Clinical evaluation of two monthly injectable contraceptives and their effects on some metabolic parameters.

One-hundred-and-thirty normally menstruating females were subgrouped equally and enrolled from the family planning clinic to study the clinical performance of the monthly injectable contraceptives medroxyprogesterone acetate 25 mg + estradiol cypionate 5 mg (Cycloprovera) and norethisterone enanthate 50 mg + estradiol valerate 5 mg (HRP-102) and their effects on some metabolic parameters. The contraceptive efficacy after 6 months of use for both drugs was 100%. No change in menstrual pattern occurred in 74% of Cycloprovera users and 67.3% of HRP-102 users. A statistically significant decrease (P less than 0.01) occurred in HDL-cholesterol and total serum protein values and a statistically significant increase (P less than 0.01) was observed in hematocrit value of Cycloprovera users only. Body weight and blood pressure values after 6 months of drug use showed no statistically significant changes in both groups. Also, no statistically significant changes were noticed in both groups for hemoglobin, post-prandial blood glucose, cholesterol, A/G ratio, SGPT and SGPT values following 6 months of injectable contraceptive use. None of the injectable users developed cervical dysplastic changes cytologically.

Ovarian morphology and histopathology in post pill amenorrhea.

PIP: There have been a large number of reports of amenorrhea after oral contraception termination. It may be due to oversuppression of the hypothalamic-pituitary axis or to direct atrophic effects on the endometrium. Comparative studies were done by means of a laparoscopic examination of the ovaries of 20 women with postpill amenorrhea as compared with normal ovaries. In the women with postpill amenorrhea the ovaries were free from the fimbrial ends of the tubes. They were almond-shaped and were close to the size of the resting ovaries in the control group. The amenorrhea patients' ovaries were of a porcelain white color with no superficial blood vessels. There were no corpora lutea or growing follicles. Ovarian biopsies showed diffuse fibrous stroma, primordial primary follicles, and atrophic follicular cysts. Endometrial biopsy showed characteristic atrophic or resting endometria. None of the findings were pathological, which may explain why most cases of postpill amenorrhea are reversible.^ieng

The effect of seminal sperm concentration on sperm transport in the reproductive tract of female rabbits treated with progesterone or diethylstilbestrol.

Forty-two mature Baladi female rabbits were used in a randomized 3x2 factorial experiment to determine the effects of three treatments (control, progesterone injection: 2 mg/doe and DES injection: 0.1 mg/doe) and two semen sperm cell concentrations (1x10(6) and 60x10(6) sperm/0.25 ml semen on sperm transport and distribution in the female reproductive tract. The injections were given for three consecutive days after which rabbits were injected with 5 IU HCG and inseminated with 0.25 ml semen. The does were sacrificed 10 hrs after insemination and the sperm were recovered and counted from the oviducts, uterine horns, cervices and vagina. Total spermatozoa recovered was high when rabbits were inseminated with 60x10(6) sperm as compared to those inseminated with 1x10(6) sperm. When rabbits were injected with progesterone or DES, the number of sperm recovered relative to the total number of sperm inseminated was high in rabbits inseminated with 1x10(6) sperm, in comparison to those inseminated with 6x10(6) sperm. The number of sperm recovered was highest from cervix which was followed by vagina, uterus and oviducts. DES increased the number of the total sperm recovered while progesterone decreased the number as compared to control. This trend was also observed within the different segments of the reproductive tract and with groups inseminated with 1x10(6) or 60x10(6) sperm/0.25 ml semen. The effect of DES was more obvious with does inseminated with low sperm numbers. Significant correlation coefficients were found between the sperm numbers recovered in the uterus and oviducts and in the cervix and uterus of all groups of rabbits.

Effects of unilateral ovariectomization on the numbers of sperm in the oviducts, uterus and cervix of rabbits.

The experiment was designed to determine the effect of removing one of the rabbits' ovaries on the numbers of sperm in the oviducts, uterine horns and cervices. The possible relationship between the anatomical asymmetry of the two sides of the reproductive tract and the distribution of sperm within different segments of the tract was also studied. Fifteen female rabbits were used; five were kept intact as the control group, five were right ovariectomized and five were left ovariectomized. All rabbits were injected with 50 IU HCG to induce ovulation and then inseminated with 60x10(6) sperm in 0.25 ml semen. Does were inseminated one month after unilateral ovariectomy. Animals were sacrificed 10 hrs later and sperm was recovered from the right and left oviducts, uterine horns and cervices. Unilateral ovariectomy significantly reduced the total numbers of sperm recovered as compared with intact does. The total numbers of sperm recovered from each of the two sides of the tract were not affected by the site of the removed ovary. Sperm numbers were high in the cervices of all groups and then decreased gradually in the upper segments of the tract. Sperm numbers that reached the oviduct of the intact rabbits were greater than those of both unilateral ovariectomized groups of rabbits. Differences between the length of the left and right cervices and uterine horns were not significant, but the right oviduct was significantly longer than the left oviduct.

Effect of supplementary oral estrogen on long-acting injectable progestogen contraception.

PIP: To test the effectiveness of daily oral doses of estrogen in regulating the menstrual cycle of women receiving 150 mg of depo-medroxyprogesterone acetate (DMPA), 32 women were administered 1 mg of stilbestrol daily in conjunction with their DMPA injections for 90 days. A control group of 31 women received DMPA with a placebo for the same period of time. After the first 90 days, 28 women were chosen from both the stilbestrol group and placebo group, and were instructed to take 1 mg of stilbestrol daily for 3 weeks of each of the 3 subsequent 4 week periods, with 22 women receiving no medication. Continuous daily doses during the first 90 days failed to diminish the incidence of uterine bleeding of the silbestrol group when compared to the controls. Supplemental administration of estrogen did not significantly alter the appearances of endometrial biopses or kayopyknotic indices. Cyclic administration of oral estrogen for 3 weeks of a 4 week period caused regular withdrawal uterine bleeding. It was concluded that there was very little advantage to the administration of supplemental oral estrogen to women using DMPA, except in the case of a women who psychologically needs a bleeding period.^ieng

Contraception with an injectable progestin. A study of its use in postpartum women.

PIP: 100 patients received 150 mg of depo-medroxyprogesterone acetate (DMPA) supplied as Depo-Provera, between Days 1 and 5 postpartum and then at 3-month intervals. Vaginal cytologic smears and endometrial biopsies were obtained 6 weeks and 3 months after the first injection and then 3 months following each subsequent injection during a 1 year study period. Of the 100 patients, 82 received at least 1 subsequent injection. Of these 22 received injections 1-4 weeks late. At the end of 1 year 43 patients had continued the treatments and 31 continued longer. 24 stopped for medical reasons, mostly irregular vaginal bleeding. Others had moved away or lacked transportation to the hospital. By the end of the year 77% of the patients were amenorrheic. About as many lost as gained weight. Of 275 endometrial biopsies obtained from 86 patients none showed a secretory type of endometrium. 6 weeks after first injection 44% of biopsies showed a minimally proliferative type of endometrium. Later this type of reaction became less frequent and more showed a quiescent type. At 1 year 40% of biopsies showed an atrophic endometrium. In 241 vaginal smears both the mean and median karyopyknotic indices were low. Resumption of spontaneous ovulation occurred at prolonged and unpredictable intervals after stopping therapy. Pregnancy occurred in 6 women, a failure rate of .51% per 100 woman-years of use.^ieng