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Systemic polidocanol from intravenous or pressurized intrauterine administration produces reversible cardiovascular toxicity. JVS Vasc Sci 2022; 3:316-335. [PMID: 36439699 PMCID: PMC9692028 DOI: 10.1016/j.jvssci.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Fatal allergic responses and cardiac arrhythmias have been reported with the intravenous (IV) administration of polidocanol. We sought to identify the physiologic mechanism of systemic cardiovascular response after transcervical (TC) and IV administration of polidocanol. Methods We continuously monitored blood pressure (BP) and heart rate using an arterial line during IV and intraperitoneal (IP) administration of polidocanol solution (PS) and polidocanol doxycycline solution in female rats and TC and IP administration of polidocanol foam (PF) and PDF (TC only) in female baboons. We performed TC procedures using a catheter with (pressurized) and without (nonpressurized) balloon inflation. Baboons also underwent monitoring during IV PS administration with and without pretreatment with antihistamines. We performed cardiac echo and electrocardiograms during selected experiments. We defined a refractory hypotension as a sustained decrease of more than 30% from baseline that prevented delivery of the target dose. Results We found a dose-related increase in the proportion of baboons that developed refractory hypotension during TC administration of 5% PDF and PF, an effect confined to pressurized administration. The infusion of 0.5% PS in rats induced a rapid and dramatic refractory hypotension. The inclusion of doxycycline did not improve or deteriorate these outcomes, and doxycycline solution or saline (control) alone did not affect BP. All five female baboons that received up to 20 mL of 1% PS (200 mg) developed refractory hypotension. Pretreatment with diphenhydramine, ranitidine, or both did not block the refractory hypotension induced by IV administration of 1% PS (100 mg). In contrast, only one of the six female baboons treated with IP PF 400 mg developed a decrease of more than 30% in BP, and this response was not sustained. Cardiac echocardiography done in four baboons during TC treatment demonstrated a decrease in cardiac output as the physiologic mechanism of hypotension. We did not observe important changes on the electrocardiograms. Conclusions Adverse cardiovascular effects of polidocanol treatment occur owing to a direct myocardial effect of polidocanol and not as a result of a hypersensitivity reaction. Pressurized TC administration of PF results in refractory hypotension owing to endometrial vascular uptake of polidocanol and not as a result of uptake from peritoneal surfaces.
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Hernandez JL, Park J, Yao S, Blakney AK, Nguyen HV, Katz BH, Jensen JT, Woodrow KA. Effect of tissue microenvironment on fibrous capsule formation to biomaterial-coated implants. Biomaterials 2021; 273:120806. [PMID: 33905960 PMCID: PMC8135119 DOI: 10.1016/j.biomaterials.2021.120806] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 12/19/2022]
Abstract
Within tissue exposed to the systemic immune system, lymphocytes and fibroblasts act against biomaterials via the development of a fibrous capsule, known as the foreign body reaction (FBR). Inspired by the natural tolerance that the uterine cavity has to foreign bodies, our study explores the role of microenvironment across classical (subcutaneous) and immune privileged (uterine) tissues in the development of the FBR. As a model biomaterial, we used electrospun fibers loaded with sclerosing agents to provoke scar tissue growth. Additionally, we integrated these materials onto an intrauterine device as a platform for intrauterine biomaterial studies. Polyester materials in vitro achieved drug release up to 10 days, greater pro-inflammatory and pro-healing cytokine expression, and the addition of gelatin enabled greater fibroblast attachment. We observed the materials that induced the greatest FBR in the mouse, had no effect when inserted at the utero-tubal junction of non-human primates. These results suggest that the FBR varies across different tissue microenvironments, and a dampened fibrotic response exists in the uterine cavity, possibly due to immune privilege. Further study of immune privileged tissue factors on biomaterials could broaden our understanding of the FBR and inform new methods for achieving biocompatibility in vivo.
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Affiliation(s)
- Jamie L Hernandez
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, WA, 98105, USA
| | - Jaehyung Park
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, WA, 98105, USA
| | - Shan Yao
- Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, 97006, USA
| | - Anna K Blakney
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, WA, 98105, USA
| | - Hienschi V Nguyen
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, WA, 98105, USA
| | - Bob H Katz
- ContraMed LLC, 900 E. Hamilton Ave, Campbell, CA, 95008, USA
| | - Jeffrey T Jensen
- Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, 97006, USA
| | - Kim A Woodrow
- Department of Bioengineering, University of Washington, 3720 15th Ave NE, Seattle, WA, 98105, USA.
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Ketamine Use in Hysterosalpingography (the Jimah Procedure): A Follow-Up of Bilateral Tubal Evaluation of 27 Infertile Women at a Teaching Hospital, Ghana. Radiol Res Pract 2021; 2021:6657137. [PMID: 33959397 PMCID: PMC8075684 DOI: 10.1155/2021/6657137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 11/17/2022] Open
Abstract
Background Pain, anxiety, and distress are common in radiological investigations including hysterosalpingogram (HSG). Studies suggest that sedation allows patients to better tolerate diagnostic imaging and image-guided procedures by relieving anxiety, discomfort, and pain. This study aimed at assessing the safety and effectiveness of ketamine use in HSG and the proportion of true positive bilateral tubal blockage during HSG using the Jimah Procedure. Methods We performed repeated HSG workup under IV ketamine (20–40 mg/mL) sedation for 27 infertile women at the Cape Coast Teaching Hospital. The exclusion criteria included unilateral tubular blockage, acute infection of the vagina or cervix, active vaginal bleeding, glaucoma, and high blood pressure at the time of the study. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results A total of 27 patients (age range: 25–48 years) previously diagnosed of bilateral tubal blockage or spasm were enrolled for the repeat HSG procedure. The median age was 34 years (IQR: 32–37), while secondary infertility (20) (74.1%) was the commonest indication. None of the patients reported of pain or distress during or after the procedure. Two (7.4%) women vomited after HSG. Twelve patients (44.4%) had bilateral tubal blockage (true positive), while tubal patency was seen in 15 (55.6%) patients on HSG under ketamine sedation. Conclusion This study found IV ketamine sedation produces profound anesthesia and analgesia and eliminates tubal spasm. We recommend that radiologists in developing countries should consider sedating patients during HSG and documenting observations and patients' feedback to help assess safety and effectiveness in local settings.
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Shveiky D, Cohn D, Elyashiv A, Nissenbaum Y, Neuman T, Karavani G, Bloom AI. A novel technology for reversible fallopian tubal occlusion using a reverse thermo-responsive polymer-Preliminary results from a rabbit animal study. Contraception 2021; 104:319-323. [PMID: 33894249 DOI: 10.1016/j.contraception.2021.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To determine if PF-88, a reverse thermo-responsive polymer designed to create a gel at body temperature and liquefy at a lower temperature (21°C) can reversibly occlude the fallopian tubes in rabbits. STUDY DESIGN Mature female New Zealand White rabbits underwent laparotomy and placement of 22-gage catheter into the lumen of the distil uterine horns for evaluation of tubal patency by fluoroscopy using radio opaque contrast and treatment with PF-88. In the Acute Phase group (n = 5) after PF-88 treatment we immediately cooled the serosal surface of the tube with ice for 90 seconds to liquify the gel then reassessed patency. In the Survival Phase groups, animals recovered from the initial surgery and then underwent a second procedure for evaluation of tubal occlusion and reversibility at 4 (n = 3), 14 (n = 2), and 28 (n = 3) weeks after the initial procedure. We compared the histologic appearance of the treated fallopian tubes to untreated controls (n = 3). RESULTS In the Acute Phase, we found all 10 fallopian tubes patent on initial evaluation, occluded following treatment with PF88, and patent following re-liquification by chilling. Animals in the Survival Group, all but one of the treated tubes appeared blocked at follow-up and patent following chilling. The treatment failure occurred in an animal in the 4-week group. Tubes treated with PF88 showed no histologic evidence of residual material or damage after removal of the polymer. CONCLUSION The PF-88 reverse thermo-responsive polymer demonstrated the ability to reversibly block fallopian tubes for up to 28 weeks. IMPLICATIONS The demonstration of reversible occlusion of the fallopian tube of rabbits using PF-88, a thermo-responsive reverse polymer, support additional studies to evaluate the potential of this polymer as a contraceptive in women.
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Affiliation(s)
- David Shveiky
- Department of Obstetrics and Gynecology, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Daniel Cohn
- The Casali Institute of Applied Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ariel Elyashiv
- The Casali Institute of Applied Chemistry, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yitzhak Nissenbaum
- Department of Medical Imaging, Interventional Radiology Unit, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tzahi Neuman
- Department of Pathology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Gilad Karavani
- Department of Obstetrics and Gynecology, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel
| | - Allan I Bloom
- Department of Medical Imaging, Interventional Radiology Unit, Hadassah Medical Center - Hebrew University of Jerusalem, Jerusalem, Israel
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Salam Ansari A, Sevliya K, Badar A, Lohiya NK. Reversible inhibition of sperm under guidance as an intratubular and reversible contraception in female rats: An experimental study. Int J Reprod Biomed 2021; 19:47-56. [PMID: 33554002 PMCID: PMC7851472 DOI: 10.18502/ijrm.v19i1.8179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/31/2019] [Accepted: 06/29/2020] [Indexed: 11/24/2022] Open
Abstract
Background Reversible inhibition of sperm under guidance (“RISUGⓇ”) is a promising intravasal male contraceptive. Objective An exploratory study was conducted with a concept of non-invasive, transcervical, single-intervention and reversible contraception using RISUGⓇ in females. Materials and Methods In this experimental study, 60 adult Wistar albino female rats weighing 150-155 g, 3-4 months old were divided into four groups: group I: sham-operated control; group II: tubal occlusion with RISUG for 90 days; group III: tubal occlusion with RISUGⓇ for 90 days and reversal with dimethyl sulphoxide and group IV: tubal occlusion with RISUGⓇ for 90 days and reversal with 5% NaHCO. Animals were subjected to bilateral fallopian tube occlusion with RISUGⓇ and reversal with DMSO and NaHCO3. The estrous cycle, fertility and histology of fallopian tube were evaluated. Results Group I showed 100% fertility during all mating schedules. Animals of experimental groups indicated positive mating, but 0% fertility was evident following 30, 60, and 90 days of tubal occlusion. However, after reversal, fertility steadily increased to normalcy in groups III (50% at 45 days, 80% at 105 days, 100% at 150 and 195 days) and IV (70% at 45 and 105 days, 100% at 150 and 195 days) animals. Group II illustrated disorganized inner cell linings and eosinated RISUGⓇimplant-filled lumen. Reversal groups (III and IV) revealed complete restoration of cellular histo-architecture. Regular estrous cycle was noticed in all experimental groups.
Conclusion RISUGⓇ is suitable for single intervention, intratubular, reversible contraception in female rats.
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Affiliation(s)
- Abdul Salam Ansari
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
| | - Kiran Sevliya
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
| | - Ayesha Badar
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
| | - Nirmal Kumar Lohiya
- Department of Zoology, Center for Advanced Studies, University of Rajasthan, Jaipur, Rajasthan, India
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Cordero-Franco C. Reviving permanent contraception: New medical procedures or new service delivery modalities? Best Pract Res Clin Obstet Gynaecol 2020; 66:15-27. [DOI: 10.1016/j.bpobgyn.2019.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 12/04/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
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Patil E, Thurmond A, Hart K, Seguin J, Edelman A, Jensen JT. Intrauterine fluid instillation to confirm tubal occlusion after transcervical permanent contraception: A pilot study .. Contraception 2019; 101:40-45. [PMID: 31655066 DOI: 10.1016/j.contraception.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine if women with tubal patency experience more fluid loss compared to those with bilateral tubal occlusion following intrauterine instillation of fluid via a balloon catheter. STUDY DESIGN In this prospective cohort pilot study, we enrolled women with prior Essure® procedures and healthy controls from September 2016 to July 2017. We excluded women using an implant or intrauterine device, or with a prior cesarean delivery or permanent contraception procedures other than Essure®. An infusion pump delivered saline via balloon catheter under continuous pressure monitoring. After one minute, we withdrew the fluid and recorded volumes in and out. Subjects then underwent hysterosalpingogram for evaluation of tubal patency. We conducted crude analyses with t-tests and sensitivity analyses. RESULTS We recruited 23 participants; ten provided analyzable data in each group. Hysterosalpingogram confirmed patency in all control and occlusion in all post-Essure® subjects in the analysis group. We found the median volume of saline lost among control subjects [7.8 mL (7.4, 8.4)] larger than post-Essure® participants [2.2 mL (2.0, 3.8), p < 0.01]. While 50% of control subjects tolerated the full 10 mL of fluid instillation, none of the post-Essure® subjects tolerated this volume (p = 0.03). A combination of saline loss ≤4 mL and participant intolerance of the full 10 mL volume yielded sensitivity of 0.80 (95% CI: 0.57, 1.00) and specificity of 1.00 for bilateral tubal occlusion. CONCLUSION Instillation of a fixed volume into the uterus may discriminate between women with tubal patency and occlusion following permanent contraception procedures with high specificity and adequate sensitivity. These findings should be validated in larger, more diverse study populations. IMPLICATIONS Confirmation of tubal occlusion following permanent contraception with an office-based approach could improve acceptability of transcervical approaches. The recent removal of Essure® from the U.S. market increases the need for novel transcervical procedures and occlusion verification methods.
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Affiliation(s)
- Eva Patil
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR 97239, USA.
| | - Amy Thurmond
- Womens Imaging & Intervention, 17050 Pilkington Rd, Suite 130, Lake Oswego, OR 97035, USA
| | - Kyle Hart
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR 97239, USA
| | - Jacqueline Seguin
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR 97239, USA
| | - Alison Edelman
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR 97239, USA
| | - Jeffrey T Jensen
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, UHN 50, Portland, OR 97239, USA
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Zimmerman KL, Stefanacci JD, Greenberg SM. Use of 1% polidocanol and pre‐ and post‐computed tomography for treatment of a suspected nasolacrimal duct cyst in a dog. Vet Ophthalmol 2019; 22:374-380. [DOI: 10.1111/vop.12644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/11/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022]
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Patil E, Thurmond A, Edelman A, Fu R, Lambert W, Seguin J, Jensen JT. Pressure dynamics in the non-gravid uterus: intrauterine pressure cannot confirm tubal occlusion after non-surgical permanent contraception. Contraception 2017; 96:330-335. [PMID: 28687179 DOI: 10.1016/j.contraception.2017.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The objective was to determine if intrauterine pressure can distinguish bilateral tubal occlusion (BTO) from unilateral or bilateral tubal patency (TP) in women following a permanent contraception procedure. STUDY DESIGN We used a small inline pressure sensor to continuously monitor intrauterine pressure during hysterosalpingogram (HSG) in a cross-sectional study that enrolled women having HSGs for any indication. The primary outcome was the peak intrauterine pressure compared between women with BTO and TP as verified by HSG. RESULTS We enrolled 150 subjects, of which 111 (74.0%) provided usable pressure readings. Of these, 98/111 (88.3%) had TP, and 13 (11.7%) had BTO. There was no difference in peak intrauterine pressure for subjects with TP (mean 293.8±58.7 mmHg) compared to those with BTO (292.7±71.3 mmHg, p=.95). Among parous women, peak intrauterine pressure in subjects with BTO (311.9±78.0 mmHg) was higher but not significantly different from subjects with TP (282.7±49.2 mmHg, p=.20). In linear regression analysis, peak intrauterine pressure was not associated with age, body mass index, gravidity or having at least one prior live birth. CONCLUSIONS Measurement of peak intrauterine pressure does not distinguish between women with patent and blocked fallopian tubes. This approach would not be clinically useful to verify occlusion following permanent contraception. IMPLICATIONS Peak intrauterine pressure does not differ between women with patent and occluded fallopian tubes and cannot be used to confirm tubal occlusion after nonsurgical permanent contraception.
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Affiliation(s)
- Eva Patil
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA.
| | - Amy Thurmond
- Womens Imaging & Intervention, 17050 Pilkington Rd, Suite 130, Lake Oswego, OR 97035, USA
| | - Alison Edelman
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Rongwei Fu
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - William Lambert
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jacqueline Seguin
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jeffrey T Jensen
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
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Callahan RL, Kopf GS, Strauss JF, Tworoger SS. Tubal contraception and ovarian cancer risk: a global view. Contraception 2017; 95:223-226. [DOI: 10.1016/j.contraception.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/09/2016] [Accepted: 09/04/2016] [Indexed: 12/15/2022]
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Jensen JT, Hanna C, Yao S, Thompson E, Bauer C, Slayden OD. Transcervical administration of polidocanol foam prevents pregnancy in female baboons. Contraception 2016; 94:527-533. [PMID: 27421766 PMCID: PMC5083254 DOI: 10.1016/j.contraception.2016.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 07/06/2016] [Accepted: 07/10/2016] [Indexed: 12/01/2022]
Abstract
Background Our objective was to conduct a pilot study to determine if transcervical administration of polidocanol foam (PF) with or without doxycycline or benzalkonium chloride (BZK) would prevent pregnancy in baboons. Methods In study phase 1, adult cycling baboons underwent a hysterosalpingogram to evaluate tubal patency prior to transcervical infusion of 20 mL of 5% PF followed by 1 mL of saline containing 100 mg doxycycline (5%/doxy; n=5), 3% PF plus doxycycline (3%/doxy; n=4), 3% PF with 0.01% BZK (3%/BZK; n=4) or no additional treatment (control; n=9). Immediately following treatment, animals received intramuscular depot medroxyprogesterone acetate (DMPA, 2 mg/kg) to suppress cyclicity during healing and were then socially housed with males of proven fertility. The primary outcome was pregnancy within six cycles of resumption of menses (efficacy phase 1). During study phase 2, PF-treated females from study phase 1 contributed additional cycles (6–8) of exposure (efficacy phase 2), and 5 control females who had recovered from medical abortion (after study phase 1 pregnancy) were subsequently treated with 5% PF (with DMPA) and exposed to breeding (efficacy phase 1; n=3 six cycles, n=2 five cycles). Results All females resumed normal menstrual cycles and mating activity after DMPA. During efficacy phase 1, 7/9 (78%) control females became pregnant. In contrast, fewer pregnancies occurred in PF-treated females: 5% PF 0/5 (0%), 5%/doxy 1/5 (20%), 3%/doxy 1/4 (25%) and 3%/BZK 1/4 (25%). During efficacy phase 2, only one additional pregnancy occurred (3%/BZK). Conclusions A single transcervical treatment with 5% PF prevented pregnancy in most baboons. Cotreatment with doxycycline or BZK did not improve results. Implications Transcervical intrauterine administration of PF resulted in a high rate of tubal occlusion with prevention of pregnancy; refinements are needed to increase the contraceptive rate following a single treatment to near 100%.
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Affiliation(s)
- Jeffrey T Jensen
- Department of Obstetrics & Gynecology, Oregon Health & Science University (OHSU), Portland, OR; Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR.
| | - Carol Hanna
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
| | - Shan Yao
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
| | - Emily Thompson
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
| | | | - Ov D Slayden
- Department of Obstetrics & Gynecology, Oregon Health & Science University (OHSU), Portland, OR; Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR
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Slayden OD, Lee DO, Yao S, Jensen JT. Polidocanol induced tubal occlusion in nonhuman primates: immunohistochemical detection of collagen I-V. Contraception 2016; 94:521-526. [PMID: 27417518 PMCID: PMC5083255 DOI: 10.1016/j.contraception.2016.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/28/2016] [Accepted: 07/05/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Intrauterine administration of polidocanol foam (PF) can create fallopian tube occlusion in nonhuman primates. The objective of this study was to determine if PF-induced tubal obstructions contain collagen in the extracellular matrix. STUDY DESIGN We compared tissue samples of the intramural fallopian tube obtained from previous studies evaluating the effects of intrauterine infusion of 5% PF 2-12 weeks after treatment. Serial sections of the intramural portion of the fallopian tube obtained from representative treated (rhesus macaques, n=7; baboon, n=11) and untreated control (macaque, n=3; baboon, n=5) animals were stained with hematoxylin and eosin to identify tubal occlusion and by immunohistochemistry for collagens Col-I, Col-III and Col-IV. Descriptive results are summarized. RESULTS Control animals exhibited histologically normal fallopian tubal epithelium with no staining for Col-1, light staining for Col-III and Col-V in the lamina propria and Col-IV distributed evenly in the extracellular matrix of the lamina propria. Treatment with PF resulted in acute tissue damage confined to the intramural tube; no epithelial damage or occlusion occurred in the tubal isthmus or ampulla. Blockade of the intramural tube demonstrated fibrosis with the epithelium replaced with extracellular matrix that stained strongly for Col-I, Col-III, Col-IV and Col-V. Col-II was undetectable. CONCLUSION Tubal blockage induced by PF resulted in loss of normal epithelium and accumulation of collagens Col-I, Col-III, Col-IV and Col-V at the site of obstruction. The presence of dense collagen staining supports the hypothesis that PF infusion creates lasting tubal obstructions. IMPLICATIONS This study demonstrates that PF-induced tubal occlusion results in deposition of collagens suggesting the potential for a more lasting blockade. The structural nature of this occlusion supports the development of intrauterine administration of PF as a nonsurgical method of permanent contraception.
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Affiliation(s)
- Ov D Slayden
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, 97006, USA; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, 97239, USA.
| | - Dong Ock Lee
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, 97006, USA; Center for Uterine Cancer, National Cancer Center, Gyeonggi-do, 410-769, Republic of Korea
| | - Shan Yao
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, 97006, USA
| | - Jeffrey T Jensen
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR, 97006, USA; Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, 97239, USA
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Abstract
PURPOSE OF REVIEW Permanent methods are the most commonly used contraceptive options worldwide. Even with the increase in popularity and accessibility of long-acting reversible methods, there remains high demand for permanent options, especially among women in developing countries. RECENT FINDINGS Traditional methods of permanent contraception, such as postpartum tubal ligation and interval surgical tubal occlusion or electrocautery by mini-laparotomy or laparoscopy are well tolerated and highly effective. Bilateral total salpingectomy for ovarian cancer risk reduction is currently being investigated. Hysteroscopic tubal occlusion reduces or eliminates the need for anesthesia, but requires surgical training and specialized equipment. Alternative permanent contraception methods are being explored including immediately effective hysteroscopic methods, and nonsurgical permanent contraception methods that have the potential to improve access and reduce cost. SUMMARY Permanent contraception methods are an important part of the contraceptive methods mix designed to meet the needs of women who have completed desired family size or wish never to become pregnant. Current surgical approaches to permanent contraception are well tolerated and highly effective. The development of a highly effective nonsurgical approach could simplify the provision of permanent contraception.
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Affiliation(s)
- Eva Patil
- Oregon Health & Science University, Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, (503) 418 4500
| | - Jeffrey T. Jensen
- Oregon Health & Science University, Department of Obstetrics and Gynecology, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, (503) 418 4500
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Conceptualizing risk and effectiveness: a qualitative study of women’s and providers’ perceptions of nonsurgical female permanent contraception. Contraception 2015; 92:128-34. [DOI: 10.1016/j.contraception.2015.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/01/2015] [Accepted: 03/02/2015] [Indexed: 11/19/2022]
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Improvement of stability of polidocanol foam for nonsurgical permanent contraception. Contraception 2015; 92:103-7. [PMID: 26070858 DOI: 10.1016/j.contraception.2015.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/02/2015] [Accepted: 06/03/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Polidocanol foam (PF), used clinically as a venous sclerosant, has recently been studied as a safe and inexpensive means for permanent contraception. Delivering the sclerosant to the fallopian tubes as a foam rather than a liquid increases the surface areas and thus enhances the desired epithelial disrupting activity of the agent. However, the foam is inherently unstable and degrades with time. Therefore, increasing foam stability and thus duration of the agent exposure time could increase epithelial effect while allowing reduction in agent concentration and potential toxicity. MATERIALS AND METHODS We studied methods to improve foam properties that might improve safety and efficacy of PF for intrauterine application. Several types of microporous filters adapted to a syringe-based foaming device were used to study the effect of pore structures on the formation of PF. The foam drainage time and bubble size were characterized. The addition of benzalkonium chloride (BZK) to polidocanol was also investigated for its effects on foam characteristics. RESULTS A syringe-based foaming device adapted with an inline filter produced smaller bubble PF with a longer foam drainage time. PF generated with a circular pore filter lasts longer than with a noncircular pore filter. The addition of 0.01% of BZK also improved the stability of PF. CONCLUSION The stability of PF is affected by the pore characteristics of the filter used for foam generation and enhanced by the presence of a small amount of BZK. The improved foam, if shown to be efficacious in animal models of contraception, could lead to a safe, simple and inexpensive method alternative to surgical contraception.
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Jensen JT, Hanna C, Yao S, Bauer C, Morgan TK, Slayden OD. Characterization of tubal occlusion after transcervical polidocanol foam (PF) infusion in baboons. Contraception 2015; 92:96-102. [PMID: 26070857 DOI: 10.1016/j.contraception.2015.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/02/2015] [Accepted: 06/02/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Our long-term goal is to develop a nonsurgical method of fallopian tubal occlusion for the purpose of permanent contraception. We have previously demonstrated that transcervical administration of 5% polidocanol foam (PF) can create tubal occlusion in macaques but that multiple treatments are required. In this study, we assessed the efficacy of various regimens of PF with and without depomedroxyprogesterone acetate (DMPA) (to control ovarian cycle phase) in the baboon. STUDY DESIGN Adult cycling female baboons were evaluated for tubal patency by hysterosalpingography and then received a transcervical infusion of PF with (+) or without (-) an intramuscular injection of DMPA (3.5 mg/kg). Two concentrations of PF were compared: 1% [(+) DMPA, n=5; (-) DMPA, n=3] and 5% [(+) DMPA, n=4; (-) DMPA, n=3]. Controls received (+) DMPA (n=2) or (-) DMPA, (n=3) only. The reproductive tracts were removed 1-3 months after treatment for examination. RESULTS No fallopian tubal occlusion was observed in negative controls (±DMPA). Histologic complete tubal occlusion was observed in 3/8 of females treated with 1% PF and in 6/7 treated with 5% PF. Histologic evaluation suggested that 1% PF is associated with prolonged chronic inflammation (more than 2-3 months), while 5% treatment eliminates the epithelial lining, at least focally, and resolves into complete occlusion within 1-2 months. This pattern of complete occlusion was seen in all 4 females that received 5% PF (+DMPA) and in 2/3 that received 5% PF (-DMPA). CONCLUSION In a baboon model of transcervical permanent contraception, a single treatment with 5% PF resulted in complete tubal occlusion more reliably (85%) than 1% PF (38%). Cotreatment with DMPA may improve treatment results with 5% PF but requires additional study. IMPLICATIONS A finding that a single transcervical treatment with 5% PF can occlude the fallopian tubes of baboon supports further study of this approach as a novel strategy for permanent contraception for women.
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Affiliation(s)
- Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA; Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA.
| | - Carol Hanna
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Shan Yao
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Cassondra Bauer
- Southwest National Primate Research Center, San Antonio, TX 78227, USA
| | - Terry K Morgan
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA; Department of Pathology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Ov D Slayden
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA; Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA
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Liechty ER, Bergin IL, Bell JD. Animal models of contraception: utility and limitations. Open Access J Contracept 2015; 6:27-35. [PMID: 29386922 PMCID: PMC5683139 DOI: 10.2147/oajc.s58754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Appropriate animal modeling is vital for the successful development of novel contraceptive devices. Advances in reproductive biology have identified novel pathways for contraceptive intervention. Here we review species-specific anatomic and physiologic considerations impacting preclinical contraceptive testing, including efficacy testing, mechanistic studies, device design, and modeling off-target effects. Emphasis is placed on the use of nonhuman primate models in contraceptive device development.
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Affiliation(s)
| | | | - Jason D Bell
- Program on Women's Health Care Effectiveness Research, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
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Harrington EK, Gordon D, Bahulekar P, Garg BS, Osgood-Roach I, Jensen JT, Aengst J. Interest in nonsurgical female permanent contraception among men in Portland, Oregon and eastern Maharashtra, India. Contraception 2015; 92:135-8. [PMID: 25769440 DOI: 10.1016/j.contraception.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 03/04/2015] [Accepted: 03/05/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We examined the men's attitudes and perceptions toward the concept of female nonsurgical permanent contraception (NSPC) or novel approaches to permanent contraception (PC) that do not require incisions or surgical equipment/hysteroscope. STUDY DESIGN Cross-sectional survey of married/partnered men in Portland, OR, and rural eastern Maharashtra, India. Descriptive analysis was performed. RESULTS In India (N=150), most men (80%) anticipated that their partners would undergo PC in the future, compared to 30% in Portland (N=170). About a third (39.6% in India, 82% in Portland) reported being uncomfortable with PC for partners due to the need for surgery. Most men (85% in India, 82% in Portland) expressed a preference for a hypothetical new method of female NSPC over surgery, if safe and effective. CONCLUSION Most men sampled in two diverse settings expressed interest in NSPC for women. IMPLICATIONS Men's perceptions of new female contraceptive methods are important to the contraceptive development process. Men may find a safe and effective nonsurgical method of permanent female contraception more acceptable than surgical PC.
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Affiliation(s)
- Elizabeth K Harrington
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Mail Code L466, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Diana Gordon
- Oregon National Primate Research Center, 1505 Northwest 185th Avenue, Beaverton, OR 97006, USA
| | - Pramod Bahulekar
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha 442102, Maharashtra, India
| | - B S Garg
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha 442102, Maharashtra, India
| | - Isabel Osgood-Roach
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Mail Code L466, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
| | - Jeffrey T Jensen
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Mail Code L466, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA; Oregon National Primate Research Center, 1505 Northwest 185th Avenue, Beaverton, OR 97006, USA
| | - Jennifer Aengst
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Mail Code L466, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA; Department of Anthropology, Portland State University, PO Box 751, Portland, OR 97207, USA
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The history and current status of fallopian tube pressures - developing alternate methods for confirmation of tubal occlusion. Contraception 2015; 92:124-7. [PMID: 25592081 DOI: 10.1016/j.contraception.2015.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 12/04/2014] [Accepted: 01/05/2015] [Indexed: 11/21/2022]
Abstract
Permanent contraception with hysteroscopic tubal ligation is an increasingly popular choice for women around the world. However, inconveniences associated with the required confirmation test for tubal occlusion can be prohibitive. As new methods of permanent contraception are being investigated, ways of making all aspects of the procedure more accessible and comfortable for women should be considered. Means of examining tubal patency in the infertility population, such as tubal perfusion pressures measured at the time of hysterosalpingogram (HSG), provide inspiration for alternative methods of tubal occlusion confirmation after contraception. Evaluation of intrauterine pressures measured by a manometer attached to an intrauterine balloon catheter could serve as a preliminary tool for verification of tubal occlusion; higher pressures would indicate tubal occlusion and lower pressures would indicate the need for confirmatory HSG. The development and validation of this technique is ongoing and could reduce overall costs and patient burdens associated with the current tubal occlusion confirmation procedure.
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Sitruk-Ware R, Nath A. Applying emerging science to contraception research: implications for the clinic. Expert Rev Endocrinol Metab 2015; 10:115-126. [PMID: 30289046 DOI: 10.1586/17446651.2015.972369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Emerging science will make an important contribution towards the development of improved contraceptives. While long-acting reversible contraceptives remain the most effective method, new user-controlled, mid-acting methods will avoid the need for procedures requiring trained providers. Contraceptives combined with other agents may bring additional health benefits, such as dual protection against both pregnancy and sexually transmitted infections. Emerging research areas in proteomics allowed the discovery of new reproductive targets that may lead to non-hormonal contraceptives for both men and women. Current research objectives include the improvement of existing contraceptive methods, as well as discovery of new materials able to deliver new molecules more specifically to their target without systemic actions.
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Affiliation(s)
| | - Anita Nath
- b 2 Karnataka Health Promotion Trust, Bangalore, India
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