The use of cervical caps at the University of California, Berkeley: a survey

A survey of cap use and efficacy of women who initially purchased a cervical cap at the University of California at Berkeley Student Health Service is described. It reports the follow-up of 65 U.C. women students who purchased either Vimule or Cavity-rim cervical caps from May, 1978 through June, 1981 and raises questions about cervical cap use and efficacy. Participants were divided into two groups: regular and irregular users. Of the 33 regular users, 16 experienced unplanned pregnancy during the study. Survival probabilities were 80% at 6 months, 73% at one year and 52% after 2 years. Life table analysis of the 33 regular users indicated a 20% probability of pregnancy in the first 6 months of use, 27% by 1 year and 48% by the end of 2 years.

[Sperm centrifugation in azoospermia?]

In cases of azoospermia especially after vasectomy the investigation of the seminal sediment investigation is necessary. Exclusive on this way it is possible to find some side dispersed spermatozoa. The described case deals with a pregnancy about 48 days following vasectomy. Postoperative the sperm sediment investigation was not performed. In the following judicial hearing the doctor justified himself, that there do'nt exist any special direction in different textbooks of andrology as well as of urology. But this case demonstrates the necessary of the seminal sediment, which is the most important andrological investigation after vasectomy. For this it is not necessary to find special directions, this is common use.

Delayed spontaneous recanalization of the vas deferens

Eight patients were identified who had undergone successful vasectomy a mean of 4.6 years previously and in whom all were microscopically shown to have recurrent motile spermatozoa in their ejaculate. All had been referred following a pregnancy in their wives, and all agreed to undergo repeat vasectomy. Histological examination of the excised portions revealed the presence of spermatozoa in the distal end of one side; but also the presence of a well formed sperm granuloma in continuity with both divided ends of the vas. There does not appear to be any correlation with the suture previously used, nor incidence of infections or injury. Although recanalization is a recognized complication of vasectomy, the majority have occurred within months of the operation. The association of the delayed recanalization with sperm granuloma formation in these cases suggests an aetiological link, it being previously reported that such granuloma can develop up to six years postoperatively.

Nonspermicide fit-free diaphragm trial reported

The standard technique of diaphragm fitting and the use of spermicide with diaphragms have been challenged by Edward Stim, a physician who developed and tested a nonspermicide fitfree disphragm (NFFD) method. He suggested that the main cause of diaphragm failure was erratic use, and that occasional nonuse was a result of the irritations caused by overly large diaphragms, the messiness of spermicides, and the need to anticipate intercourse in order to place the diaphragm in advance. From 1974-79, Stim prescribed the Koroflex diaphragm with a rim diameter of 60 mm for all his patients requesting diaphragm contraception. He believed the 1 size produced "an efficient sperm-blocking obstruction in virtually all women." Stim deemphasized spermicide use while carefully instructing the women on correctdiaphragm placement and advising continual use of the device. He reported a high rate of effectiveness for a barrier method, with 1.1 pregnancies/100 woman-years of use. Failure rates ranging from 2-19% have been reported for users of conventional diaphragms with spermicide. In 1981, the Marie Stopes House in London undertook a study to determine the failure rate for the NFFD as compared to that reported for the conventional diaphragm, to ascertain acceptability of NFFD to women and their partners, and to determine whether NFFD offered significant practical advantages for service delivery. Family Health International assisted in the analysis of data. The incidence of pregnancy in the Marie Stopes study was much higher than had been previously reported. A total of 39 (35.5%) of the women remained in the study discontinued use of the NFFD within a 12-month period, 20 (18.2%) because they become pregnant. Of 110 women enrolled in the trial, 22 (20%) were lost to follow-up. The 2nd most common reason for termination of NFFD use was "personal reasons," including lack of confidence in the method. In spite of the reported pregnancy rate of 24.1/100 women at 12 months, a high level of acceptability of the NFFD was demonstrated among the women who had used it successfully. In fact, 48 (43.6%) women refused to discontinue use of the method even after being told of the high risk of pregnancy. Although the diaphragm is a proven contraceptive method, research remains to be done in this area. The NFFD study was not able to distinguish whether lack of fit or nonuse of spermicides caused the failures. A next step may be a small controlled trial of fitted diaphragms with and without spermicides.

Building a family: unplanned events

Couples in developed societies are often unsuccessful in achieving precise family building goals despite the widespread use of birth control. Unplanned events that frustrate reproductive intentions to varying degrees include contraceptive failure, sterility, miscarriage, prolonged conception delay, undesired sex combination of offspring, divorce, and the death of a spouse or a child. This paper reviews the probability of the occurrence of these events using US data. It is concluded that the large majority of newlyweds will experience at least one unplanned event during the family building phase of the life cycle.

Comparison of three types of tubal sterilisation: the medan experience

Three methods of tubal sterilisation, viz. laparoscopy, culdoscopy and minilaparotomy, were evaluated in a trial involving 300 voluntary acceptors at the University Hospital in Medan, Indonesia. Equal numbers of women were randomly assigned to the three surgical groups. The results showed little differences among patients in the three groups for age, number of living children, contraceptive and abortion histories and pre-existing medical conditions. As expected, average surgical time for minilaparotomy was significantly higher than the times reported for the endoscopic techniques. Minilaparotomy also produced the highest incidence of operative complications while culdoscopy accounted for the highest rate of hospitalisation following operation. Four-year follow-up of the patients revealed only one case of pregnancy in the culdoscopy group, three years after tubectomy .

Studies on the role of intestinal bacteria in metabolism of synthetic and natural steroid hormones

Administration of antimicrobial agents to subjects taking oral contraceptives has been reported to lead to contraceptive failure and subsequent pregnancy. In women taking oral contraceptives antimicrobial agents could have an effect on both endogenous hormone levels and on the metabolism of the exogenously administered steroids. To investigate these possibilities, antimicrobial agents were administered for short periods to normal women taking various steroid drugs: Megestrol acetate (MA), medroxyprogesterone acetate (MPA), norethisterone (NET), a combination of NET and ethinylestradiol (EE) or a combination of lynestrenol and EE. During ampicillin administration the 24-h morning plasma concentrations of MA, MPA and NET were increased compared to the control values. In the MA and MPA experiments the afternoon values were determined and also found to be increased. In the subjects taking oral contraceptives plasma EE concentration showed a tendency to decrease during ampicillin administration on the third, fourth or fifth morning of ampicillin administration, but was never lower than the pretreatment values. In other experiments plasma estrone (E1) and estradiol (E2), urinary total E1, E2 and estriol (E3) and fecal unconjugated and conjugated E1, E2 or E3 were determined by RIA before, during and after administration of oxytetracycline (2 X 500 mg/day for 5 days) to 5 young male subjects. Furthermore urinary and fecal estrogens were determined in 1 male subject after administration of erythromycin for 6 days and in 2 normally menstruating women after tetracycline and trimethoprim administration, respectively. During treatment with antimicrobial drugs an increase in the excretion of fecal conjugated and, with the exception of the oxytetracycline experiments, also of unconjugated estrogens paralleled a decrease in urinary estrogen excretion, especially for E2 and E3. In both urine and feces the E1/E2 and E1 + E2/E3 ratios increased due to diminished reductive metabolism of estrogens in the gut. No significant effects on plasma unconjugated estrogen concentrations were observed. The results suggest that the intestinal bacterial flora plays a significant role in estrogen metabolism. However, further studies are necessary, because our results do not explain why administration of antibiotics may cause contraceptive failure.

Characteristics of women who stop using contraceptives

A relatively new multivariate life-table technique has permitted the effect of socioeconomic characteristics on first-year contraceptive failure rates to be determined to a greater degree of precision than was possible in the past. This technique is employed in this article to determine the one-year rates of contraceptive discontinuation among currently married U.S. women, using data from the 1973 and 1976 National Surveys of Family Growth (NSFG). The results indicate that poor women, black women and younger women are all relatively more likely to stop using contraceptives for reasons other than method-switching or the desire to become pregnant, as are women who have not completed high school, Catholic women and those who have never had a birth. Of all methods, the IUD is associated with the lowest rate of discontinuation. Pill users over age 30 are more likely to stop using their method than are comparable women using the IUD, diaphragm or condom. Women relying on spermicides are generally most likely to cease using a method. Finally, the subgroups of women who are most likely to stop using a particular method also are generally the groups that are most likely to experience contraceptive failures, while those that are least likely to discontinue use are also least likely to fail. Two exceptions are women who rely on rhythm and those who use the pill. The former experience relatively high rates of failure but are relatively less likely to stop using the method, and the latter have relatively high rates of discontinuation despite a low rate of failure.