Evaluation of the infertile couple.

Infertility may be caused by gross pelvic pathology, difficulties with insemination of the cervix and uterine cavity, partial or complete occlusion of the fallopian tubes, female endocrine abnormalities or male factors. Some forms of pelvic pathology as well as some tubal occlusions are amenable to surgical correction. Clomiphene citrate has given good results in some patients with endocrine abnormalities.

Oral contraceptives.

Variations in the side chains attached to the gonadal hormones can produce marked changes in the potency of these compounds and can even change their predominant actions. Modification of testosterone renders it less androgenic and greatly enhances its progestational effect. The antifertility action of oral contraceptives may be exerted through any of several mechanisms: supression of follicular development, suppression of ovum expulsion or changes in endometrium or cervical mucus.

The Pap smear: take two.

The results of two "pancervical" Pap smears taken sequentially at the same sitting were evaluated on 2,823 patients in a Family Planning Program as part of a national sample to evaluate abnormal cervical cytology and method of contraception. It was found that obtaining two smears increased the detection of abnormal cytology in these patients by 86 per cent. Every group participating in this national study found a large increase in sensitivity, though not to the degree noted in our population. The importance of this result for case-finding and subsequent rescreening procedures is evident, and emphasizes that the single "pancervical" Pap smear is an insensitive procedure for detecting abnormal cervical cytology.

Fallopian tube occlusion in rabbits with silicone rubber.

A new system for transcervically blocking the Fallopian tubes with cured-in-place silicone rubber has great potential for fertility control. Good retention, antifertility efficacy, and retrievability were observed in rabbits, and no adverse tissue reactions were seen in oviducts containing silicone elastomer. Continuing studies with rabbits and rhesus monkeys attempt to determine long term efficacy and histologic changes.

Effect of abdominal transplanted mammary tumor on peritoneal fluid cytology in mice.

In this study C3H/HeJ female mice received an intraperitoneal injection of mammary tumor suspended in saline; After 14 days, the presence of mammary neoplasm was detected by a significant change in the cytodifferential counts of aspirated peritoneal fluid. Previous studies suggest that ovarian cancer can be detected in mice and in women by the characteristic changes produced in abdominal cellular fluid distribution.

The effect of vasectomy and oviduct section on mouse behavior (38554).

The spontaneous movement of vasectomized adult Swiss Webster male mice was 60% less than sham-operated controls 45 days after the operation. A similar trend was recorded for tubectomized frmales. Exploratory behavior as measured by the open field test was not significantly influenced by either surgical proceedure.

Antifertility and uterine response to polyethylene intrauterine devices in rabbits.

PIP: The uterine effects of polyethylene IUDs were studied in 11 adult female rabbits. 9 implantation sites were observed in the IUD-containing uterine horns, while 39 were observed in contralateral control horns. The implants were located between the ovary and IUD, and the resorptions were found close to the IUD. The white blood cell count of uterine fluid in the IUD horn was about twice that in the control uterine horn, while uterine fluid micro-pH values were slightly lower in IUD-containing horns than in controls. IUD-containing horns had about 50% of the stainable material that controls had. The results suggest that the lytic enzyme freed from the uterine mucosa is insufficient to effect a maximum antifertility response in polyethylene IUD-treated rabbits.^ieng

The antifertility effect and improved tolerance of copper bearing hydrogel coated intrauterine devices in rabbits.

PIP: Polyethylene IUDs covered with hydrogel over copper wire were tested in 20 New Zealand white rabbits. None of the rabbits with copper-bearing hydrogel-coated IUDs became pregnant as compared with 86.6% of the sham-operated controls and 38.5% of those with only hydrogel-coated IUDs. 50% of the hydrogel-coated IUDs with copper were expelled; no fragmentation of either copper or hydrogel was seen. The total white blood cell count in uterine fluid was increased 68.1% by copper-bearing hydrogel-coated IUDs. It is concluded that hydrogel coating of copper IUDs enhances tolerance of the devices, improves the contraception, and reduces the expulsion rate. Copper diffusion from the hydrogel-coated IUD was 37.5 mcg/ml.^ieng

Dysplasia and the pill--a progress report on the American Women's Health Program.

PIP: 25,000 contracepting women attending family planning facilities in 1 3 clinical units in the United States and Puerto Rico have been enrolled in a study to determine the relationship, if any, of method of contraception to cervical dysplasia. Although the investigators are not yet in a position to report on any association or nonassociation, certain aspects of the study are described. Personal characteristics of those patients with dysplasia or cancer of the cervix detected at the time of enrollment will be compared, retrospectively, in the months ahead with the characteristics of the remainder of the cohort. The scope of work involved in defining the "prevalence" cases encompases retesting patients whose enrollment smears were diagnosed cytologically as unsatisfactory, neoplasm uncertain, or mild to moderate dysplasia. T he screening technique of 2 sequential cervical scrapings results in an increase of 50% of cytologically detected cases as compared with a single scrape. Approximately 80% of pill acceptors are 29 years old or less compared with 70% of the IUD users and 50% of the users of other methods. The pill acceptors comprise 51% of the total group, the IUD users, 31%, and users of other methods, 19%. It appears that in this analysis choice of contraception as a possible variable of cervical neoplasia rates will not be confounded with age at first coitus.^ieng

Pharmacophysiologic and clinical aspects of oral contraceptives.

PIP: To date, 2 synthetic estrogens and 8 progestogens have been incorporated in the marketed oral contraceptives (OCs) in the US. At present 21 pills are available representing 14 different estrogen and progestin combinations and 1 minidose progestogen (alone). 2 OCs utilizing substituted progesterone as the progestin component have been withdrawn from the market. All of the OCs now available in the US utilize substituted testosterone as progestins. The trend is toward prescribing low estrogen dose OCs perhaps resulting from the statistical relationship between higher estrogen dose OCs and thromboembolism.^ieng

Antifertility agents: introduction and history.

PIP: The article is a brief historical account of the birth and development of steroidal contraception. Over 400 oral contraceptive agents have been and/or are in use. Attention is called to particular medical writers who have composed excellent historical accounts of the development of the synthetic estrogens and progestins used in commercial and investigative oral contraceptives.^ieng