Volumetric self-sampling of cervicovaginal fluid to determine potential fertility: a multicentre pre-effectiveness study of the Rovumeter.

The aim of this study was to assess how effectively the Rovumeter, designed for the volumetric self-sampling of cervicovaginal fluid (CVF), can be used to locate the minimum period of potential fertility (PPF) during ovulatory cycles. A multicentre, prospective study was undertaken of volunteers (attending natural family planning clinics) over three consecutive, apparently normal, menstrual cycles. All women collected daily samples of early morning urine and CVF and recorded the volumes (to the nearest 1.0 and 0.1 ml respectively). The concentrations of oestrone glucuronide (EG), luteinizing hormone (LH) and pregnanediol glucuronide (PG) were measured in all samples of early morning urine by immunoassay. A preliminary data set was used to optimize an algorithm to detect the start and end of potential fertility from the volumes of CVF. The end-points used were the normality of each menstrual cycle from its length, the length of luteal phase, and concentrations of EG, LH and PG, the start and end days of potential fertility from CVF volumes, and the minimum PPF, which was defined as the day of the LH peak minus 3 to day plus 2 inclusive. Overall, 72 women (median age 30 years, range 24-38) were recruited from three centres (23 from Birmingham, 24 from Milan, 25 from Santiago) and contributed data from 235 menstrual cycles (median length 28 days, range 23-44). The urinary LH peak was identified in 228 cycles (97%; median time, day 15 from day 1 of last menses, with range day 10 to day 35). The use of the Rovumeter gave start and end signals of potential fertility during 138 cycles (59%). The median length of the derived PPF was 8 days (range 4-18). The signals covered the defined, minimum PPF in 113 cycles [i.e. 50% of those with an LH peak; range 28% (Milan) to 62% (Birmingham)]. Overall 16/72 women (22%) had successful tests over three consecutive menstrual cycles [range 2/24 (8%; Milan) to 8/23 (35%; Birmingham)]. We conclude that signals from daily changes in the volume of CVF as determined by the use of the Rovumeter consistently locate the minimum period of potential fertility in only a small proportion of women.

[Acceptability factors of natural methods of birth regulation: the inscription and instruction phases]. / Factores de aceptabilidad de los métodos naturales de regulación de la natalidad: fases de inscripción e instrucción.

PIP: This work describes a study of factors determining the acceptability of the ovulation method of family planning conducted at the Natural Methods Clinic of the University of Chile Hospital's Department of Obstetrics and Gynecology. Persons desiring instruction concerning natural family planning complete a questionnaire, hear an introductory talk which stresses the Billings method, and receive personal instruction in modular units. Multiple factors were studied for both acceptance of registration and acceptance of the course. Entrance into the course constituted acceptance of registration, and achievement of the status of dependent users constituted acceptance of the instruction phase. 147 of the 224 couples registering in the natural family planning clinic between November 1981-August 1983 began the course of instruction, and 96 subsequently adopted the method. 42.9% of the original 224 couples thus became dependent users. A significantly positive statistical association with registration was found for 73 factors. 4 separate elements of acceptability were measured: predictive value, acceptability rate, sensitivity, and frequency. The ideal factors in terms of acceptability would have positive values on all 4 dimensions nearing 100%. The most important factors identified in the study in the phase of registration and their measures for predictive value, frequency, sensitivity, and rate of acceptability respectively were: both partners shared the decision to try the method (71%, 75%, 90%, and 53%), the method is not harmful (71%, 75%, 90%, and 53%), the male understands the basics of the method (71%, 73%, 89%, and 52%), the woman understood the functioning of natural methods (70%, 57%, 66%, and 40%). All the above factors are modifiable through information and education. Statistically significant associations were found for only 16 factors in the phase of instruction. The most important factors were that both partners had previous knowledge of the method and had no prior experience with the IUD. The predictive power of the acceptability factors varied from 17%-80% for the registration phase and from 38%-81% for the instruction phase.^ieng

Metodologia de ensenanza de los metodos naturales de regulacion de la natalidad (especial referencia al metodo de ovulacion de Billings). / Teaching methodology of the natural methods of family planning (special reference to the Billings' ovulation method

Se presenta una metodologia modular y personalizada de ensenanza de los metodos naturales de regulacion de la natalidad, con especial referencia al metodo de la ovulacion de Billings. Se describen los resultados obtenidos en la aplicacion de esta metodologia durante un periodo de 22 meses en el consultorio de metodos naturales del Hospital Clinico de la Universidad de Chile. Se destaca el particular comportamiento de las ex-usuarias de dispositivo intrauterino. Se determina el tiempo y numero de sesiones de instruccion empleadas para todo el proceso, cada modulo y situaciones de fertilidad en particular. Se senalan posibles ventajas de caracter economico de la ensenanza del M.O, en relacion a los costos de la planificacion familiar por metodos artificiales

[Study of various metabolic effects of a contraceptive used for a prolonged period]. / Estudio de algunos efectos metabólicos de un gestágeno usado en forma prolongada.

PIP: The use of oral contraceptive appears to be associated with alterations in glucose tolerance and slight increases of plasma free fatty acids and triglycerides. In this study, the glucose disappearance constant and the plasma levels of nonesterified fatty acids were studied in 63 women, carefully selected with respect to age (20-30 years), parity (less than 4), normal body weight for height and age, absence of obstetric or family precedents suggesting diabetes mellitus, and absence of other pathological conditions. The oral contraceptive (Norlestrin, Parke Davis) was administered during 1 year, starting between the 7th and 9th week of puerperium. Clinical and laboratory tests were performed before the administration of the drug, and after 3, 6, and 12 months. The number of patients was reduced to 36 at the 1st control, 30 at the 2nd, and 24 at the 3rd. A progressive deterioration of the glucose disappearance constant was observed, with significant differences (p less than .001) between the values before and 12 months after treatment. Diabetic-level values were absent. The plasma nonesterified fatty acids showed a progressive and significant increase, interrupted only during the glucose tolerance tests. There was an average increase in body weight of 4 kg at the 1st control, followed by normalization at the 12th month of treatment. The study discusses the possible causes of such alterations, emphasizing the role of many functi ons that maintain metabolic homeostasis.^ieng