Increase understanding of newer contraceptive options Utilize
recommendations for indications and contraindications of popular
contraceptive options
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In 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: CDC
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U.S. teen. pregnancy, birth, STI, and abortion rates are
substantially higher than other western industrialized nations.
Source: CDC
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Highly dependent on education and counseling Still best
provided by personal interaction
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Little recent activity with new products 2 noteworthy
options
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Adapted from WHO MEC, 4 th Edition
Slide 22
1 a condition with no restriction for the use of the
contraceptive method 2 a condition for which the advantages of a
method generally outweigh the risks 3 a condition for which the
risks of a method usually outweigh the advantages 4 a condition
that represents an unacceptable health risk if the contraceptive
method is used
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Underutilized, but an excellent option for those patients with
contraindications to hormonal contraception.
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Bosworth MC, et al
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Risk 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.
Slide 32
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):363-367
Slide 33
EC indicated for up to 5 days after unprotected intercourse
Works primarily by delaying ovulation a Selective Progesterone
Receptor Modulator Side effects similar to Plan B In clinical
trial; 1.8% pregnancy rate vs. 2.6% with Plan B (n=844, 852)
Slide 34
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 Center
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Proving to be problematic and elusive, but a new technique
shows promise.
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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.
Slide 37
The next 3 slides were actually part of a presentation first
presented 10 years ago. All 3 options have been unsuccessful, at
least so far.
Slide 38
A combination progestin and androgen therapy holds the most
promise Organon 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.
Slide 39
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.
Slide 40
Called the Bright Pill Dr. 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.
Slide 41
Reversible 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.
Slide 42
Some 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.
Slide 43
Kogan P, Wald M. Male Contraception History and Development:
Urology Clinics of North America:2014:145- 161 Dr. Wald is a
urologist at U. of I.
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For everything you do for Iowa women and their families