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[Problems in the evaluation of contraceptives (author's transl)].

For the evaluation of the effectiveness of contraceptives the Life Table method is at present the best method. It is a disadvantage that the original method of Tietze & Potter was restricted to the evaluation of intra-uterine contraception devices. A Belgian team is now in the process of developing a modified life table method for the evaluation of the effectiveness and the side effects of oral contraceptives. The reference to the Pearl-index for the effectiveness of contraceptives is unclear and in the way in which it is at present used scientifically untenable.

Clinical Trials as Topic

Modified technique for microsurgical vasovasostomy.

A modified technique of two-layer microsurgical vasovasostomy is described which permits continuous inspection of the lumen. A stricture-free anastomosis was documented in experimental animals by mating and scanning electron microscopic studies. The success of this procedure is attributed to precise placement of fine mucosal sutures, minimal fibrosis, and a fluid-tight anastomosis.

Animals

Electrophysiology of the rabbit oviduct following tubal microsurgery.

The ability of tuboplastic microsurgery to restore electrical continuity across an anastomosis site was investigated in the rabbit. Three to six weeks following transection and end-to-end anastomosis of the tubal ampulla or isthmus, the pattern of electrical activity adjacent to and across the anastomosis site was examined. Recordings were made in vitro using arrays of closely spaced suction electrodes 68 to 72 hours after an ovulating dose of human chorionic gonadotropin. The pattern of electrical activity across anastomosis sites was not significantly different from corresponding portions of unoperated control oviducts. Microsurgical anastomosis restored electrical continuity between anastomosed segments in both the ampulla and isthmus.

Action Potentials

End-to-end tubal anastomosis using an absorbable stent.

Using absorbable suture as a stent, end-to-end anastomosis of previously ligated or cauterized fallopian tubes was performed in 15 cases. Luminal patency of at least one fallopian tube has been achieved in all cases, and thus far seven pregnancies have occurred in six cases. The technique for inserting the absorbable suture into the distal and proximal portions of the tube is fully described, and the importance of repeated hydrotubations to maintain tubal patency is emphasized.

Adult

[Celioscopic sterilizations with Yoon rings. 300 cases. Immediate complications, effectiveness and reversibility].

The authors report on a series of 370 sterilisations using Yoon's rings, of which 300 were carried out laparoscopically. They confirm the efficiency of the method and its safety because there was only minimal operative morbidity. On the other hand this technique offers the possibilities of reversal of sterilisation in such a way that it should be the preferred method to be used systematically when a young woman is being sterilised.

Adult

Evaluating acceptance strategies for timing of postpartum contraception.

What is the best time after childbirth to accept contraception? The problem is to reduce overlap with postpartum anovulation, during which contraception is redundant, but simultaneously to reduce the proportion of women conceiving before contraception is inaugurated. Efficiencies of three classes of acceptance strategies at resolving this dilemma are investigated. Particular attention is paid to the postpartum acceptance rule because of its special administrative advantages. Its efficiency relative to those of other rules is found to be enhanced by conditions of short postpartum anovulation, a high proportion of ovulatory rather than anovulatory first menstrual cycles, a high level of natural fecundability, and, especially, a high level of contraceptive continuation.

Anovulation