ABSTRACT
OBJECTIVES: The aim of this study is to determine the number of sperm present in the vagina of women presenting for EC after unprotected intercourse or a condom accident. STUDY DESIGN: A total of 69 women requesting EC were included in a prospective, observational and comparative study. The absence or presence and number of spermatozoa present were examined under light microscopy in endocervical and vaginal smears. An ethinylestradiol-levonorgestrel combination (100 mcg/500 mg for two doses, 12 h apart) was then prescribed. Twenty couples were taken as controls. RESULTS: In 25 (36.2%) of the 69 women, spermatozoa were not observed. In the women in whom sperm could be identified, there were no significant differences in the mean (range) sperm count in relation to the reason for requesting EC, i.e., 11.0 (0.03-149.8) for condom slippage or breakage, and 8.1 (3.9-55) for unprotected intercourse. In the group of controls the median (range) number of spermatozoa (32.5 (2.5-304) was significantly higher (p=0.04) than the observed in the study group. CONCLUSIONS: In one-third of the women presenting for EC, no sperm were identified in the vagina. When sperm were present, the number was much lower than that after intercourse among women wishing to conceive. The risk of an unwanted pregnancy is probably, therefore, lower for women who present for EC compared with that for women who truly have unprotected intercourse.
Subject(s)
Contraception, Postcoital , Semen , Unsafe Sex , Vagina/cytology , Adolescent , Adult , Case-Control Studies , Contraception, Postcoital/statistics & numerical data , Contraceptive Agents, Female/pharmacology , Ethinyl Estradiol/pharmacology , Female , Humans , Levonorgestrel/pharmacology , Pregnancy , Pregnancy, Unwanted/drug effects , Prospective Studies , Sperm Count , Unsafe Sex/statistics & numerical dataABSTRACT
La aplicación creciente de técnicas de reproducción asistida para el tratamiento de la esterilidad ha generado diversos problemas y efectos adversos. Entre ellos, las gestaciones múltiples han, emergido como el más frecuente y uno de los más graves desde el punto de vista médico. Con el fin de evaluar su importancia en nuestro medio, y con el objetivo de diseñar estrategias correctivas, se revisaron los registros correspondientes a las 324 gestaciones producidas en el programa de fecundación in vitro de la Fundació Puigvert-Hospital de la Santa Creu i Sant Pau durante los años 2000 a 2003. La proporción de gestaciones múltiples fue de 41,4% (31,2% gemelares, 9,6% trillizos y 0,6% cuatrillzos) aunque en los años 2002 y 2003 se observó una tendencia a la reducción, como resultado de la aplicación de criterios más estrictos en el número de embriones transferidos. La indicación masculina mostró mayor frecuencia de gestaciones múltiples que otras indicaciones. Las variables clinicas y embriológicas más influyentes en la producción de gestaciones múltiples fueron la edad de la muer; el número de folículos y la dosis (menor) de gonadotropinas usada durante la estimulación, el grosor endometrial, el número de embriones totales obtenidos y transferidos, y la suma de puntuación de la calidad embrionaria. Un modelo de función discriminante seleccionó tres variables (calidad global de los embriones transferidos, edad y grosor endometrial) como mejores predictores de gestación múltiple (sensibilidad 59%, especificidad 76%). En conclusión, sigue siendo necesario reducir el número de embriones transferidos en ciclos de FIV, aunque la inclusión de ciertas variables clínicas y embriológicas mediante algoritmos predictivos, puede facilitar la elección en cada caso individual, con el fin de reducir la prevalencia de gestaciones múltiples sin disminuir la tasa global de embarazos
The increasing application of techniques of assisted reproduction for the treatment of sterility has generated a number of adverse effects. Among them, multiple pregnancies have emerged as the most frequent and serious problem from the medical point of view. With the purpose of evaluating their importance in OUT environment, and with the objective to design corrective strategies, we reviewed the registries corresponding to the 324 gestations produced in the program of fertilization in vitro of the Fundació Puigvert-Hospital de la Santa Creu i Sant Pau during years 2000 to 2003. The proportion of multiple gestations was of 41.4% (31.2% twins, 9.6% triplets and 0.6% quadruplets) althougth in 2002 and 2003 there was a tendency towards a reduction, as a result of the application of stricter criteria in the number of transferred embryos. Male infertility indication showed greater frequency of multiple gestations that other indications. The clinical and embryologic variables that significantly influenced the production of multiple pregnancies were age of the woman, the number of follicles and the (smaller) dose of gonadotrophins used during the stimulation, the endometrial thickness, the number of embryos obtained and transferred and the sum of the scores showing embryonic quality. A discriminant function model selected three variables (global quality of the transferred embryos, age and endometrial thickness) as the best predictors of multiple pregnancy (sensitivity 59% speciftcity 76%). In conclusion, it is necessary to further reduce the number of embryos transferred in cycles of FIV, although the inclusion of certain clinical and embryologic variables by means of predictive algorithms, can facilitate the election in each individual case, with the purpose of reducing the prevalence of multiple gestations without diminishing the global rate of pregnancies
