Update on emergency contraception

pre-printEmergency contraception (EC) is any method used after sexual intercourse to prevent pregnancy. This article provides an overview of the history of EC methods and describes the current availability of oral and intrauterine EC. Oral forms include the Yuzpe regimen (combining ethinyl estradiol and levonorgestrel), levonorgestrel-only pills, and ulipristal acetate, which is a new emergency contraceptive drug recently approved by the US Food and Drug Administration. The copper T-380A intrauterine device can also be used for EC. Information about dosing, timing, access, and other considerations in the provision of EC is covered. Clinicians should be aware of all available options in order to counsel women in need of EC appropriately

Individualized versus conventional ovarian stimulation for in vitro fertilization: a multicenter, randomized, controlled, assessor-blinded, phase 3 noninferiority trial

Objective To compare the efficacy and safety of follitropin delta, a new human recombinant FSH with individualized dosing based on serum antimüllerian hormone (AMH) and body weight, with conventional follitropin alfa dosing for ovarian stimulation in women undergoing IVF. Design Randomized, multicenter, assessor-blinded, noninferiority trial (ESTHER-1). Setting Reproductive medicine clinics. Patient(s) A total of 1,329 women (aged 18â40 years). Intervention(s) Follitropin delta (AMH <15 pmol/L: 12 μg/d; AMH â¥15 pmol/L: 0.10â0.19 μg/kg/d; maximum 12 μg/d), or follitropin alfa (150 IU/d for 5 days, potential subsequent dose adjustments; maximum 450 IU/d). Main Outcomes Measure(s) Ongoing pregnancy and ongoing implantation rates; noninferiority margins â8.0%. Result(s) Ongoing pregnancy (30.7% vs. 31.6%; difference â0.9% [95% confidence interval (CI) â5.9% to 4.1%]), ongoing implantation (35.2% vs. 35.8%; â0.6% [95% CI â6.1% to 4.8%]), and live birth (29.8% vs. 30.7%; â0.9% [95% CI â5.8% to 4.0%]) rates were similar for individualized follitropin delta and conventional follitropin alfa. Individualized follitropin delta resulted in more women with target response (8â14 oocytes) (43.3% vs. 38.4%), fewer poor responses (fewer than four oocytes in patients with AMH <15 pmol/L) (11.8% vs. 17.9%), fewer excessive responses (â¥15 or â¥20 oocytes in patients with AMH â¥15 pmol/L) (27.9% vs. 35.1% and 10.1% vs. 15.6%, respectively), and fewer measures taken to prevent ovarian hyperstimulation syndrome (2.3% vs. 4.5%), despite similar oocyte yield (10.0 ± 5.6 vs. 10.4 ± 6.5) and similar blastocyst numbers (3.3 ± 2.8 vs. 3.5 ± 3.2), and less gonadotropin use (90.0 ± 25.3 vs. 103.7 ± 33.6 μg). Conclusion(s) Optimizing ovarian response in IVF by individualized dosing according to pretreatment patient characteristics results in similar efficacy and improved safety compared with conventional ovarian stimulation. Clinical Trial Registration Number NCT01956110

Características da oferta de contracepção de emergência na rede básica de saúde do Recife, Nordeste do Brasil

The aim of the study was to describe the use of emergency contraception (EC) in Family Health Units in Recife between March and September, 2011. The questionnaire was answered by 234 professionals, 154 nurses and 80 physicians selected by random sampling in 117 USF. Almost all professionals (90.6%) reported availability of EC in Family Health Unit; physicians and/or nurse were the main prescribers (73.9%); 27.4% knew the distribution strategy by “women’s health kit”. Although 85.0% of professionals have already prescribed the EC, only 8.5% considered the EC as a woman’s right. The majority (80.7%) understand the Family Planning manual of the Ministry of Health and about half (51.2%) understand the Reproductive Rights manual of the municipality’s manual. 51.3% knew the EC action mechanism and 77.4% usually inform women about EC. Among those who do not explain about EC, the main reasons were: “lack of opportunity” (10.0%) for physicians and “to avoid becoming routine” (6.5%) for nurses. Half of the professionals (50.0%) reported prescribing in three recommended situations (unprotected intercourse, rape and failure of contraceptive methodin use) and 65.8% agree that religion interfere in the decision of the prescription/advice. Health professionals have demonstrated sufficient technical knowledge to prescribe EC, but do not recognize it as a right of women. Also, they consider that the influence of religion may interfere with the decision of prescribing and with the use of EC by women.O objetivo do estudo foi descrever as características da utilização da contracepção de emergência (CE) em unidades de saúde da família (USF) da cidade do Recife entre março e setembro de 2011. O questionário foi respondido por 234 profissionais, 154 enfermeiros e 80 médicos selecionados por amostragem aleatória em 117 USF. Quase todos os profissionais (90,6%) informaram disponibilidade da CE na USF; médico e/ou enfermeiro foram os principais dispensadores (73,9%) e 27,4% conheciam a estratégia de distribuição através do “kit saúde da mulher”. Apesar de 85,0% dos profissionais já terem prescrito a CE, apenas 8,5% a consideram como direito da mulher. A maioria (80,7%) conhecia o manual de Planejamento Familiar do Ministério da Saúde e cerca de metade (51,2%) conhecia o manual de Direitos Reprodutivos do município. Entre os entrevistados, 51,3% conheciam o correto mecanismo de ação e 77,4% costumam informar às mulheres sobre CE. Os principais motivos para não informar foram: “falta de oportunidade” (10,0%) para os médicos e “para evitar que se tornem rotina” (6,5%) para os enfermeiros. Metade dos profissionais (50,0%) informaram prescrever nas três situações preconizadas (relação desprotegida, estupro e falha do método contraceptivo em uso) e 65,8% concordam que a religião interfere na decisão da prescrição/orientação. Os profissionais de saúde demonstraram ter conhecimento técnico suficiente para prescrever a CE, porém não a reconhecem como um direito das mulheres. Além disso, consideram que a influência religiosa pode interferir na decisão da prescrição e no uso da CE pelas mulheres

Symposium 4 "Joint CSAS/5th International Meeting on Biotechnology in Animal Reproduction"

In ARCHIV - 10841