Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and periopera...Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.展开更多
Objective:To explore the experiences of contraceptive use,reasons for discontinuation,and future intent to use modern contraceptives among married men in West Bengal,India.Methods:A community-based cross-sectional qua...Objective:To explore the experiences of contraceptive use,reasons for discontinuation,and future intent to use modern contraceptives among married men in West Bengal,India.Methods:A community-based cross-sectional qualitative study was conducted among married men(n=10),aged 18 to 50 years by in-depth face-to-face interviews using a predesigned interview guide.The results were transcribed,coded and analysed recognising major themes.Results:The study identified the following themes as a rationale for men’s limited involvement in contraception:insufficient knowledge and education about contraception,cultural and religious barriers,misconceptions,economic hardships,gender-based disparities,and a shortage of male healthcare workers,along with a reluctance to seek help.Limited overall awareness about the specific role of men in reproductive health was also believed to hinder men's meaningful involvement in fertility regulation issues.Conclusions:Several challenges are identified among married males related to effective contraception use and the findings emphasize the importance of comprehensive education,culturally sensitive strategies,and improving access and affordability of contraceptives to overcome such barriers.These steps are essential for enabling informed reproductive health decisions and improving reproductive health outcomes.展开更多
AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google S...AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period （within 10 min）, early post placenta period （10 min to 72 h）, and de-layed/interval period （greater than 6 wk）. Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS： IUD insertion in the immediate postpartum （within 10 min of placental delivery）, early postpartum （10 min up to 72 h） and Interval/Delayed （6 wk onward） were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal （copper） IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION： IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.展开更多
In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic sta...In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.展开更多
The vas deferens is a site which can be exploited for male contraception without undue side effects. The only ef-fective technique available for male contraception is vasectomy, being practiced world wide, despite tha...The vas deferens is a site which can be exploited for male contraception without undue side effects. The only ef-fective technique available for male contraception is vasectomy, being practiced world wide, despite that it is a perma-nent surgical procedure and its successful reversal is not assured. Although no-scalpel vasectomy minimizes surgicalprocedures, the fate of its reversal is akin to that of vasectomy. Several occlusive and non-occlusive vasal procedureswhich claim to be reversible without surgical intervention, possess more disadvantages than advantages. Vas occlusionwith plug, ' Shug' or medical grade silicone rubber, although claimed to produce reversible azoospermia without affect-ing spermatogenesis, requires skilled microsurgery for their implantation and later removal. RISUG^R, a non-scleroticpolymer styrene maleic anhydride (SMA), could be more advantageous than vasectomy and other vas occlusive proce-dures in that it could be a totally non-invasive procedure by 'no-scalpel injection' and 'non-invasive reversal'. It isclaimed to offer long-term contraception without adverse side effects and also to be possible as a male spacing methodby repeated vas occlusion and non-invasive reversal. The drug is currently under multicentre Phase Ⅲ clinical trial.展开更多
Objective: To give an historical record of the research of the World Health Organization (WHO) Task Force to develop methods of male contraception; to examine the social, political, medical, pharmaceutical, funding, a...Objective: To give an historical record of the research of the World Health Organization (WHO) Task Force to develop methods of male contraception; to examine the social, political, medical, pharmaceutical, funding, and other factors that influenced progress; and to suggest reasons why such methods are only now becoming available. Design: Review of basic and clinical research over 30 years. Setting: Task force of a multinational agency and collaborating agencies. Conclusion(s): Through the involvement of many international scientists, the WHO Task Force has uniquely contributed to the exploratory phases of the research in male contraception and by its multicenter contraceptive efficacy studies has accelerated progress towards the ideal hormonal method. Despite an adverse climate involving social and political attitudes, funding constraints, and pharmaceutical industry hesitations, WHO formed coalitions with governments and international agencies to sustain research with results that apply to men in culturally diverse populations and thereby to influence activities across the whole range of global reproductive health and family planning.展开更多
The induction of infertility in males of several species through epididymal interference is more difficult to achieveby reduction of the mounts of epididymal secretions (eg α-glucosidase, L-carnitine) or immunologica...The induction of infertility in males of several species through epididymal interference is more difficult to achieveby reduction of the mounts of epididymal secretions (eg α-glucosidase, L-carnitine) or immunological interferencewith secreted proteins ( eg D/E, P34H, P26h) than by direct actions of drugs on sperm function (eg inhibition ofglyceraldehyde 3-phosphate dehydrogenase by chloro-compounds). The latter approach holds promise for mankind ashuman sperm are susceptible to glycolytic inhibition. Future contraceptive developments may arise from production oftargeted inhibitors, research on the displacement of sperm proteins in the epididymis and interference with sperm plasmamembrane ion channels.展开更多
Aim: To explore the causes of the difference in spermatogenic suppression between responders and non-responders in Chinese men treated with levonorgestrel (LNG) implants plus testosterone undecanoate (TU) injectable. ...Aim: To explore the causes of the difference in spermatogenic suppression between responders and non-responders in Chinese men treated with levonorgestrel (LNG) implants plus testosterone undecanoate (TU) injectable. Methods: The 16 Chinese volunteers treated were divided into two groups in regard to the sperm count during the treatment period, 7 men in the responder group (Group R), including 6 azoospermia and one severe oligozoospermia, and the remaining 9 in the non-responder group (Group N), including 4 oligozoospermia and 5 with sperm counts greater than 20×106/mL. The differences in serum profiles of FSH, LH, T, LNG and T/LH ratio were compared between the two groups and the correlation between the seminal fluid parameters and serum reproductive hormones was analyzed. Results: The serum FSH level was lower in Group R than that in Group N (P<0.05), while the serum LH and LNG levels were higher in Group R than those in Group N (P<0.05). The sperm density (P<0.01, r=0.235), motility (P<0.01, r=0.326) and vitality (P<0.01, r=0.219) showed significantly positive correlation with the serum FSH level. Conclusion: The blood LNG and T levels, the degree of FSH inhibition and/or the sensitivity of the pituitary-testis axis to exogenous steroids, as well as the individual spermatogenetic potential and the functional status of the Leydig cells may be factors bringing about individual differences in spermatogenic suppression in Chinese men treated with LNG and TU.展开更多
The methods devised for male contraception are meagre. In the crrrent communication, we review 3 recently de-veloped methods applied for male contraception: testicular suspension, polyester-induced azoospermia and pro...The methods devised for male contraception are meagre. In the crrrent communication, we review 3 recently de-veloped methods applied for male contraception: testicular suspension, polyester-induced azoospermia and prolactin in-jection. The testicle was suspended in the superficial inguinal pouch close to the scrotal neck using 2 methods: stitchand ball. The azoospermic effect of the polyester sling seems to be due to 1) creation of electrostatic field across theintrascrotal structures, and 2) disordered thermoregulation. Prolactin administration, as a contraceptive method is effi-cient and safe and has the potential to be developed as a male contraceptive. The effect of the above mentioned 3methods is reversible. These methods, especially testicular suspension and polyester suspensors, are simple and easilyapplicable and were well acceptable by the subjects. (Asian J Androl 1999 Dec; 1: 161 - 167)展开更多
Objective To assess perception and level of proper utilization of emergency contraception （EC） among female undergraduates. Methods Cross-sectional questionnaire study was performed on 383 female undergraduates in N...Objective To assess perception and level of proper utilization of emergency contraception （EC） among female undergraduates. Methods Cross-sectional questionnaire study was performed on 383 female undergraduates in Nigeria in June 2006. Data analysis was with Z-square test and logistic regressions （P 〈O. 05）. Results One hundred and five （48.2%） had been sexually exposed. Only 32 （30.5%） used regular contraception. Seventy-three （24.3%）female undergraduates were aware of EC. Only 29 （7.6%） had used EC before. Most would not use emergency contraceptive drugs in future due to lack of awareness （64.8%）, and fear for future fertility and of drugs being injurious to health. Use of EC was associated with awareness of correct interval for use （OR=9.1; 95%CI： 2.1-39.9）. Conclusion There is poor knowledge about EC and poor use, while significant need remains. Most knowledge was acquired from peers and inaccurate. Peer educators are important and professionals＇ knowledge needs improvement.展开更多
The study aimed to evaluate reversal of short- and long-term vas occlusion with reversible inhibition of sperm under guidance （RISUG） using dimethyl sulfoxide （DMSO） and sodium bicarbonate （NaHCO3） in male rabbi...The study aimed to evaluate reversal of short- and long-term vas occlusion with reversible inhibition of sperm under guidance （RISUG） using dimethyl sulfoxide （DMSO） and sodium bicarbonate （NaHCO3） in male rabbits （Oryctolagus cuniculus）. Animals were divided into seven groups containing five animals each. Fortnightly, semen analysis revealed that sperm concentration and output steadily declined after vas occlusion and complete azoospermia was attained at 30-60 days postinjection. Spermatozoa reappeared at 60-75 days of reversal and normozoospermia was noticed between 135 days and 150 days in the reversal groups. All spermatozoa were found nonmotile prior to azoospermia and a gradual recovery in sperm motility was observed between 105 days and 135 days of reversal. A significant decline in viability of sperms was noticed during vas occlusion up to 30-60 days which recovered at 60-75 days postreversal and normalized by 75-105 days in the reversal groups. A significant enhancement in the sperm abnormalities was recorded in all vas occluded animals as well as those in initial periods of reversal. Other parameters, namely, semen volume, ejaculation time, pH, color, and consistency, remained unaltered during all phases of the study. Fertility test, at the intervals of 15 days, demonstrated that animals exhibited complete sterility during the entire period of vas occlusion. A gradual recovery in fertility was observed with the appearance of spermatozoa following vas occlusion reversal and 100% fertility was observed following 135-150 days of reversal. F, progeny of reversed animals was found normal. The results suggest that reversal with DMSO or NaHCO3 is feasible, with normal progeny, following short- and long-term contraception.展开更多
Aim： To analyze factors influencing the efficacy of hormonal suppression of spermatogenesis for male contraception. Methods： A nested case-control study was conducted, involving 43 subjects, who did not achieve azoo...Aim： To analyze factors influencing the efficacy of hormonal suppression of spermatogenesis for male contraception. Methods： A nested case-control study was conducted, involving 43 subjects, who did not achieve azoospermia or severe oligozoospermia when given monthly injections of 500 mg testosterone undecanoate （TU）, defined as partial suppressors compared with 855 subjects who had suppressed spermatogenesis （complete suppressors）. Sperm density, serum testosterone, luteinizing hormone （LH） and follicle stimulating hormone （FSH） concentrations at the baseline and the suppression phase were compared between partial and complete suppressors. Polymorphisms of androgen receptor （AR） and three single nucleotide variants and their haplotypes of FSH receptor （FSHR） genes determined by polymerase chain reaction （PCR） and DNA sequencing technique were compared between 29 partial and 34 complete suppressors. Results： Baseline serum LH level was higher and serum LH as well as FSH level during the suppression phase was less suppressed in partial suppressors. Additionally, in a logistic regression analysis larger testis volume, higher serum FSH concentrations alone, or interaction of serum LH, FSH, testosterone and sperm concentrations were associated with degree of suppression. The distribution of polymorphisms of AR or FSH receptor genes did not differ between partial and complete suppressors. In cases with incomplete FSH suppression （FSH 〉 0.2 IU/L）, the chances of reaching azoospermia were 1.5 times higher in the subjects with more than 22 CAG triplet repeats. Conclusion： Partial suppression of spermatogenesis induced by 500 mg TU monthly injections is weakly influenced by hormonal and clinical features but not polymorphism in AR and FSHR genes.展开更多
The cystic fibrosis transmembrane conductance regulator (CFIR) or the small conductance cAMP-activated chlo-ride channel encoded by the CFTR gene has been shown to play an important role in the formation of the epidid...The cystic fibrosis transmembrane conductance regulator (CFIR) or the small conductance cAMP-activated chlo-ride channel encoded by the CFTR gene has been shown to play an important role in the formation of the epididymalfluid microenvironment. Recent work in our laboratory has shown that this protein is also expressed by developing germcells indicating a role of this protein in spermatogenesis. In view of the fact that the CFTR gene has a far reaching andwidespread effect on human reproduction, understanding the role of CFTR in the male reproductive tissues and its inter-vention by pharmacological agents can open a new avenue of research into the development of novel male contracep-tives. (Asian J Androl 2000; 2: 39 - 45 )展开更多
Urokinase-type plasminogen activator （uPA） is closely related to male reproduction. With the aim of investigating the possibility for uPA as a potential contraceptive target, in the present work, Kunming male mice w...Urokinase-type plasminogen activator （uPA） is closely related to male reproduction. With the aim of investigating the possibility for uPA as a potential contraceptive target, in the present work, Kunming male mice were immunized by human uPA subcutaneous injection at three separate doses for 3 times. Then the potency of the anti-human uPA antibody in serum was analyzed, and mouse fertility was evaluated. Serum antibody titers for human uPA in immunized groups all reached 1：10,240 or higher levels by enzyme linked immunosorbent assay, and mating experiments revealed that pregnancy rates and the mean number of embryos implanted after mating declined obviously （P 〈 0.05） when compared with control groups. However, the mating capacity and reproductive organ weights had no obvious change, and histological analysis of the testes and epididymides also showed normal morphology for immunized male mice. Sperm function tests suggested that the sperm concentration, sperm viability, sperm motility, and in vitro fertilization rate for the cauda epididymis sperm in uPA-immunized groups were lower than those in the controls （P 〈 0.05）. Together, these observations indicated that subcutaneous injection human uPA to the male mice could effectively reduce their fertility, and uPA could become a new target for immunocontraception in male contraceptive development.展开更多
Objective:To investigate the contraceptive effect of intratesticular injection of chlorhexidine gluconate in dogs and compare it with that of zinc gluconate neutralized with arginine.Methods:Twenty-four sexually matur...Objective:To investigate the contraceptive effect of intratesticular injection of chlorhexidine gluconate in dogs and compare it with that of zinc gluconate neutralized with arginine.Methods:Twenty-four sexually mature male mongrel dogs were randomly divided by replicate into four groups(n=6 per group).GroupⅡreceived intra-testicular injection of 2 mL zinc gluconate(10 mg/mL)neutralized with arginine.GroupⅡreceived intratesticular injection of 2 mL chlorhexidine gluconate(5%w/v).GroupⅢreceived intratesticular injection of 2 mL chlorhexidine gluconate(4%w/v).GroupⅣdid not receive any treatment and served as the control group.Testicular morphometry was conducted on day 0,7,15 and 30 after treatment.Semen was collected and evaluated on day 0 and 30.Data were analyzed using repeated measures analysis of variance.Results:There was no difference in the mean values of various parameters between dogs treated with zinc gluconate and those treated with chlorhexidine gluconate at any of the time points.In dogs treated with zinc gluconate or chlorhexidine gluconate,there was a significant increase in the testicular morphometric parameters on day 7 followed by a significant reduction thereafter(day 15 and 30).In contrast,there was no change in any of the parameters in the control untreated dogs during the course of the study.Compared to the pre-treatment values,the mean scrotal circumference and the mean paired testicular volume and testicular weight on day 30 were significantly lower in the treated dogs.Semen samples collected on day 30 from treated dogs were found to be azoospermic,whereas no change in semen quality was observed in the control untreated dogs.Conclusions:Intratesticular injection of chlorhexidine gluconate(5%w/v and 4%w/v)is equally as effective as zinc gluconate neutralized with arginine for chemical contraception in dogs.展开更多
Objective To calculate unmet need for contraception according to revised definition, mapping the contraception service needs and analyze factors related to the unmet need for contraception in Nusa Tenggara Barat （NTB...Objective To calculate unmet need for contraception according to revised definition, mapping the contraception service needs and analyze factors related to the unmet need for contraception in Nusa Tenggara Barat （NTB）. Methods This research design was cross sectional, using data from Indonesia Demographic and Health Survey 2012. Subjects were from 1 362 household, and were married women aged 15-49 years in NTB Province （685 women）. Calculating method of unmet need for contraception used revised version, and analysis method was univariate, bivariate, and multivariate （Logistic regression）. Results Majority of married women aged 15-49 years in NTB need contraception service （73.1%）. However, it was known that met need for contraception was only 56.0%. Meanwhile, unmet need rate for contraception in NTB was 17.1%, specifically 11.5% for spacing and 5.6% for limiting. Factors contributing to unmet need for contraception in NTB were： household assets at above average （OR=O. 77）, parity of 2-3 children （OR=0. 73）, women with junior high school education level （0R=0.68）, never be visited by health workers （OR=O. 68）. Conclusions Factors that contribute to unmet need for contraception in NTB are household assets, parity, education level and visited by health workers. Government has to prioritize those f our factors in policy intervention and promotion of family planning participation program in NTB.展开更多
Introduction: Emergency contraception is used as an emergency procedure to prevent unintended pregnancy secondary to an unprotected se xual intercourse and method failure. Hence, this study assessed the level of knowl...Introduction: Emergency contraception is used as an emergency procedure to prevent unintended pregnancy secondary to an unprotected se xual intercourse and method failure. Hence, this study assessed the level of knowledge and utilization of emergency contraception among undergraduate regular female students of Hawassa University, south Ethiopia. Methods: An institution-based cross-sectional survey was conducted among female students of Hawassa University in December 2012. Seven hundred seventy six of the students were sampled by using multistage sampling technique. Pretested structured questionnaire was used to collect the data. Results: The majority 719 (92.7%) of female university students ever had sexual intercourse and 17 (2.2%) experienced forced sex. Eight (47%) of these 17 students experienced unintended pregnancy all of which resulted in an induced abortion. Three hundred seventy nine (72.2%) of the respondents had knowledge about emergency contraceptives and only 41 (10.8%) of them had ever used emergency contraceptives;oral contraceptive pills were the most widely used form of all emergency contraceptives 41 (10.8%). Age, marital status and age at menarche were associated with knowledge of emergency contraception;moreover, residence, year of study and experience of forced sex were found to be predictors of emergency contraception utilization. Conclusion: Female university students had been experiencing high rate of unintended sexual practice and pregnancy, low knowledge level and utilization of emergency contraceptives;moreover, they had no youth-friendly access to the services. Therefore, there is a need for collaborated effort to improve service access and scale up their utilization level to prevent unwanted pregnancy.展开更多
After more than half a century of development,the intrauterine contraception(IUD)has become a relatively mature method of contraception and treatment of gynecological diseases.This paper reviewed the development of IU...After more than half a century of development,the intrauterine contraception(IUD)has become a relatively mature method of contraception and treatment of gynecological diseases.This paper reviewed the development of IUDs,different types of IUDs,and some problems due to them,such as bleeding,infection,malposition,dislocation,expulsion,etc.And the causes of clinical side effects,complications,and corresponding treatments of IUDs were overviewed as well.展开更多
Effective regulation of human fertility has global consequences in terms of resource depletion, pollution and pover-ty. Current family planning services predominantly target a female clientele with few significant dev...Effective regulation of human fertility has global consequences in terms of resource depletion, pollution and pover-ty. Current family planning services predominantly target a female clientele with few significant developments in malefertility regulation for over a century. The last two decades have witnessed a gathering interest, initially from the scien-tific community, and laterally from industry, in the development of safe, reliable, reversible methods of contraceptionfor men. This review summarises the methods of male fertility regulation which are currently available and critically ex-amines the published data on novel developments in male hormonal contraception which offer the potential of improvedcontraceptive choice for all in new millennium. (Asian J Androl 2000; 2: 3 - 12)展开更多
文摘Objectives Salpingectomy and tubal ligation are commonly performed for permanent contraception in women.Salpingectomy has been suggested to reduce the risk of ovarian cancer,but its comparative operative and perioperative risks have not been well established.The objective of this study is to compare the peri-and postoperative complications of laparoscopic tubal ligation with those of salpingectomy for permanent contraception.Methods A retrospective review of 49,445 patients who underwent laparoscopic salpingectomy or tubal ligation for permanent contraception between 2017 and 2021 was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program database.Statistical analysis involved t test,chi-square test,and logistic regression analysis with the use of the random forest algorithm.The primary outcomes were perioperative and postoperative complications.Results Of the total cohort,45,307(91.6%)underwent laparoscopic salpingectomy,and 4138(8.4%)received laparoscopic tubal ligation.There were significant differences between the salpingectomy and tubal ligation groups with respect to several demographic characteristics,including age,BMI,minority status,and variations in past medical history.These demographic characteristics were controlled for in the multivariate regression analysis.Salpingectomy had a higher rate of operative and postoperative complications than did tubal ligation(OR=1.78,95%CI:1.46-2.20,p<0.001).Salpingectomy was associated with a greater risk of longer operation time(OR=2.03,95%CI:2.02-2.04,p<0.001),longer hospital stay(OR=5.26,95%CI:4.57-6.09,p<0.001),increased readmission(OR=3.15,95%CI:1.92-5.65,p<0.001),and increased unplanned reoperation(OR=2.42,95%CI:1.32-5.12,p=0.010).In addition,the occurrence rates of organ space surgical site infection(OR=2.68,95%CI:1.21-7.59,p=0.032)and sepsis(OR=3.93,95%CI:1.48-16.02,p=0.020)were significantly greater in the salpingectomy group than in the tubal ligation group.Conclusions Laparoscopic tubal ligation and salpingectomy are both safe and effective procedures for permanent contraception;however,salpingectomy is more likely to be associated with peri-and postoperative complications.These findings may help guide clinical decision-making when selecting the optimal permanent contraception method for women.
文摘Objective:To explore the experiences of contraceptive use,reasons for discontinuation,and future intent to use modern contraceptives among married men in West Bengal,India.Methods:A community-based cross-sectional qualitative study was conducted among married men(n=10),aged 18 to 50 years by in-depth face-to-face interviews using a predesigned interview guide.The results were transcribed,coded and analysed recognising major themes.Results:The study identified the following themes as a rationale for men’s limited involvement in contraception:insufficient knowledge and education about contraception,cultural and religious barriers,misconceptions,economic hardships,gender-based disparities,and a shortage of male healthcare workers,along with a reluctance to seek help.Limited overall awareness about the specific role of men in reproductive health was also believed to hinder men's meaningful involvement in fertility regulation issues.Conclusions:Several challenges are identified among married males related to effective contraception use and the findings emphasize the importance of comprehensive education,culturally sensitive strategies,and improving access and affordability of contraceptives to overcome such barriers.These steps are essential for enabling informed reproductive health decisions and improving reproductive health outcomes.
文摘AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period （within 10 min）, early post placenta period （10 min to 72 h）, and de-layed/interval period （greater than 6 wk）. Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS： IUD insertion in the immediate postpartum （within 10 min of placental delivery）, early postpartum （10 min up to 72 h） and Interval/Delayed （6 wk onward） were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal （copper） IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION： IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.
文摘In the United States, maternal mortality and unintended pregnancy rates are increasing. There are growing disparities in maternal health between indigent, minority women and Caucasian women of higher socioeconomic status. Family planning has long been viewed as a solution to these problems. As reliance on permanent contraception has diminished, timely access to highly effective contraceptive methods, namely long acting reversible contraceptives, which includes the contraceptive hormonal implant and intrauterine device- has become even more important. For women in the United States and abroad, the time of delivery is the one reliable opportunity for women to receive medical care. Consistently, research has shown that providing contraception in the immediate postpartum period is safe, effective, feasible and cost effective. However, misperceptions, lack of supplies, and reimbursement issues combine to defeat attempts to provide the most effective methods of contraception during that hospitalization. We believe that it is time to tackle the problem of unintended and rapid repeat pregnancy using an evidence-based, patient-centered paradigm and to eradicate systemic barriers blocking access to contraceptive methods during hospital stay. This editorial will outline some of the more compelling evidence supporting this move and will provide insights from successful programs.
文摘The vas deferens is a site which can be exploited for male contraception without undue side effects. The only ef-fective technique available for male contraception is vasectomy, being practiced world wide, despite that it is a perma-nent surgical procedure and its successful reversal is not assured. Although no-scalpel vasectomy minimizes surgicalprocedures, the fate of its reversal is akin to that of vasectomy. Several occlusive and non-occlusive vasal procedureswhich claim to be reversible without surgical intervention, possess more disadvantages than advantages. Vas occlusionwith plug, ' Shug' or medical grade silicone rubber, although claimed to produce reversible azoospermia without affect-ing spermatogenesis, requires skilled microsurgery for their implantation and later removal. RISUG^R, a non-scleroticpolymer styrene maleic anhydride (SMA), could be more advantageous than vasectomy and other vas occlusive proce-dures in that it could be a totally non-invasive procedure by 'no-scalpel injection' and 'non-invasive reversal'. It isclaimed to offer long-term contraception without adverse side effects and also to be possible as a male spacing methodby repeated vas occlusion and non-invasive reversal. The drug is currently under multicentre Phase Ⅲ clinical trial.
文摘Objective: To give an historical record of the research of the World Health Organization (WHO) Task Force to develop methods of male contraception; to examine the social, political, medical, pharmaceutical, funding, and other factors that influenced progress; and to suggest reasons why such methods are only now becoming available. Design: Review of basic and clinical research over 30 years. Setting: Task force of a multinational agency and collaborating agencies. Conclusion(s): Through the involvement of many international scientists, the WHO Task Force has uniquely contributed to the exploratory phases of the research in male contraception and by its multicenter contraceptive efficacy studies has accelerated progress towards the ideal hormonal method. Despite an adverse climate involving social and political attitudes, funding constraints, and pharmaceutical industry hesitations, WHO formed coalitions with governments and international agencies to sustain research with results that apply to men in culturally diverse populations and thereby to influence activities across the whole range of global reproductive health and family planning.
文摘The induction of infertility in males of several species through epididymal interference is more difficult to achieveby reduction of the mounts of epididymal secretions (eg α-glucosidase, L-carnitine) or immunological interferencewith secreted proteins ( eg D/E, P34H, P26h) than by direct actions of drugs on sperm function (eg inhibition ofglyceraldehyde 3-phosphate dehydrogenase by chloro-compounds). The latter approach holds promise for mankind ashuman sperm are susceptible to glycolytic inhibition. Future contraceptive developments may arise from production oftargeted inhibitors, research on the displacement of sperm proteins in the epididymis and interference with sperm plasmamembrane ion channels.
文摘Aim: To explore the causes of the difference in spermatogenic suppression between responders and non-responders in Chinese men treated with levonorgestrel (LNG) implants plus testosterone undecanoate (TU) injectable. Methods: The 16 Chinese volunteers treated were divided into two groups in regard to the sperm count during the treatment period, 7 men in the responder group (Group R), including 6 azoospermia and one severe oligozoospermia, and the remaining 9 in the non-responder group (Group N), including 4 oligozoospermia and 5 with sperm counts greater than 20×106/mL. The differences in serum profiles of FSH, LH, T, LNG and T/LH ratio were compared between the two groups and the correlation between the seminal fluid parameters and serum reproductive hormones was analyzed. Results: The serum FSH level was lower in Group R than that in Group N (P<0.05), while the serum LH and LNG levels were higher in Group R than those in Group N (P<0.05). The sperm density (P<0.01, r=0.235), motility (P<0.01, r=0.326) and vitality (P<0.01, r=0.219) showed significantly positive correlation with the serum FSH level. Conclusion: The blood LNG and T levels, the degree of FSH inhibition and/or the sensitivity of the pituitary-testis axis to exogenous steroids, as well as the individual spermatogenetic potential and the functional status of the Leydig cells may be factors bringing about individual differences in spermatogenic suppression in Chinese men treated with LNG and TU.
文摘The methods devised for male contraception are meagre. In the crrrent communication, we review 3 recently de-veloped methods applied for male contraception: testicular suspension, polyester-induced azoospermia and prolactin in-jection. The testicle was suspended in the superficial inguinal pouch close to the scrotal neck using 2 methods: stitchand ball. The azoospermic effect of the polyester sling seems to be due to 1) creation of electrostatic field across theintrascrotal structures, and 2) disordered thermoregulation. Prolactin administration, as a contraceptive method is effi-cient and safe and has the potential to be developed as a male contraceptive. The effect of the above mentioned 3methods is reversible. These methods, especially testicular suspension and polyester suspensors, are simple and easilyapplicable and were well acceptable by the subjects. (Asian J Androl 1999 Dec; 1: 161 - 167)
文摘Objective To assess perception and level of proper utilization of emergency contraception （EC） among female undergraduates. Methods Cross-sectional questionnaire study was performed on 383 female undergraduates in Nigeria in June 2006. Data analysis was with Z-square test and logistic regressions （P 〈O. 05）. Results One hundred and five （48.2%） had been sexually exposed. Only 32 （30.5%） used regular contraception. Seventy-three （24.3%）female undergraduates were aware of EC. Only 29 （7.6%） had used EC before. Most would not use emergency contraceptive drugs in future due to lack of awareness （64.8%）, and fear for future fertility and of drugs being injurious to health. Use of EC was associated with awareness of correct interval for use （OR=9.1; 95%CI： 2.1-39.9）. Conclusion There is poor knowledge about EC and poor use, while significant need remains. Most knowledge was acquired from peers and inaccurate. Peer educators are important and professionals＇ knowledge needs improvement.
文摘The study aimed to evaluate reversal of short- and long-term vas occlusion with reversible inhibition of sperm under guidance （RISUG） using dimethyl sulfoxide （DMSO） and sodium bicarbonate （NaHCO3） in male rabbits （Oryctolagus cuniculus）. Animals were divided into seven groups containing five animals each. Fortnightly, semen analysis revealed that sperm concentration and output steadily declined after vas occlusion and complete azoospermia was attained at 30-60 days postinjection. Spermatozoa reappeared at 60-75 days of reversal and normozoospermia was noticed between 135 days and 150 days in the reversal groups. All spermatozoa were found nonmotile prior to azoospermia and a gradual recovery in sperm motility was observed between 105 days and 135 days of reversal. A significant decline in viability of sperms was noticed during vas occlusion up to 30-60 days which recovered at 60-75 days postreversal and normalized by 75-105 days in the reversal groups. A significant enhancement in the sperm abnormalities was recorded in all vas occluded animals as well as those in initial periods of reversal. Other parameters, namely, semen volume, ejaculation time, pH, color, and consistency, remained unaltered during all phases of the study. Fertility test, at the intervals of 15 days, demonstrated that animals exhibited complete sterility during the entire period of vas occlusion. A gradual recovery in fertility was observed with the appearance of spermatozoa following vas occlusion reversal and 100% fertility was observed following 135-150 days of reversal. F, progeny of reversed animals was found normal. The results suggest that reversal with DMSO or NaHCO3 is feasible, with normal progeny, following short- and long-term contraception.
文摘Aim： To analyze factors influencing the efficacy of hormonal suppression of spermatogenesis for male contraception. Methods： A nested case-control study was conducted, involving 43 subjects, who did not achieve azoospermia or severe oligozoospermia when given monthly injections of 500 mg testosterone undecanoate （TU）, defined as partial suppressors compared with 855 subjects who had suppressed spermatogenesis （complete suppressors）. Sperm density, serum testosterone, luteinizing hormone （LH） and follicle stimulating hormone （FSH） concentrations at the baseline and the suppression phase were compared between partial and complete suppressors. Polymorphisms of androgen receptor （AR） and three single nucleotide variants and their haplotypes of FSH receptor （FSHR） genes determined by polymerase chain reaction （PCR） and DNA sequencing technique were compared between 29 partial and 34 complete suppressors. Results： Baseline serum LH level was higher and serum LH as well as FSH level during the suppression phase was less suppressed in partial suppressors. Additionally, in a logistic regression analysis larger testis volume, higher serum FSH concentrations alone, or interaction of serum LH, FSH, testosterone and sperm concentrations were associated with degree of suppression. The distribution of polymorphisms of AR or FSH receptor genes did not differ between partial and complete suppressors. In cases with incomplete FSH suppression （FSH 〉 0.2 IU/L）, the chances of reaching azoospermia were 1.5 times higher in the subjects with more than 22 CAG triplet repeats. Conclusion： Partial suppression of spermatogenesis induced by 500 mg TU monthly injections is weakly influenced by hormonal and clinical features but not polymorphism in AR and FSHR genes.
文摘The cystic fibrosis transmembrane conductance regulator (CFIR) or the small conductance cAMP-activated chlo-ride channel encoded by the CFTR gene has been shown to play an important role in the formation of the epididymalfluid microenvironment. Recent work in our laboratory has shown that this protein is also expressed by developing germcells indicating a role of this protein in spermatogenesis. In view of the fact that the CFTR gene has a far reaching andwidespread effect on human reproduction, understanding the role of CFTR in the male reproductive tissues and its inter-vention by pharmacological agents can open a new avenue of research into the development of novel male contracep-tives. (Asian J Androl 2000; 2: 39 - 45 )
文摘Urokinase-type plasminogen activator （uPA） is closely related to male reproduction. With the aim of investigating the possibility for uPA as a potential contraceptive target, in the present work, Kunming male mice were immunized by human uPA subcutaneous injection at three separate doses for 3 times. Then the potency of the anti-human uPA antibody in serum was analyzed, and mouse fertility was evaluated. Serum antibody titers for human uPA in immunized groups all reached 1：10,240 or higher levels by enzyme linked immunosorbent assay, and mating experiments revealed that pregnancy rates and the mean number of embryos implanted after mating declined obviously （P 〈 0.05） when compared with control groups. However, the mating capacity and reproductive organ weights had no obvious change, and histological analysis of the testes and epididymides also showed normal morphology for immunized male mice. Sperm function tests suggested that the sperm concentration, sperm viability, sperm motility, and in vitro fertilization rate for the cauda epididymis sperm in uPA-immunized groups were lower than those in the controls （P 〈 0.05）. Together, these observations indicated that subcutaneous injection human uPA to the male mice could effectively reduce their fertility, and uPA could become a new target for immunocontraception in male contraceptive development.
基金funded by Nanaji Deshmukh Veterinary Science University(grant No.B31/Comp/2018-19 Dated 17/07/2018).
文摘Objective:To investigate the contraceptive effect of intratesticular injection of chlorhexidine gluconate in dogs and compare it with that of zinc gluconate neutralized with arginine.Methods:Twenty-four sexually mature male mongrel dogs were randomly divided by replicate into four groups(n=6 per group).GroupⅡreceived intra-testicular injection of 2 mL zinc gluconate(10 mg/mL)neutralized with arginine.GroupⅡreceived intratesticular injection of 2 mL chlorhexidine gluconate(5%w/v).GroupⅢreceived intratesticular injection of 2 mL chlorhexidine gluconate(4%w/v).GroupⅣdid not receive any treatment and served as the control group.Testicular morphometry was conducted on day 0,7,15 and 30 after treatment.Semen was collected and evaluated on day 0 and 30.Data were analyzed using repeated measures analysis of variance.Results:There was no difference in the mean values of various parameters between dogs treated with zinc gluconate and those treated with chlorhexidine gluconate at any of the time points.In dogs treated with zinc gluconate or chlorhexidine gluconate,there was a significant increase in the testicular morphometric parameters on day 7 followed by a significant reduction thereafter(day 15 and 30).In contrast,there was no change in any of the parameters in the control untreated dogs during the course of the study.Compared to the pre-treatment values,the mean scrotal circumference and the mean paired testicular volume and testicular weight on day 30 were significantly lower in the treated dogs.Semen samples collected on day 30 from treated dogs were found to be azoospermic,whereas no change in semen quality was observed in the control untreated dogs.Conclusions:Intratesticular injection of chlorhexidine gluconate(5%w/v and 4%w/v)is equally as effective as zinc gluconate neutralized with arginine for chemical contraception in dogs.
文摘Objective To calculate unmet need for contraception according to revised definition, mapping the contraception service needs and analyze factors related to the unmet need for contraception in Nusa Tenggara Barat （NTB）. Methods This research design was cross sectional, using data from Indonesia Demographic and Health Survey 2012. Subjects were from 1 362 household, and were married women aged 15-49 years in NTB Province （685 women）. Calculating method of unmet need for contraception used revised version, and analysis method was univariate, bivariate, and multivariate （Logistic regression）. Results Majority of married women aged 15-49 years in NTB need contraception service （73.1%）. However, it was known that met need for contraception was only 56.0%. Meanwhile, unmet need rate for contraception in NTB was 17.1%, specifically 11.5% for spacing and 5.6% for limiting. Factors contributing to unmet need for contraception in NTB were： household assets at above average （OR=O. 77）, parity of 2-3 children （OR=0. 73）, women with junior high school education level （0R=0.68）, never be visited by health workers （OR=O. 68）. Conclusions Factors that contribute to unmet need for contraception in NTB are household assets, parity, education level and visited by health workers. Government has to prioritize those f our factors in policy intervention and promotion of family planning participation program in NTB.
文摘Introduction: Emergency contraception is used as an emergency procedure to prevent unintended pregnancy secondary to an unprotected se xual intercourse and method failure. Hence, this study assessed the level of knowledge and utilization of emergency contraception among undergraduate regular female students of Hawassa University, south Ethiopia. Methods: An institution-based cross-sectional survey was conducted among female students of Hawassa University in December 2012. Seven hundred seventy six of the students were sampled by using multistage sampling technique. Pretested structured questionnaire was used to collect the data. Results: The majority 719 (92.7%) of female university students ever had sexual intercourse and 17 (2.2%) experienced forced sex. Eight (47%) of these 17 students experienced unintended pregnancy all of which resulted in an induced abortion. Three hundred seventy nine (72.2%) of the respondents had knowledge about emergency contraceptives and only 41 (10.8%) of them had ever used emergency contraceptives;oral contraceptive pills were the most widely used form of all emergency contraceptives 41 (10.8%). Age, marital status and age at menarche were associated with knowledge of emergency contraception;moreover, residence, year of study and experience of forced sex were found to be predictors of emergency contraception utilization. Conclusion: Female university students had been experiencing high rate of unintended sexual practice and pregnancy, low knowledge level and utilization of emergency contraceptives;moreover, they had no youth-friendly access to the services. Therefore, there is a need for collaborated effort to improve service access and scale up their utilization level to prevent unwanted pregnancy.
基金supported by Beijng Municipal Administration of Hospitals,Ascent Plan[DFL20181401]of China.
文摘After more than half a century of development,the intrauterine contraception(IUD)has become a relatively mature method of contraception and treatment of gynecological diseases.This paper reviewed the development of IUDs,different types of IUDs,and some problems due to them,such as bleeding,infection,malposition,dislocation,expulsion,etc.And the causes of clinical side effects,complications,and corresponding treatments of IUDs were overviewed as well.
文摘Effective regulation of human fertility has global consequences in terms of resource depletion, pollution and pover-ty. Current family planning services predominantly target a female clientele with few significant developments in malefertility regulation for over a century. The last two decades have witnessed a gathering interest, initially from the scien-tific community, and laterally from industry, in the development of safe, reliable, reversible methods of contraceptionfor men. This review summarises the methods of male fertility regulation which are currently available and critically ex-amines the published data on novel developments in male hormonal contraception which offer the potential of improvedcontraceptive choice for all in new millennium. (Asian J Androl 2000; 2: 3 - 12)
