CONTRACEPTION: A PERSONAL CHOICE

CONTRACEPTIVE UPDATE2014Thomas Ross, D.O.

OBJECTIVES:Increase understanding of newer contraceptive optionsUtilize recommendations for indications and contraindications of popular contraceptive optionsTeen PregnancyIn 2012, for women ages 15-19 years, the live birth rate was 29.4 per 1,000.This is a record low for U.S. teens and a decrease of 6% from 2011.The decline appears related to a decrease in sexual intercourse and an increase in consistent contraceptive use.

Source: CDCTeen birth rates declined for all races and ethnicity except Native Americans.4

However,U.S. teen. pregnancy, birth, STI, and abortion rates are substantially higher than other western industrialized nations.Source: CDC

Effective ContraceptionHighly dependent on education and counselingStill best provided by personal interactionOral ContraceptivesLittle recent activity with new products2 noteworthy options

CDCs U.S. Medical Eligibility Criteria for Contraceptive Use, 2010Adapted from WHO MEC, 4th EditionMEC CATEGORIES1 a condition with no restriction for the use of the contraceptive method2 a condition for which the advantages of a method generally outweigh the risks3 a condition for which the risks of a method usually outweigh the advantages4 a condition that represents an unacceptable health risk if the contraceptive method is used

ParaGardUnderutilized, but an excellent option for those patients with contraindications to hormonal contraception.

Emergency

Contraception

Bosworth MC, et al

Bosworth MC, et alDecreased efficacy with increased BMIRisk of pregnancy increased for women over BMI 25 who used Plan B. Risk of pregnancy after unprotected intercourse was basically the same with or without taking levonorgestrel (5.8% vs. 5.6%) in two randomized trials.Evidence of decreased efficacy was also seen with ulipristal to a small degree.Subsequent studies needed to clarify risk Glasier A, et al. Can we identify women at risk of pregnancy despite using EC? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011;84(4):363-367Ulipristal acetate (UPA) a.k.a. ella or ellaOneEC indicated for up to 5 days after unprotected intercourseWorks primarily by delaying ovulation a Selective Progesterone Receptor ModulatorSide effects similar to Plan BIn clinical trial; 1.8% pregnancy rate vs. 2.6% with Plan B (n=844, 852)A Vaccine Against Pregnancy?New method in development, vaccination against human chorionic gonadotropin (hCG). Antibodies are created by hCG production (when pregnancy occurs), similar to when your body fights an infection. Your immune system attacks the embryo which is producing hCG. The vaccine is effective for approximately one year.Source: Epigee, Feminist Women's Health CenterMale ContraceptionProving to be problematic and elusive, but a new technique shows promise.Male attitudes are changing!Several recent non-scientific surveys of men have shown over 50% of those responding state they would be willing to use a reversible contraceptive method. The pharmaceutical companies have been very slow to aggressively pursue what they percieve as a limited market.Studies have proven very problamaticThe next 3 slides were actually part of a presentation first presented 10 years ago.All 3 options have been unsuccessful, at least so far.Male Hormonal ContraceptionA combination progestin and androgen therapy holds the most promiseOrganon is testing, in the U.S. and Europe, an etonogestrel subdermal implant with testosterone injections every 4-6 weeks. This will likely be the first MHC approved by the FDA. It is scheduled to be on the market by 2005, but U.S. availability may be 5 years. What about a male pill?An oral pill containing desogesterel and testosterone is also in clinical trials. Results are very promising.The Population Center for Research in Reproduction at the U. of W. in Seattle is testing several male contraceptive methods.A novel, non-hormonal male contraceptive!Called the Bright PillDr. Haim Breitbart in Tel Aviv is performing early testing on a compound that blocks protein synthesis by sperm, that is essential for penetration thru the eggs cell membrane.A single pill may be effective for 1 to 3 months with no decrease in testosterone production.Vas deferens injectionReversible inhibition of sperm under guidance (RISUG) developed in India by Dr. Sujoy Guha is a procedure involving injecting a copolymer of styrene/maleic anhydride (SMA) into both vas deferens tubes. This does not obstruct the tubes, but rather damages the sperm as it moves past it. A solution of sodium bicarbonate can flush out this copolymer and restore fertility.VasalgelSome of the men in India have been using RISUG for highly effective contraception for more than 15 years. Reversibility studies have only been done in animals. In 2010, the Parsemus Foundation purchased the rights to develop RISUG in the U.S. The new polymer is called Vasalgel. Clinical trials were expected to start this year.Best source for male contraception informationKogan P, Wald M. Male Contraception History and Development: Urology Clinics of North America:2014:145-161Dr. Wald is a urologist at U. of I.Questions and CommentsThank youFor everything you do for Iowa women and their families