Recent advances in hormonal contraception

Study of the effect of ulipristal acetate on human sperm ability to interact with tubal tissue and cumulus-oocyte-complexes

OBJECTIVE

Ulispristal acetate (UPA) is a selective progesterone receptor modulator widely used for emergency contraception (EC). The described main mechanism of action is by inhibiting or delaying ovulation; however, the postovulatory effects of the drug are still on debate. Therefore, the aim of this study was to determine whether UPA could interfere with human sperm fertilizing ability.

STUDY DESIGN

Human motile spermatozoa were incubated under capacitating conditions with or without UPA, and then used to inseminate human tubal explants, mouse cumulus-oocyte complexes and zona-free hamster eggs. The ability of UPA to interact with human sperm progesterone (P)-binding sites was investigated by incubating the cells with fluorescent-labeled P and analyzing them by fluorescence microscopy.

RESULTS

UPA did not affect the ability of human sperm to bind to human tubal tissue explants surface or to penetrate the mouse cumulus mass and the zona-free hamster eggs. In addition, concentrations of UPA much higher than those present in the plasma of EC pill users were required to bind to human sperm P-binding sites.

CONCLUSIONS

Our study supports a lack of an agonist or antagonist action of UPA on different functional parameters associated with the fertilizing ability of human sperm.

IMPLICATIONS

This study provides new functional evidence supporting that the contraceptive action of UPA is not related to effects on human sperm cells, contributing to a better understanding of the mechanism of action of UPA as EC.

Oral contraception in Denmark 1998-2010

BACKGROUND

Oral contraceptives (OC) are the most popular contraception in Denmark. Overall figures on use are well described, but more detailed use patterns according to type and age need to be updated.

OBJECTIVES

To assess trends in the use of OC including progestogen-only pills among Danish women in 1998-2010 and to describe in detail use patterns in 2010. Design. Annual cross-sectional prescription statistics.

SETTING

Denmark.

POPULATION

Danish women 10-49 years old.

MATERIAL AND METHODS

Analysis of prescription data from the National Registry of Medicinal Products Statistics from 1 January 1998 through 31 December 2010.

RESULTS

Combined OC (COC) with 50 μg estrogen decreased their market share from 3% in 1998 to zero in 2010, and COC with 30-40 μg estrogen decreased to 50% in 2010, in contrast, COC with 20 μg estrogen increased to 46% in 2010. Progestogen-only pills accounted for 4%. COC with levonorgestrel decreased, while the use of pills with desogestrel and gestodene among two-thirds of current users was constant.

CONCLUSION

Low-dose COCs gradually replaced middle-dose pills. Pills with newer progestogens are used primarily by young women, and 85% of users in 2010 were on products with desogestrel, gestodene, drospirenone or cyproteroneacetate. We still need low-dose pills with 1(st) and 2(nd) generation progestogens on the Scandinavian market.