[Response to stress of the MLCu 250 intrauterine device]. / Comportamento a fatica del dispositivo intrauterino MLCu 250.

The study examined the response to stress of a particular type of intrauterine device (MLCu 250) which had already been evaluated due to a supposed tendency to intracavity fragmentation. The study, which was carried out using original equipment specially designed for this experiment, highlights a reduced resistance to mechanical stress in both new IUDs and in those already subjected to several months' use.

[Mechanical resistance of intrauterine devices. Experimental evaluation]. / La resistenza meccanica dei dispositivi intrauterini. Una valutazione sperimentale.

In view of the possible intracavitary breakage of an IUD, an experimental model was created to evaluate resistance to mechanical stress in new IUDs and IUDs which had been used for varying periods (6-12-24 months). The results of the study showed that, in addition to a slight inhomogeneity of the product which is probably due to incorrect industrial manufacturing procedures, there is also a correlation between the risk of breakage and intrauterine ageing which is particularly evident in some IUDS.

[Vaginitis and vaginosis]. / Vaginiti e vaginosi.

Recently, within the wide subject on vaginal phlogosis a new pathology has been included. Owing to its peculiar characteristics, as it is not to be regarded as a vaginitis in the strict sense of the word, it has been identified as anaerobic bacterial vaginosis. The latter proves to be different from most common vaginitis related pathologies as a result of a series of microbiological and clinical patterns that are widely dealt with in this research. Moreover, the author place special emphasis on the diagnostic and therapeutic aspects of vaginosis.

Chlamydial infection and male infertility: an epidemiological study.

Chlamydia-positive genitourinary infections are common causes of male and female infertility. Semen abnormalities are often associated with Chlamydia infections. A large population of male patients, admitted to our clinic for genitourinary infection, were examined for genitourinary pathogens, including Chlamydia, and for semen abnormalities. There were higher abnormalities semen in Chlamydia-infected patients than either non-Chlamydia-infected or healthy controls. Chlamydia therapy by antimicrobial agents improved semen characteristics. Chlamydia infection contributes to seminal fluid abnormalities and probably to male infertility. A search for chlamydial infection is warranted whenever semen abnormalities are noted. An antimicrobial therapy improves semen quality when effective in eradicating Chlamydia.

[Intrauterine contraception in women over 35-years old: comparison between copper and progesterone IUDs]. / La contraccezione intrauterina dopo i 35 anni: confronto tra dispositivi potenziati al rame e al progesterone.

PIP: Lately physicians have become more cautious about dispensing oral contraceptives to their patients aged 35 and older. Therefore, there has been a increase in IUD prescriptions for this age group. Research has also increased to determine which IUD is most effective and which causes fewer side effects. An Italian survey comparing copper and progesterone IUDs provides some of the necessary facts. The survey was conducted on 100 women ages 35 and over (50 with the progesterone and 50 with the copper). Many had previously used IUDs and most had already had children. The doctors expected to find some alterations in the rhythm of the menstrual cycle but found no significant variations. There was, however, a notable difference in the duration of and in the amount of blood flow during the menstrual cycle. Although apparently augmented in both groups, with copper IUDs the flow seems to be more abundant but the prolongation is less, while with the progesterone the duration seems to be prolonged but blood flow is limited. The few episodes that could be described as hemorrhage were found in progesterone users, who complained with greater frequency of white cell loss. The 1st finding was that 86% of the women studied with the copper IUD were able to complete the designated term, while only 76% were able to with progesterone IUDs. Of the 3 pregnancies which did occur (1 of them was ectopic), all were from progesterone IUD users. Hemorrhaging played a role in early removal in some progesterone users and the reduction in the flow quantity caused a tolerance problem in some cases. The only real drawback to the copper IUD is that it causes more pelvic back pain cases. There are no valid reasons indicated for preferring the progesterone IUD. Overall, 96% of the copper IUD users were satisfied while only 70% of those with the progesterone IUDs were satisfied.^ieng

[Clinical experiences with progesterone-releasing IUD]. / Esperienze cliniche con il dispositivo intrauterino potenziato al progesteorne.

PIP: The authors carried out testing on the progesterone--releasing IUD and the results obtained on 120 women (14 nulliparous and 106 multiparous) are similar to those obtained withother devices. Some characteristics appear to be of a positive nature (low incidence of metrrorhagia, dysmenorrhea, and pelvic pain). The occurrence of 2 ectopic pregnancies out of 5 seems to suggest more caution in prescribing it, especially for the nulliparous woman. (author's modified)^ieng

[Steroid intra-uterine contraception: progesterone-releasing devices. II. Insertion, clinical problems and contraceptive dependability]. / Contraccezione intrauterina steroidea. Dispotivi liberanti progesterone. II. Inserzione, problemi clinici e sicurezza contraccettiva.

PIP: The advantages and disadvantages of the progesterone-releasing intrauterine device (IUD), Progestasert, are investigated, relying on the published literature and the authors' own experiences. Insertion of the Progestasert presents very few problems except in certain cases, particularly in nulliparous women. A complete gynecologic examination is indispensible before insertion to guarantee the absence of contraindications (e.g., pregnancy, anatomically abnormal uterus, tumors, pelvic inflammatory disease, acute cervicitis). Pain or discomfort at insertion appears infrequently, except among nulliparas. Similarly, pain after insertion is rare, but occurs most often in nulliparous women. Because of the insertion technique required for this IUD, cases of perforation of he uterus or cervix are virtually nonexistent. Expulsion of the Progestasert is very infrequent; it appears that incorrect insertion is the primary cause of expulsion. All studies verify a decrease in the expulsion rate after the 1st month of use. The incidence of pelvic inflammatory disease in Progestasert users is significantly lower than in users of other IUDs. This may be due, in part, to the shape of the device, which does not have wide surface areas and has no sharp or pointed edges which can become embedded in the endometrial wall. Additionally, the nature of the insertion device, guaranteeing lack of contact between the transverse arm of the IUD and the vagina, assures the sterility of the IUD even at the moment of introduction into the uterus, limiting the transport of bacteria into the cavity. Lack of sufficient data on ectopic pregnancies in Progestasert users impedes a complete evaluation and definition of the problem with this particular device. One of the most frequent reasons for discontinuing use of the IUD is distrubance of the menstrual cycle. Increase in menstrual blood loss, prolongation of the menstrual period, and intermenstrual bleeding are disturbances found in users of most IUDs. The Progestasert, however, appears to decrease menstrual bleeding and shorten the menstrual period in all cases. The advantages of the Progestasert are indisputable in treating dysmennorhea. All studies agree on the attributes of topical release of progesterone in treating this illness. Studies report disappearance of symptoms in 35% of dysmennorheic patients and a marked reduction of symptoms in 65%. Not enough data exist to draw any conclusions about the teratogenic action of the Progestasert. In normal pregnancies, however, natural progesterone is found in much higher levels than that released by the IUD. Theoretically, the hormone released by the IUD should not interfere with normal fetal development. The failure rate of Progestasert is equal to or lower than that of other IUDs. Overall, the Progestasert represents a remarkable improvement over conventional IUDs.^ieng

Levels of HCG in subjects using the Progestasert(TM) intrauterine progesterone systems.

Twelve subjects using the intrauterine progesterone system were followed during 4 consecutive menstrual cycles for FSH, LH, hCG and progesterone levels. They were all multiparous, with documented ovulation and sexually active even during the ovulatory period. With the exception of one case which became pregnant, there was no evidence for the presence of hCG during the period of observation. This data, even if preliminary, suggest that the Progestasert(TM) exerts a contraceptive action which differs from that of other devices, whether medicated or not, and that, such action occurs at a stage early enough to prevent the formation of hCG.

PIP: This study measured levels of human chorionic gonadotropin (hCG) in women using a Progestasert IUD system to determine the IUD mode of action. Though it is known that this IUD system acts locally, the mechanism of the local action was not known. 12 volunteers (aged 25-35 years and multiparous) who were sexually active were admitted to the study. Hormonal profiles were routinely obtained after IUD insertion. During the observation period, all subjects showed ovulatory levels of luteinizing hormone and follicle stimulating hormone peaks followed by increased progesterone levels. 11 of 12 cases showed no evidence of hCG. The 12th subject, who was diagnosed as pregnant subsequently, showed detectable levels of hCG on Day 25 of the cycle. Apparently, unlike other IUDs, medicated or not, this system acts locally before implantation, for hCG becomes measureable 6-7 days after fertilization.

[Considerations about 548 insertions of IUD at the Family Planning Center of the University of Rome (authors transl)]. / Considerazioni su 548 inserzioni di IUD presso il centro de planificazione familiare dell'universita di Roma.

PIP: Detailed analysis of 365 patients accounting for a total of 5518 months of IUD use, revealed 11 pregnancies, 29 expulsions, and 24 medical removals. There was also a not negligible number of removals for personal reasons, but of 151 patients who completed the treatment, 115 asked for reinsertion of a new IUD. (Author's modified)^ieng