The GyneFix implant systems for interval, postabortal and postpartum contraception: a significant advance in long-term reversible contraception. International Study Group on Intrauterine Drug Delivery.

Intrauterine contraception has a number of important advantages over other forms of contraception and remains, therefore, an important method of birth control. However, side-effects and other drawbacks have reduced its overall acceptance. Also misconceptions and lack of updated scientific knowledge among the potential users and providers are major obstacles to the widespread use of intrauterine contraception. Ideally, an intrauterine device (IUD) should prevent pregnancy effectively, be well tolerated, not become displaced or expelled over time, cause a minimum of side-effects, be long-lasting, have a strictly local effect, and be easy to insert and remove. A group at the University of Ghent, Belgium, the International Study Group on Intrauterine Drug Delivery, has developed, since 1985, a totally new concept in order to improve current intrauterine contraceptive efficacy and enhance tolerance, by creating a harmonious relationship between the uterine cavity and the contraceptive 'foreign body'. The new concept (GyneFix) consists of a non-biodegradable suture thread made of surgical 00 monofilament polypropylene on which six copper tubes are threaded, providing a total surface area of 330 mm2. The upper and lower tubes are crimped onto the thread to keep the tubes in place. The upper extremity of the thread is provided with a knot which serves as an anchor. The knot is implanted in the myometrium of the uterine fundus with a specially designed insertion instrument, thereby permanently securing the device in the uterine cavity. Since the initial clinical investigations, over 10,000 woman years of experience and up to 10 years' follow-up in international multicenter, non-comparative and comparative clinical trials have been collected. The clinical material also included a large number of nulligravid and nulliparous women. Due to the design characteristics of the GyneFix and its anchoring in the uterine fundus, an optimal tolerance and almost complete absence of expulsion were obtained. The constant release of copper ions in the upper part of the uterine cavity results in the high effectiveness of the anchored device. The effectiveness is higher than in the high-load conventional copper IUDs which have a risk of becoming displaced, partially or totally expelled in 10% or more (nulliparous women), resulting in a significant number of accidental pregnancies. The absence of frame and, as a consequence, its flexibility, explain the low incidence of side-effects and the very low incidence of complications, such as pelvic inflammatory disease and ectopic pregnancies. This new concept could be a major step forward in the acceptance of intrauterine contraception worldwide and increase its popularity. This article reviews the experience with the new concept for interval, postabortal and postpartum contraception.

[Vasectomy through a single scrotal incision. Review of 500 cases. Technical note]. / Vasectomía por incisión única escrotal. Revisión de 500 casos. Nota técnica.

PIP: The authors describe their experience over the past 3 years with 500 vasectomies performed by a single midline scrotal incision. Azoospermia was achieved in all cases in 2-6 months. Complications included 20 cases of granulomas without recanalization, 5 cases of spontaneously reabsorbed hematomas, 3 cases of epididimitis, and 4 of infection of the incision. The ducts are displaced through the incision and sectioned, electrocoagulated, and ligated on each end. The advantages of the method include easier performance and shorter operative time, especially in obese men. The risk of infection and hematomas is reduced because there is only 1 incision. Patients experience less pain. Disadvantages include the possibility of ligating the same duct twice, and of tearing by applying too much force to bring the duct through the incision.^ieng

[New advances in contraception and sterilization]. / Nuevos avances en contracepción y esterilización.

PIP: The advances in contraceptive and sterilization methods likely to be available within the next few years will probably consist of improvements of existing methods rather than revolutionary new techniques. Among female vaginal methods, vaginal sponges incorporating spermicides have been constructed of collagen or polyurethane mixed with nonoxynol 9, and an intravaginal contraceptive device consisting of a biodegradable membrane impregnated with spermicide is under development. The spermicidal capacity of propranolol and the capacity of electrolytes such as bisodium phosphate to render the cervical mucus impenetrable to sperm are under study. A cervical cap with a valve to allow cervical secretions to pass has been tested in 140 volunteers over 26 months without problems. New progestin-releasing IUDs which control infection, menstrual blood loss, and dysmenorrhea, quinacrine-releasing IUDs which induce tubal obstruction, IUDs which release antifibrinolytic substances to control menstrual bleeding, postpartum IUDs designed to resist expulsion, and intracervical devices which release spermicides or produce changes in the cervical mucus are in various stages of development. Tubal occlusion through use of chemical agents such as quinacrine and phenolmucilage has not been totally effective in all cases. Achievement of temporary sterility through insertion of small plugs in the tubal ostium has not yet been perfected enough for clinical trials. A removable device which would surround and obstruct the fimbria but which could be removed whenever desired has given promising preliminary results in animal tests. The only new hormonal agent introduced in recent years that has come into wide use is desogestrel, which has twice the progestational activity of levonorgestrel, less androgenic effect, and a better effect on high density lipoprotein cholesterol when combined with ethinyl estradiol than any other currently used hormonal combination. Promising new delivery systems for hormonal contraceptives include subdermal implants, especially the Norplant system which can be left in place for up to 6 years and has a very low failure rate and good tolerance and continuation rates. Vaginal rings containing levonorgestrel and estradiol have given low pregnancy rates in trials but are not expected to be ready for widespread use in the near future. Several different types of biodegradable delivery systems are under development but it is still too early for an evaluation of their advantages. Analogs of luteinizing hormone releasing hormone including buserelin offer promise for future development of contraceptive methods. Other substances that may potentially be used in contraception include inhibitors of the luteal phase or of steroid synthesis, immunologic agents such as placental and trophoblastic antigens, and newly discovered follicular peptides such as ovulation maturation inhibitor. Male contraceptive agents under development include testosterone, gossypol, LHRH analogs, sperm antigens, and sperm inhibitors of vegetal origin.^ieng

Combined use of copper-T and benzalkonium chloride spermicide.

PIP: The efficacy, tolerance and suitability of the combined use of an IUD and a vaginal spermicide has been studied. The Copper-T IUD was chosen because of the authors' wide experience with this model. The spermicide used was benzalconium chloride (0.0189 g) in the form of vaginal suppositories. 103 women from the outpatient family planning clinic of Hospital Clinico Department of Obstetrics and Gynecology, Barcelona, were selected at random from women who elected to have an IUD. The women had 1-3 children, were engaged in sexual intercourse at least once a week, and were 18-36 years. They were instructed on how the suppositories should be used to achieve maximum efficacy. They were also advised to use suppositories whenever they had sexual intercourse. 57 of the 103 women used combined method for 12 months, 26 used it for 6 months, whereas 17 only completed 3 months of therapy. 14% of the women complained of pruritus or vaginal discomfort while using the suppositories. The women used the method for 1978 months. Using the life tables of Tietze, the failure rate was 0.8/100 women/year at 6 months of use, and 1.6/100 women/year at 12 months.^ieng

[Prolactin secretion in women using IUDs]. / Estudio de la secrecion de prolactina en pacientes portadoras de DIU.

PIP: Prolactin variations in women wearing IUDs (Lippes Loop, Copper T-Device) were evaluated. All had been wearing the devices for at least 6 months. Results are compared to those of a control group during the follicular and luteal phases. There was no increase observed in prolactin secretion in either phase in relation to the control group. However, there was a slight increase in prolactin secretion during the luteal phase in patients wearing IUDs as compared to the follicular phase; nevertheless, this increase was not significant. It is concluded that the IUD does not influence the normal variations in prolactin secretion.^ieng