise (IUD) and Foetal Growth Restriction (FGR). SPSS, version 11.5. Placentae of twenty seven women with foetal demise and of equal number of women with foetal growth restriction were studied. Placental weight was less than 10(th) percentile in 61.5% women in IUD group and in 93% women in the FGR group. Gross examination of placentae showed abnormalities in 12 (44%) women of IUD group and in 16 (59%) women of FGR group. Histopathological abnormalities were observed in 74.1% women of the IUD group and in 66.7% women of FGR group. Placental histopathology correlated with clinical risk factors in 60% women of IUD group and in 40% women of FGR group. Among the women with no clinically explainable cause for IUD and FGR, 86% and 57% had placental histopathological abnormalities respectively. The histopathological abnormalities of the placenta can be used to document the clinical causes of foetal demise and growth restriction; it may explain the causes in cases of clinically unexplained foetal demise and foetal growth restriction.

Urinary Diversion in Early Childhood: Indications and Outcomes in the Exstrophy Patients

To evaluate indications and applicability of continent and incontinent urinary diversion (CUD and IUD, respectively) in early childhood in patients with classic bladder exstrophy (CBE). Using an institutionally approved exstrophy database, patients with CBE born after 1980 who underwent CUD or IUD by 2 surgeons within the first 5 years of life were identified. All aspects of their care and clinical outcomes were studied. In the CUD group (n = 14), only 21% had successful primary closure. Indications were desire to be dry (7), persistent hydronephrosis (4), urinary tract infections (UTIs) (1), repeat CUD (1), and inaccessible proper follow-up (1). Three patients had neobladder creation, 10 had bladder augmentation with continent stomas, and 2 underwent ureterosigmoidostomy. Currently, all patients are dry with clean intermittent catheterization (CIC). In the IUD group (n = 5), only 1 had successful primary closure. In addition to small, noncontractile bladders, the indications for IUD were severe hydronephrosis (2), recurrent UTIs (2), and noncompliance with catheterization (1). Four patients were re-diverted to CUD after a mean of 9.4 years and 1 has colon conduit. All are socially dry via catheterization. There was no case of renal function loss or malignant transformation. The need for early diversion in CBE is primarily driven by upper tract changes after secondary closure and social factors. Urinary diversion can be safe in younger children with a favorable continence outcome.

Progestin-only contraceptives: effects on weight.

Progestin-only contraceptives (POCs) are appropriate for many women who cannot or should not take estrogen. Many POCs are long-acting, cost-effective methods of preventing pregnancy. However, concern about weight gain can deter the initiation of contraceptives and cause early discontinuation among users. The primary objective was to evaluate the association between progestin-only contraceptive use and changes in body weight. We searched MEDLINE, CENTRAL, POPLINE, EMBASE, LILACS, ClinicalTrials.gov, and ICTRP, and contacted investigators to identify other trials. All comparative studies were eligible that examined a POC versus another method or no contraceptive. The primary outcome was mean change in body weight or body composition. Two authors extracted the data. We computed the mean difference with 95% confidence interval (CI) for continuous variables and odds ratio with 95% CI for dichotomous variables. We did not conduct meta-analysis due to the various contraceptive methods and weight change measures. Fifteen studies examined progestin-only pills (N=1), Norplant (N=4), and depot medroxyprogesterone acetate (DMPA) (N=10). Comparison groups were similar for weight change in 11 studies. Four studies showed differences in weight or body composition change for POCs compared to no hormonal method. Adolescents using DMPA had a greater increase in body fat (%) versus a group using no hormonal method (mean difference 11.00; 95% CI 2.64 to 19.36). The DMPA group also had a greater decrease in lean body mass (%) (mean difference -4.00; 95% CI -6.93 to -1.07). In another study, weight gain (kg) was greater for the DMPA group than an IUD group (mean difference 2.28, 2.71, 3.17, respectively). The differences were notable within the normal weight and overweight subgroups. One study showed the Norplant (six-capsule) group had greater weight gain (kg) than a non-hormonal IUD group (mean difference 0.47 (95% CI 0.29 to 0.65) and a group using non-hormonal or no method (mean difference 0.74; 95% CI 0.52 to 0.96). Another study also showed a Norplant group also had greater weight gain (kg) than an IUD group (mean difference 1.10; 95% CI 0.36 to 1.84). We found little evidence of weight gain when using POCs. Mean gain was less than 2 kg for most studies up to 12 months, and usually similar for the comparison group using another contraceptive. Appropriate counseling about typical weight gain may help reduce discontinuation of contraceptives due to perceptions of weight gain.

Contraceptive efficacy and local effects of bioceramic IUD in rat

The contraceptive efficacy and local effects of bioceramic IUD in rat were studied. The experiment was divided into four groups: bioceramic IUD group; stainless steel IUD group; operation control group; normal control group. All IUD samples were put into uterus of rats. The experimental results show that the alumina bioceramic has a strong contraceptive effect for those rats. In bioceramic IUD group the endometrial inflammation reaction was as mild as that in stainless IUD group during the early days (30 days) and gradually abated with time during the late days (60 days). The experiments show that the alumina bioceramic has a good biocompatibility and contraceptive effects and hint at the alumina bioceramic IUD may become a more safety reproduction family planning IUD.