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Sex ratio associated with timing of insemination and length of the follicular phase in planned and unplanned pregnancies during use of natural family planning.

This was a multicentred, prospective study of pregnancies among women using natural family planning. The women maintained natural family planning charts of the conception cycle, recording acts of intercourse and signs of ovulation (cervical mucus changes, including peak day and basal body temperature). Charts were used to assess the most probable day of insemination relative to the day of ovulation and length of the follicular phase of the cycle. The sex ratio (males per 100 females) for 947 singleton births was 101.5, not significantly different from the expected value of 105. The sex ratio did not vary consistently or significantly with the estimated timing of insemination relative to the day of ovulation, with the estimated length of the follicular phase or with the planned or unplanned status of the pregnancy. Although these findings may be affected by imprecision of the data, the study suggests that manipulation of the timing of insemination during the cycle cannot be used to affect the sex of offspring.

Family Planning Services↗

Home monitoring with the ClearPlan Easy Fertility Monitor for fertility awareness.

Many couples planning a pregnancy have had to gauge the best time for sexual intercourse from subjective indications, e.g. cervical mucus changes, or retrospective information, e.g. temperature and calendar methods. Between women, and within a woman, there are considerable variations in menstrual cycle length and underlying hormonal patterns. Although fertility test kits are available, most still rely on visual interpretation by the user. A new combination of immunochemical testing and computing technology is now available in the ClearPlan Easy Fertility Monitor. This paper describes the features of this accurate, simple-to-use, home-based fertility monitor, which gathers data on hormonal patterns and takes account of the individuality of menstrual cycles in women. These data and information about other events, such as sexual intercourse, can be stored in the monitor and accessed by the couple and their medical professional for retrospective review. The monitor is useful for couples who have just started trying to conceive, or those who have been planning a pregnancy for some time.

Estrone↗

Changes in enzyme levels in human cervical mucus during the menstrual cycle.

Cervical mucus is a complex secretion produced by the endocervical epithelium. A comparative analysis of 30 enzymes was carried out on 15 women during their periovulatory period (days 10 to 16 of the menstrual cycle). Nine different enzymes were always found to be present in the cervical mucus. Changes in enzymatic activity were further studied in two of the women, one with a normal (27-day) and the other with a short (20-day) menstrual cycle. The data were compared with those for the same enzymes in the saliva of these two women. Each woman's ovulation time was determined through hormone measurements in urine and blood, as well as by recording basal body temperature and by Billing's method. Our results indicate that a maximum peak occurs for several enzymes during the periovulatory period.

Adult↗

Copper-containing IUDs are not associated with an increase of malondialdehyde levels in cervical mucus.

The malondialdehyde (MDA) content of cervical mucus from 23 healthy adult females was measured using an ion-pairing HPLC method capable of detecting 10 pmol MDA. Ten of the women were wearing copper IUDs, four were wearing plastic IUDs, and nine controls were not wearing an IUD. Cervical mucus was sampled during the follicular, periovulatory, luteal, and menstrual phases. The study was designed to determine if there is a relationship between MDA formation and the use of a copper IUD. A total of 79 samples were analyzed. Only 16 of the samples had sufficient MDA for reliable quantitation with the level ranging from 0.1 nmol/g to 2.32 nmol/g. In 19 of the samples, trace levels (less than 0.06 nmol/g) were detected but could not be reliably quantitated. In the remaining 44 samples, no MDA was detectable. There was no correlation between the presence of copper- or non-copper-containing IUDs and the level of MDA. These results are contrary to a previously published report that used a less specific method for MDA analysis.

Adult↗

Correlation of plasma gonadotrophins and ovarian steroids pattern with symptomatic changes in cervical mucus during the menstrual cycle in normal cycling women.

27 healthy young Italian women were studied to evaluate their ability to identify symptomatically the potentially fertile phase of the menstrual cycle by self observation of their cervical mucus pattern as described in the Ovulation Method Billings. The women's observations were correlated with daily plasma levels of FSH, LH, estradiol-17 beta and progesterone. Ovulation was considered to occur on the day following the LH peak. The hormonal assays revealed that 2 of the 34 cycles studied were anovulatory. 24 of the 27 subjects in the study group demonstrated their ability to recognize the onset of the mucus discharge and the peak symptom from the first cycle after teaching, another two from the second cycle. The only other subject contributed an anovulatory cycle in which the hormonal assay confirmed the accuracy of her mucus observations. In the study, the mean interval between the time of ovulation as assessed and the peak symptom recorded by the subjects was 0.0 days, with a range from -2 to +1 days. The mean time interval from the first recorded symptom to the estimated day of ovulation was 6.0 days, with a range from 3 to 10 days. The study shows that young Italian women can be taught to recognize their cervical mucus pattern as described in the Ovulation Method Billings. The accuracy of their observations is demonstrated by the hormonal assays. The study also confirms the conclusion reached in earlier similar studies that there is a direct correlation between the cervical mucus symptom and the potentially fertile phase of the cycle. Research is currently being conducted on a larger number of couples employing the Ovulation Method Billings to actually regulate their fertility.

Adolescent↗

Temporal relationship between Uniplant insertion and changes in cervical mucus.

This study was undertaken to determine the time required by a single implant containing nomegestrol acetate to affect cervical mucus production and sperm penetration in women. All subjects were investigated and, if necessary, treated for any kind of cervicitis or vaginitis prior to starting cervical mucus study. The subjects had not used hormonal contraception for at least three months prior to investigation. They were counseled to use condoms during this study and also to refrain from intercourse during the period of cervical mucus sampling. Follicular development and endometrial thickness were analyzed by transvaginal sonography. Cervical mucus examination, sperm penetration test, and transvaginal sonography were performed during the control cycle and during the first cycle of Uniplant use. Blood samples were taken for the measurement of estradiol, LH, and progesterone. Cervical mucus and sperm penetration tests were evaluated according to the World Health Organization (WHO) criteria. In the treated cycle, when cervical mucus reached a score of 8-10, Uniplant was inserted, independent of the day of the cycle. Cervical mucus was then collected at 0, 4, 8, 12, 24, 48, and 96 h later until a marked change in volume, consistency, ferning spinnbarkheit, and cellularity was observed. All samples were also used for sperm penetration test. Preovulatory estradiol and LH peak decreased significantly compared to pre-implant insertion. Progesterone levels were within the normal limit. Cervical mucus and sperm penetration tests were not affected by Uniplant in the first 12 h. Twenty-four hours after Uniplant insertion, cervical mucus and sperm penetration tests were affected in 70.6% of the women. Forty-eight hours after implant insertion, the women were affected. Follicular rupture occurred in the majority of the women 48 h after implant insertion. Based on these results, it is possible to conclude that Uniplant can affect estradiol and LH preovulatory peaks and disrupt the process of cervical mucus production and sperm penetration, but it was unable to prevent ovulation when inserted in the preovulatory phase.

Adult↗

Long-acting steroidal contraception: an update.

Long-acting, injectable contraceptives first became available in the 1960s. It is currently estimated that almost 3.5 million women are now using depo-medroxyprogesterone acetate (DMPA); 800,000 are using norethindrone enanthate (NET-EN), and another few hundred thousand are using a variety of once-a-month injectables comprised of progestin plus estrogen. The advantages of injectable contraceptives are that they are highly effective, independent of coitus, easily administered, and they ensure regular contact with health services personnel. The last factor may be considered a disadvantage by some, since contact is more frequent than would be required for routine health services. The major disadvantage of the progestin-only formulations is disruption of normal menses, giving rise to unpredicted episodes of bleeding and spotting. With the once-a-month formulation, on the other hand, there are few discontinuations due to disruption of menses. For a long-acting method to be used longer than 6 months, it is desirable to choose an implant, since the method can be discontinued at will. The first implant system to be developed was Norplant, a set of six rubber capsules filled with levonorgestrel and implanted under the skin. The implant releases sufficient levels of medication to protect against pregnancy. For the first 5 years, the average failure rate was four or five per thousand users per year. The failure rate for women using standard oral contraceptives is approximately 20 to 50 per thousand. The most common side effect of the implant method is the disruption of the menstrual cycle, an effect that is particularly marked in the first month of use.(ABSTRACT TRUNCATED AT 250 WORDS)

Contraception↗

[Parenteral contraceptive drugs: depot progestins].

Depot progestins as injectables, implantables or vaginal rings are suitable for contraception in those female patients, in which risk factors (e.g. cardiovascular risk) exclude the use of estrogen-progestin mixtures. In this paper the mode of action, indications, contraindications, advantages and disadvantages of the various methods using depot-progestins are discussed. Injectables contain either medroxyprogesterone acetate or norethistronenantate; both steroids are released slowly within a limited time interval (2 to 4 months) out of a depot. The major effect is a change of the cervical mucus. Side-effects are disturbances of the menstrual cycle (e.g. breakthrough bleedings) as well as an amenorrhea after frequent use (up to 50% of all cases). The subdermal implantables (Norplant 2 or 5) release levonorgestrel out of a depot over a time period of at least 5 years. Steroid plasma levels are lower than in those patients using a progestin-only pill. Side-effects of implantables are disturbances of the menstrual cycle (e.g. breakthrough bleeding); in patients who desire to conceive a child or suffer from undesirable side-effects the implantables can be removed at every time. The progestin releasing vaginal rings are in a stage of controlled clinical trials. The advantages depend on ethe easy mode of administration (implantation or removal). Side-effects are also breakthrough bleedings.

Administration, Intravaginal↗

Pattern of clinical features of Kawasaki disease.

OBJECTIVE: To study the pattern of clinical features, complications, and outcome of Kawasaki disease among Saudi children. METHODS: Medical records and referral letters of all children (1997 through to 2001) diagnosed with Kawasaki disease were reviewed. This study was carried out at King Faisal Specialist Hospital and Research Center, Riyadh, Kingdom of Saudi Arabia. Collected data included clinical features, laboratory results, echocardiogram findings, therapy, complications and outcome. RESULTS: Thirteen children (10 boys, 3 girls) were reviewed, age range from 0.3 to 7 years (mean 3.4 years). Nine patients met 5 out of 6 criteria for the diagnoses of Kawasaki disease and 4 met 4 out of 6 criteria and coronary aneurysm. Thirteen patients had fever and skin rash for more than 5 days, 12 had extremity and oral mucus changes, 9 had bilateral conjunctivitis, and 7 had cervical lymph node enlargement. Other associated clinical features include diarrhea, and aseptic meningitis in 3 patients, ischemia of the fingers and toes in 2, arthritis in 2, arthralgia in one, seizure and pneumonia in one. Hepatosplenomegaly, pancytopenia and elevated liver enzymes in one, hepatomegaly and normal liver enzymes in 2 patients. Cardiac complication seen in 4 patients (30%), all of them were boys, 3 had coronary artery aneurysm (4-7 mm) and one had giant aneurysm (9mm), one of the 3 patients had axillary and subclavian artery aneurysm as well. Two out 4 patients were treated with intravenous immunoglobulin and aspirin within 10 days of illness and one was treated on day 21 and one was treated with aspirin alone. Aneurysmal changes persisted in 3 patients and resolved in one patient who was treated early. Extra-cardiac complications include reaction to intravenous immunoglobulin, coagulopathy, thrombocytopenia, hemophagocytic syndrome and ischemia of peripheral extremities. CONCLUSION: Our observation showed a high percentage (30%) of coronary aneurysm and unusual complications, this is most likely due to delay in the diagnosis and initiation of treatment.

Child↗

Changes in the sialic acid concentration in the major cervical glycoprotein from the bonnet monkey (Macaca radiata) during a hormonally induced cycle.

The major macromolecular component of monkey cervical mucus has been purified from crude monkey cervical mucus at various times during a hormonally induced estrous cycle. The major component, a high-molecular weight glycoprotein, was secreted in large amounts in midcycle mucus. The glycoprotein exhibited human blood group B activity and contained the same concentration of L-fucose, D-galactose, N-acetyl-D-galactosamine, and N-acetyl-D-glucosamine during the cycle. There were no changes in the amino acid composition or in the number of carbohydrate side chains. There was a significant increase in the amount of sialic acid in the glycoprotein purified from midcycle mucus. Changes in the specific viscosity and the far ultraviolet circular dichroic spectra were also observed. The possible control of sperm penetration by the glycoprotein is discussed.

ABO Blood-Group System↗