Comparison of the efficacy of intrauterine diclofenac and ibuprofen pellets as adjuvants to quinacrine nonsurgical female sterilization.

To investigate relative efficacy of intrauterine diclofenac and ibuprofen as adjuvants to intrauterine quinacrine for nonsurgical sterilization, a total of 900 women were systematically allocated to 2 monthly insertions of pellets of diclofenac (75 mg) or ibuprofen (55.5 mg) as adjuvants to intrauterine quinacrine (216 mg) in a rural private practice in West Bengal, India. All women were prescribed oral contraceptives for three months from first insertion. In the middle of the study increased care was taken to insert pellets at the fundus. There was no statistically significant difference found in cumulative life-table pregnancy failure rates at 36 months for women receiving diclofenac (2.7 +/- 0.82) or ibuprofen (3.4 +/- 0.89). Taking care to insert pellets at the fundus resulted in a decline of failures at 24 months from 4.4 +/- 0.92 to zero. Intrauterine administration of pellets of quinacrine (216 mg) plus diclofenac (75 mg) or ibuprofen (55.5 mg) with 3 months' oral contraception provides acceptable efficacy if pellets are inserted to the fundus.

A potential single insertion protocol for quinacrine pellet non-surgical female sterilization.

Two preliminary single-insertion clinical trials of the quinacrine pellet method of non-surgical female sterilization were compared. Both trials used transcervical application of quinacrine, 252 mg, and diclofenac, 75 mg, as pellets. In the first trial (21 April 1992 to 17 February 1993), 58 women received oral contraceptives for three months. In the second trial (19 February 1993 to 25 May 1994), 229 women received medroxyprogesterone acetate, 150 mg IM, at the time of quinacrine insertion. At 18 months, the life-table pregnancy failure rate per 100 women of the first trial was 8.6 (SE 3.7), whereas the failure rate for the medroxyprogesterone acetate group was 0.5 (SE 0.5), p<0.05. There were no serious complications or side-effects in either group. Larger confirming trials with random allocation and long-term systematic follow-up are needed to determine whether a single injection of medroxyprogesterone improves the efficacy of quinacrine.

Reversal of sterilization due to application of quinacrine by means of transcervical tubal catheterization.

PIP: The cornual and intramural scarring associated with quinacrine-induced female sterilization has been presumed to make this method irreversible. However, this article presents the cases of two women from Calcutta, India, with successful reversal achieved through transcervical catheterization with recanalization under fluoroscopic guidance. The first woman, age 28 years, had been sterilized five years earlier by three treatments with 252 mg of quinacrine; the second, age 22 years, had been sterilized two years before reversal request with two quinacrine doses. Recanalization of the proximal right tube was achieved in both cases through use of two or three catheterization systems in sequential order; attempts to repair the left tube resulted only in venous intravasation. The gritty sensation during guide-wire recanalization was consistent with fibrosis in the intramural portion of the fallopian tube. The availability of this technique may increase the acceptability of quinacrine sterilization, especially in countries such as Egypt and Indonesia where national family planning programs require that sterilization techniques are reversible.^ieng

Studies of quinacrine and of tetracycline for non-surgical female sterilization.

The transcervical quinacrine pellet method developed by Zipper and co-workers is potentially a much needed safe, inexpensive, and effective non-surgical method of female sterilization. This method utilizes an intrauterine device inserter to deposit 250 mg of quinacrine hydrochloride as pellets in the uterine cavity. No complications or side effects, other than temporary pain and oligomenorrhea, have been reported. Tetracycline has an established track record for safety. It also has been reported to have properties similar to quinacrine as a sclerosing agent, with potential as a non-surgical method using the quinacrine insertion technique. To expand the experience with quinacrine and to study tetracycline as an alternative, studies were undertaken under the auspices of the Indian Rural Medical Association in Calcutta, India. During the period 14 August, 1979 to 28 June, 1984, 414 women received three insertions of 200 mg of quinacrine. There were 29 failures and a three-year life table failure rate of 8.5. During the period 25 April, 1984 to 28 December 1984, 55 women received three insertions of 200 mg of tetracycline. By 1 June, 1986 there were 32 failures among the 55 cases for a failure rate of 58%. A more recent study using a single dose of 1000 mg of tetracycline also produced unacceptably high failure rates.

Follow-up study of oral contraceptive acceptors in Howrah District in India.

In the Howrah District in India, three clinics--one in each of the urban, slum, and rural areas of the city--were initiated by the Humanity Association of Howrah in November of 1968 to supply oral contraceptives (OCs) to women from 15 to 45 years of age. The project was discontinued in September, 1972. Of the 1700 patients still active when the project ended, 1527 were contacted for the follow-up survey. Findings indicate that most women in this district were satisfied with OCs and would continue to use them if they were available. In corroboration of this, it was found that 43% of the women had used OC'S obtained from other sources after the project was discontinued. While 35.5% of the women who used no contraceptive method after project ended reported becoming pregnant or suspected that they were pregnant at the time of the interview, only 4.2% of those who reported using some form of contraception reported pregnancy or suspected pregnancy. The demographic impact of the project will be evaluated on the basis of data to be obtained in a subsequent survey of the same communities.