In developing countries with high levels of malnutrition and iron deficiency, the menstrual blood loss sometimes associated with IUD use can represent a serious maternal health concern. To identify the IUD models associated with the least amount of bleeding, 365 clients of the Mexican Institute of Social Security's Volunteer Family Planning Program participated in a 12-month comparative study of 11 IUDs. Menstrual blood loss was measured before IUD insertion; at 1, 3, 6, 9, and 12 months; and 1, 2, and 3 months after removal. Mean menstrual blood loss at baseline was 43.6 +or- 6.3 ml. The greatest increase in bleeding (above 80 mg) was recorded among acceptors of the Lippes Loop-D and Copper T-380 devices; the Copper T-200 and 220C and Multiload 250 were in an intermediate position (below 80 mg), while the Copper 7 induced little change. In contrast, users of the 5 progestogen-releasing IUDs experienced a decline in menstrual bleeding that was proportional to the amount of steroids released or the progestational potency. This reduction was greatest (96%) for the IUD that released 8 mcg/day of levonorgestrel. However, this category of IUDs is more costly and necessitates earlier removal; in addition, many women discontinue use of hormone-releasing IUDs precisely because of the associated amenorrhea. Recommended, therefore, is promotion of the Copper T-220C, which can remain in place for 10 years. In selected cases, short-term treatment with nonsteroidal anti-inflammatory agents can reduce IUD-associated hypermenorrhea and promote contraception continuation.
In Vietnam between 1989 and 1993, the modern contraceptive prevalence rate stopped at 38%. In 1984, the government implemented economic renovation (Doi Moi). This closed agricultural cooperatives which had supported commune health centers. Health workers received either low or no wages, resulting in low morale, absenteeism, and moving to the private sector or agriculture. Most women began using the IUD because it was low cost and easy to monitor, provided long-term protection against pregnancy, and there was a limited supply of oral contraceptives (OCs) and condoms. Condom use fell from 13% in 1984 to 1.4% in 1993. More than 80% of contraceptive users used the IUD. The IUD is not appropriate for many women because of health problems: 60-70% of pregnant women and 80% of parturient women have anemia, 40-60% of women have reproductive tract infections, and sexually transmitted diseases are rising. Vietnam's Prime Minister and the Communist Party are committed to expanding the range of the contraceptive method-mix and choice. Limited method choice is especially a problem in rural areas. It increases the abortion rate. About 38% of abortions supplant modern and traditional family planning methods. Improper counseling, insufficient knowledge, and low promotion of OCs account for the low use of OCs. Inferior quality, aversion by couples, and inaccessibility in most rural areas limit condom use. Women's fear and husband's objection outweigh the government's promotion of sterilization. Providers have limited comprehensive accurate and current knowledge of contraceptives. Health service facilities are concentrated in urban and semiurban areas. The quality of care in rural areas, where there is no clean water supply, is inferior. An annual target used to forecast contraceptive needs risks contraceptive stocks expiring during storage and/or disruptions in supply of users. Consecutive actions to eliminate constraints to use of other methods, developing a community level service delivery system to provide a wide range of methods, and developing specific service delivery systems for specific methods are optional strategies to expand method choice in Vietnam.
Researchers are developing vaccines to control fertility by inducing antibody and/or cell-mediated immune response against either a hormone or an antigen associated with gametes. The beta-human chorionic gonadotropin (hCG) vaccine, delivered with the tetanus toxoid vaccine, is reversible and causes only minimal side effects. It causes a large variability of antibody response. An improved version uses the beta-hCG linked with the alpha-subunit of another species (hetrospecies dimer). It is more immunogenic and produces antibodies at higher titres than does the beta-hCG-TT vaccine. It does not affect menstrual regularity. Researchers have formulated Praneem VILCI (vaccine-inducing local cell-mediated immunity) with purified extracts from Azardichta indica, an ancient Indian tree, to prevent pregnancy during the 1st 3 months. It is administered into the uterus and may be a feasible compatible approach with the hCG vaccine. Praneem VILCI does not affect ovarian function or sexual drive. The follicle-stimulating hormone vaccine has caused oligospermia and reduced fertilizing capacity of the sperm in monkeys. Contraceptive vaccines need to induce an effective and sustained immune response over a designated period in virtually all acceptors. Improved and more potent and safe adjuvants are probably needed to achieve such a response. Carriers with T cell epitopes with no suppressor T cell determinants can overcome variation in the immune response due to MCH-restriction in human populations with dissimilar immunogenetic background. Future vaccines may be polyvalent with various antigens prohibiting fertility at more than 1 point in the reproductive process. Contraceptive vaccines need to deliver multiple doses of the vaccine at 1 contact point. Biodegradable polymer microspheres can deliver antigens periodically. Live recombinant vaccines using engineered vectors can effect immunization with 1 or more doses. They would be cost effective and producible in large amounts, which would make them affordable for developing countries.
HIV is in the semen and epididymal epithelia. A possible malfunction of the physiological barriers in the seminiferous epithelium may be an early response to HIV. Tight bonds between Sertoli cells serving as the blood-testis barrier may be the site of the breakdown that permits circulating HIV to penetrate the seminal compartment. Receptive partners of anogenital intercourse are more susceptible to HIV infection and progression to AIDS because some metabolites of semen extend to the vascular/lymphatic system. As couples move closer to stage IV of HIV infection, infertility is more likely. Condom use during all sexual encounters outside of long term monogamous relationships is advocated, even if other contraceptives are used. The US government requires strict quality controls on the manufacture of condoms to eliminate condom failure during correct use. HIV cannot penetrate an intact latex condom, thus it prevents the spread of HIV. Not everyone accepts condoms. Laboratory tests show that various spermicidal compounds destroy HIV and other sexually transmitted disease organisms. Yet, epidemiologic studies do not show that spermicides alone can protect against HIV transmission. Either intracellular location of HIV protects it from spermicides, or the toxicity of the spermicide causes genital ulcers which facilitate HIV transmission. An increase in condom sales in the US has occurred, particularly in the states with the highest AIDS rates (California and New York). Condoms made of lamb cecum are an option to men who are allergic to latex. Spermicides can also cause allergic reactions. Physicians should not prescribe the pill to prostitutes who reject condom use. Future research should examine HIV receptor on T lymphocyte, sperm, and brain neurons; local immunity against sperm antigen; development of locally enhanced immune response within the genital tract lumen; and purification/identification of immunosuppressive substances in seminal plasma.
Immunization with gonadotropin-releasing hormone (GnRH) effects relatively long-term azoospermia. Either administration of ample exogenous testosterone or letting the effects of the antibodies diminish naturally results in complete reversibility of the GnRH contraceptive vaccine. In one experiment, fertility was completely restored in all rats 12 months following the cessation of booster injections. Since GnRH immunization suppresses testosterone synthesis, subjects could potentially suffer the undesirable symptoms of hypogonadism, thus necessitating adequate testosterone supplementation. Administration of low dose testosterone treatment to GnRH-immunized rats effectively maintains sexual function and other androgenic characteristics without restoring fertility. Specifically, low dose testosterone delivered by sustained release Silastic implants (2 cm) to laboratory rats reactivates and preserves libido and weights of accessory sex organs while continuing to suppress spermatogenesis. Other researchers obtain similar results by injecting GnRH-immunized rats with testosterone. The rat model not only shows that GnRH immunization/testosterone replacement causes azoospermia without adversely influencing libido, sexual function, and other androgen-dependent processes, but also yields low cost, simplicity, and infrequent administration (i.e., periodic booster injections). An immunological method of inhibiting spermatogenesis combined with administration of exogenous testosterone offers promise as a strategy leading to a convenient, reversible, and effective male contraception.
Gonadotropin releasing hormone (GnRH) antagonists prevent endogenous GnRH from binding to and activating its receptor-mediated signal transduction pathway. Specifically, they inhibit pituitary gonadotropin production, which in turn immediately suppresses luteinizing hormone/follicle stimulating hormone secretion. GnRH antagonists suppress testosterone secretion and produce azoospermia in nonhuman primates, but also cause loss of libido and impotence. When testosterone (e.g., 25 mg testosterone enanthate) is replaced after GnRH antagonist treatment begins, azoospermia is still achieved without affecting libido. A GnRH antagonist administered by nasal spray in postpartum Marmoset monkeys was effective at preventing pregnancy. The GnRH antagonist found in the breast milk was not bioactive in the infants, probably because it is broken down in the infant gut. GnRH antagonists may help women with a family history of breast cancer or other medical contraindications to oral contraceptives. Antiprogestins prevent pregnancy by blocking ovulation and by suppressing implantation. The evidence suggests that antiprogestins interrupt or delay endometrial maturation. The antiprogestin RU-486 has been used as a postcoital contraceptive agent. Preliminary evidence shows that both GnRH antagonists and antiprogestins may someday be added to the mix of contraceptive offerings.
In southwest China between April, 1988, and March, 1990, providers at 5 family planning centers in Sichuan, Guangxi, Yunnan, and Guizhou provinces performed 2713 vasectomies using 7 occlusion techniques. They all used the no-scalpel vasectomy technique to expose, isolate, and divide the vas deferens. Researchers compared the follow-up outcomes of the various techniques during 1988 and 1992. The techniques included open-ended technique with the fascia interposition (group A); removal of vas segment and ends ligated with no. 1 silk suture (group B); vasectomy with fascia interposition on testicular ends (group C); same as group B plus cautery and washing the ends with phenol or 95% ethanol and normal saline (group D); folding and ligating prostatic ends with no. 1 silk suture (group E); electrocoagulation on ends of vas (group F), and open-ended without fascial interposition (group G). In the 2 years postvasectomy, 61 wives (2.57%) had at least 1 pregnancy. Sperm were still present in the semen of 27 of their vasectomized husbands at 2 years postvasectomy. Recanalization had occurred in 78 (3.29%) men overall. Among the 78 recanalization cases, 27 wives (34.6%) became pregnant (1.14% for the entire population). Group D cases whose vas ends were washed with phenol had a significantly higher reappearance rate of sperm than did those whose ends were washed with 95% ethanol (5.88% vs. 0; p .01). A significant difference in the reappearance rates of sperm in various technique groups occurred with group A having the lowest rate and group G having the highest rate (0.55% vs. 7.53%; p .0001). The reappearance rates for the 2 interposition groups were not statistically different (0.55% for group A and 2.63% for group C). Differences in the complication rates occurred (e.g., 0 for group A vs. 2.17% for group G; p .01). Based on these results, vasectomy plus interposition is the best vas occlusion technique.
Copper-releasing IUDs cause severe dermatitis (e.g., urticarial eruptions and eczema) in copper-sensitive women. Such exposure of subcutaneous areas is a cofactor for HIV infection. The excessive menstrual bleeding that accompanies IUD use and absorption of virions and infected cells in the semen of HIV-infected males by IUD tails facilitates HIV infection. IUD tails have the highest concentration of HIV in infected women. HIV causes cervicitis in HIV-infected women. The cross reactivity between pelvic inflammatory disease (not rare among copper-IUD users) and sexually transmitted diseases (STDs) increases the risk of HIV infection. Having multiple sex partners is a risk factor of HIV/STD infections. IUDs, diaphragms, latex condoms, and spermicides may cause an allergic reaction in men and women. Condoms made of lamb cecum are an option to men who are allergic to latex. The single greatest factor for HIV infections in Africa is chancroid. The sudden increase of syphilis in the US parallels the sudden increase in HIV transmission. Physicians need to consider the following before treating pregnant STD patients with an antibiotic: possible risk to fetus, altered kinetics and etiology of the STDs, and choice, dose, route, and duration of antibiotic treatment. Family planning services should focus on HIV-infected women, so they can avoid pregnancy. Many public health and family planning clinics offer counseling and HIV-antibody testing. Human semen has various subpopulations of leukocytes. Leukocytes that have enveloped sperm can take sperm antigens to the lymphatic system. The great individual variation in frequency of CD4+ lymphoid cells and monocytes/ macrophages is clinically important in infectivity of semen in HIV-positive men. T4+ lymphocytes are in the semen of fertile and infertile men. HIV carriers should wear condoms. Partial inactivation of HIV after 10 minutes in the condom at 37 degrees Celsius occurs, but inactivation varies by trademark.
Estrogens and progestins influence rates of cell proliferation in the breast and endometrium. Current oral contraceptives (OCs) inhibit endometrial cell division and protect against ovarian cancer. Findings of a 1991-1992 pilot trial of a prototype contraceptive show that the addition of a gonadotropin releasing hormone agonist [GnRHA] significantly reduces the doses of estrogen and progestin to a point lower than that of current OCs. The prototype includes the GnRHA and 0.625 mg of conjugated estrogen (CE) (6 days/week) and 10 mg medroxyprogesterone acetate (13 days/4 months). The subjects were 25-40 year old premenopausal women with a 5-fold greater than normal risk of breast cancer who did not want to become pregnant within the next 2 years and who lived in California. The women began the contraceptive regimen during the luteal phase of the menstrual cycle. Women in the treatment group had fewer symptoms than those in the control group because the regimen eliminated symptoms associated with the luteal phase (i.e., premenstrual syndrome). A small increase of the estrogen dose to 0.9 mg CE eliminated the few instances of hot flushes or vaginal dryness. Few subjects had unscheduled bleeding or spotting, and its incidence fell with time. Women in the treatment group experienced a beneficial increase in high density lipoprotein cholesterol. They lost bone mineral density (BMD) (measured at the lumbar spine) at an annual rate of 1.9% which was near significance (p = .07), even though 0.625 mg CE is enough to prevent loss of BMD in normal postmenopausal women. Women in the treatment group experienced a greater reduction in mammographic densities than did those in the control group. This is promising, since decreased densities are believed to be linked to a decreased risk of breast cancer. It appears that this regimen reduces the amount of breast cell mitotic activity. Researchers are developing a combined depot form of the complete regimen administered every 3-4 months.
There has been a widespread epidemic of hypokalemia of unknown cause in China since 1964. The symptoms are fatigue and muscle weakness followed by flaccid paralysis with lowered serum potassium level. This hypokalemia is different from that described in medical textbooks. A large number of patients suffering from hypokalemic paralysis were found to live in certain cotton growing districts of China. After repeated epidemiological survey, most investigators concluded that the incidence of hypokalemic paralysis in those districts was related to subjects' use of crude cottonseed oil as their cooking oil. Crude cottonseed oil contains gossypol, a potential male antifertility agent postulated by Qian et al. in 1980 to be capable of inducing hypokalemia. Accumulated data, however, do not support the hypothesis of gossypol-induced hypokalemia. The authors reanalyze evidence on the notion of gossypol-induced hypokalemia and suggest that an unknown cause rather than gossypol was the true cause for the observed hypokalemia in gossypol takers. The issue of gossypol-induced hypokalemia remains unsettled and in need of thorough reconsideration. Meanwhile, the clinical trial for gossypol in China has been abandoned along with the worldwide pursuit of gossypol as a male antifertility agent. Many results on the subject conducted in China are brought together, some of which are not available in the usual western scientific literature.
The Norplant system (levonorgestrel implants) provides excellent protection against pregnancy (typical failure rates, 0.2% for Norplant vs. 0.4% for female sterilization and 3% for oral contraceptives [OCs]). Women may choose to have the capsules removed before the end of the 5-year period. The pregnancy rate in former Norplant users is similar to that of women who have not used Norplant. Active thrombophlebitis or thromboembolic disorders, abnormal genital bleeding, known or suspected pregnancy, acute liver disease, benign or malignant liver tumors, and breast cancer are contraindications to Norplant. Trained providers should insert Norplant capsules within the 1st 7 days of the menstrual cycle. The most common side effect is change in menstrual bleeding, particularly irregular and/or prolonged bleeding during the 1st year. Norplant's cost is about 50% lower than that of OCs (US$11 vs. $21.40 per month; $133 vs. $278 per year; and $665 vs. $1391 over 5 years). Norplant-1 and Norplant-2 are comparable. This article provides step-by-step instructions, including photographs, on how to insert and remove the implant capsules and to remove a hard-to-retrieve capsule.
Researchers have conducted considerable experiments on the effectiveness and therapeutic values of Chinese herbs and parts of plants. We should not ignore the significance of natural medicine. The Chinese have been perfecting medicinal therapy based on the raw ingredients of plants/herbs and their derivatives for thousands of years. Chinese practitioners of traditional medicine prescribe medicines based on yin and yang. Traditional medicine is communicated in a verb or written form. Natural resources used in traditional medicine to treat diseases are not limited to just medicinal plants but also include animals, shell fish, and minerals. Parts of plants used in traditional medicine are leaves, stems, flowers, bark, and root. Chinese medicine is the world's oldest continuous surviving tradition. The Chinese experimented with local plants, often resulting in mild to violent reactions. This process allowed them to become familiar with poisonous plants and those that could relieve pain or successfully treat illness. Current allopathic medicines are composed of synthetic compounds copied from natural chemical derivatives, which tend to be more potent than the original compound. Some medicinal plants used to effect conception/contraception include Striga astiatica (contraceptive); Eurycoma longifolia (male virility); and a mixture of lengkuas, mengkudu masak, black pepper seeds, ginger, salt, and 2 eggs (increase libido). Women in Malaysia take jamu to preserve their body shape and to provide nutrition during pregnancy. Praneem causes local cell-mediated immunity in the uterus. Clinical trials of Praneem with or without the hCG vaccine are planned.
Vasectomy is a simple, safe, effective, and popular method of permanent male sterilization worldwide. Physicians should do various preoperative procedures with each man requesting vasectomy: complete medical history, scrotal exam, digital rectal exam, counseling on vasectomy and other forms of contraception, and fertility history. Experienced surgeons use newer, minimally invasive surgical techniques to more quickly perform vasectomy (no- scalpel vasectomy) with reduced vasectomy-related morbidity and more patient satisfaction than the traditional surgical techniques. The traditional techniques require injection of an anesthesia, e.g., lidocaine. Surgeons can perform the no-scalpel vasectomy on an outpatient basis, which reduces complications, costs, and inconvenience. A patient who has azoospermia on 2 consecutive semen analyses at an interval of 5-6 weeks is considered infertile. Even though some studies report an increased risk of prostate cancer in vasectomized men, closer examination of the studies finds a likely screening bias or do not find an increased risk. Nevertheless, providers must inform men asking for vasectomy about these studies. They should perform an annual digital rectal examination in 50-70 year old vasectomized men (as they should for all 50-70 year old men). Vasectomized men in this age group should also have an annual serum prostatic specific antigen.
Based on results from the Pakistan Demographic and Health Survey, female sterilization is viewed by married women as the most preferred method of contraception and should be promoted as an effective method of family planning. Demand currently far exceeds the availability of services, particularly in rural areas where 70% of the population lives. Surgical sterilization is not desired by women and carries with it a certain amount of morbidity. A promising approach is transcervical insertion of active agents to produce tubal occlusion. The historical background and description of how quinacrine acts in the uterus are provided. The results of use of the nonsurgical procedure of quinacrine introduction into the uterine cavity for female sterilization in Pakistan are discussed. From January to December 1990, in rural and urban Failsalabad, Pakistan, 2100 women received a single insertion of 7 pellets (252 mg) of quinacrine hydrochloride through a Copper-T IUD inserter. The procedure was performed by the author and other doctors and traditional birth attendants (TBA). Patients were instructed to return if there was severe pain, bleeding, or a missed period, and TBAs were to maintain regular contact with their clients and report complications immediately. Other patients (167) accepted transabdominal tubal ligation and transvaginal tubal ligation (235); these small numbers show the popularity of the quinacrine procedure. In a sample of 450 patients, 7% showed minor side effects. Vaginal discharge for 5-10 days was reported by all women. Also reported was 1-6 days of pain in the lower abdomen, amenorrhea for 2-3 months, and irregular menstruation, menorrhagia, backache, feelings of heaviness, dyspareunia, and itching. 4% became pregnant in varying periods after insertion. 36/47% continued the pregnancy and the remainder had dilatation and curettage (D and C) with vaginal tubectomy, D and C, or unknown actions. The rates of ectopic pregnancy are one third to one sixth of those with surgical procedures (.24/1000 procedures versus .75/1000 for surgical methods), but the pregnancy rate is higher (4-5% versus .5% for surgical procedures). Reduction of the failure rate to 1% is possible with insertion of 400 mg of Brufen a half hour before quinacrine insertion.
A total of 698 medical personnel from 28 provinces who received no-scalpel vasectomy (NSV) training starting in 1980 were mailed a questionnaire in 1991. A total of 489 persons responded: 427 were males and 62 were females, aged 17-57 years. The average time interval since training was 6 years. A total of 235,848 procedures of NSV were done by these 489 trainees, with an average of 482 procedures performed per trainee. With 221 trainees having conducted training programs for the next generation, a total of 6020 trainees had been trained. Subsequent to training, 377 trainees continued practicing vasectomy whose performance was affected by the sex of the trainee, affiliation and location, previous experience with vasectomy, and the number of procedures performed during training (p 0.001). The NSV practice rate of male trainees and family planning trainees was higher than that of female trainees and those in the health care system (p 0.001). 204 respondents were affiliated with the family planning service system and 285 with the health care system, and the average number of procedures performed per trainee in the family planning service system was higher than that in the health care system (p 0.001). The majority of procedures were performed at county and township levels (p 0.05). Most procedures were performed by medical assistants, nurses, midwives, and paramedicals. The mean number of procedures performed by paramedicals was higher than by medical professionals per trainee (p 0.01). A multiple stepwise regression analysis showed that the number of NSVs after training was closely related to the trainee's professional level, previous experience with vasectomy (p 0.001), the number of cases done during training, and the time elapsed after training. Designing a program for surgical trainers and practitioners that would comprise candidates with some experience in traditional vasectomy is recommended. At least 5 procedures should be performed during practical training. For vasectomy training, male candidates appear to be better than female ones.
Pakistan and other countries with high population growth rates are in need of an acceptable procedure to prevent fertilization and lower birth rates and reduce maternal mortality. Vaginal tubectomy and nonsurgical tubectomy are discussed as forms of female sterilization which may be suitable to women and countries with limited finances. 15,000 cases of vaginal tubectomy have been performed in Pakistan during 1972-92 with a failure rate of 1/1000 and no ectopic pregnancies. Quinacrine nonsurgical procedures have been used on about 4000 case during 1990-93 with no serious complications or side effects; the failure rate is 4% and no ectopic pregnancies have resulted. Vaginal tubectomy is suitable for Pakistani patients who have fatty abdomens and are reluctant to have an abdominal operation. Women also find the absence of an abdominal scar desirable because of the fear of abdominal rupture. Laparoscopic tubectomy is compared to vaginal tubectomy. In laparoscopic sterilization ectopic pregnancy is high for patients who have coagulation and division. Laparoscopic tubectomy case also have more complications than vaginal tubectomy cases requiring laparotomy. Vaginal tubectomy procedures are simple and economical, require short hospitalizations, have short recovery periods, have minimal postoperative discomfort and lower minor morbidity and major complications, and can be combined with other vaginal procedures. Endoscopic procedures may require general anesthesia which carries its own risks, requires sophisticated equipment and operative skill, and is not suitable for obesity; endoscopes are expensive in cost and maintenance. Other types of interval sterilization are not as accepted by women. Culdoscopic tubal ligation and hysteroscopic tubal occlusion are feasible and acceptable alternatives to vaginal tubectomy. Many gynecologists acquired skills in one method, which is used continuously; this makes it difficult to compare methods. Both vaginal tubectomy and quinacrine introduction into the uterine cavity are described as medical procedures.
Slovenia, an independent state since January 1992, conducted a KAP-type survey of 1117 male and female respondents aged 15-44 years between August 1989 and March 1990. The aim of the survey was to assess the social, medical, and demographic factors in low fertility and to identify fertility determinants. An explanation was needed for inadequate use of contraceptives, which were easy and inexpensive to obtain, and for reliance on abortion. The questionnaire included 180 questions on 16 topics; the same questions were asked of men and women with a few exceptions. There was a mean age of 30 years and 59% were married. 77% were employed and 59% had finished secondary school. The average number of children was 1.3; desired number of children was 2.4. 43% of women with children wished to stop childbearing. 13% desired an additional child; 32% wanted 2 or more children and 12% wanted 3 or more children. 62% believed that every woman should have a child. The ideal family of 2 children was reported by 60%. 31% favored 3 children. 58% considered a family size of 2 children appropriate for their own family. Over 75% reporting 2 children appropriate for their family size thought 2 children were ideal. 99% considered family planning as a mutual decision. 24% thought men's participation in decision making was inadequate, because men did not have sufficient opportunity to speak with a doctor. Women did not have confidence in men and wanted to make decisions alone. There were significant differences in attitudes by sex. 87% of men and 90% of women were sexually active. 41% reported that at the beginning of their sexual activity there was little discussion of contraception. Of those discussing contraception, 57% decided to use contraceptives of which 71% decided on regular use and 20% on use only during the fertile phase of the cycle. 33% of women who decided alone relied on regular use of withdrawal, and a larger number of joint decisions involved withdrawal as a method of choice. The greatest differences in subjective and objective knowledge were for condoms, diaphragm, and foam/jelly. Ever use of contraception was 85% for women and 56% for a reliable method. There were big differences between characteristics of women who used or did not use contraception. Traditional sexual behavior occurs for most Slovenians; family planning is not an accepted part of their lives.
In Guadalajara and Mexico City, Mexico, researchers collected and analyzed semen samples from fertile men who were sexually abstinent for 3 days to evaluate the effect heparin has on sperm nuclear decondensation patterns and motility. They used 3 sesquiterpene-lactones to inactivate the thiol groups on the outer membrane of sperm cells: I (17, 18 dehydroviguiepinin), II (Budlein A), and III (Zaluzanin A). Sesquiterpene-lactones I, II, an III had an inhibitory effect of 81%, 73%, and 27%, respectively, 6 hours after the sperm had been incubated with heparin for 6 hours. First mixing the sperm with reduced glutathione before adding 17, 18 dehydroviguiepinin increased the decondensating effect of heparin 350% above that of sperm not incubated with both glutathione and heparin. Sperm motility fell 80%, 60%, and 16%, respectively, 15 minutes after incubation with sesquiterpene-lactones I, II, and III. When sperm was incubated with heparin only, sperm motility was consistently higher for 5 hours. None of the compounds used to incubate the sperm affected sperm viability. The findings provided more information about the molecular biology of mammalian spermatozoa and suggested that sesquiterpene-lactones may be effective male contraceptives.
24 kinds of pure compounds extracted from Chinese herbal medicines were studied for their effects on human sperm motility. 7 were found to inhibit sperm motility at the concentration of 2 mg/ml. These 7 substances were further investigated for their sperm motility-inhibitory effect at the concentration of 3.0 mg/ml, 4.5 mg/ml, and 6.75 mg/ml to test the dose-related response. The results showed that 5 of the 7 extracts, namely casuarinin, cinnamtannin B-1, pedunculagin, epicatchin-(4beta-8)-epicatechin-(4beta-8)-catechin, and catechin have a strong inhibitory effect on sperm motility with dose-response relationship. Since the chemical structures of these extracts have already been determined, further studies should aim at exploring the mechanisms of their antimotility effect on human sperm. It would appear that some traditional Chinese herbal medicines have the potential of becoming new and acceptable forms of male oral contraceptives in the future.
