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Recent advances in female sterilization.

Advances in female sterilization have been made over the last five years in both its techniques and medico-social acceptance. Prior to 1970, the majority of tubal sterilizations were carried out by partial or complete surgical excision of both tubes by laparotomy in most cases, or by partial salpingectomy by an anterior or posterior colpotomy in selected cases. The traditional operations by the abdominal route comprised the Madlener method, the Pomeroy method, the Irving method and the Aldridge method. These methods will not be discussed further.

Anesthesia, Local

The I-R system of hybrid dysgenesis in Drosophila melanogaster: influence on SF females sterility of their inducer and reactive paternal chromosomes.

A specific kind of sterile F1 female, denoted SF, arises when females from strains known as reactive are crossed with males from the complementary class of strains (inducer). It has been shown that this sterility results from the interaction between the maternal reactive cytoplasm and any one of the paternal inducer chromosomes. This interaction yields other dysgenic traits including non-disjunction and mutations. In this note, the abilities of paternal gametes containing various combinations of inducer and reactive chromosomes to give more or less sterile SF females when fertilising standard reactive oocytes were compared. Although they did not cause SF sterility, reactive chromosomes, when present in sperm containing at least one inducer chromosome, were found to influence the intensity of sterility: variations of SF sterility were observed between SF females which differed only by one paternally inherited reactive chromosome. Reactive chromosomes are known to control the cytoplasmic state of reactive females. The present results suggest that this chromosomal control also takes place in SF females.

Animals

Non-mendelian female sterility in Drosophila melanogaster: hereditary transmission of I factor.

Systematic crosses between various strains of Drosophila melanogaster lead in some cases to partly sterile F1 females. Two main classes of strains, inducer and reactive, may be recognized on the basis of the fertility of F1 female progeny. Females which may show incomplete sterilty (SF female) arise only when reactive females are crossed with inducer males, other crosses, including the reciprocal, producing only fertile F1 females. SF sterility appears as the result of an interaction between two factors, R brought into the initial cross by the reactive mother and maternally inherited, and I brought by the inducer father. The present paper reports on the hereditary transmission of I factor. It is shown that when transmitted through heterozygous males, bearing chromosomes of both inducer and reactive origin, I factor may be strictly linked to any one of the three major chromosomes of inducer strains. Such chromosomes carrying I factor were called inducer chromosomes. When transmitted through heterozygous females, this Mendelian behavior fails to hold, and non-inducer chromosomes coming from reactive strains may become inducer independently of the production of recombined gametes. This phenomenon was called chromosomal contamination. This contamination occurs even between nonhomologous chromosomes.

Animals

[Non-mendelial female sterility in Drosophila melanogaster: demonstration of an inducer chromosome 4].

Crosses between two classes of Drosophila melanogaster strains (reactive and inducer) may lead to partially sterile F1 females. This sterility, called S.F. sterility, can be characterized by its physiological features. It appears to be the result of an interaction between two factors: "R" brought into the initial croos by the reactive mother and "I" by chromosomes of the inducer father. Except for chromosome 4, each chromosome of the well known inducer strains may carry the I factor (inducer chromosomes). The present results provide evidence for the presence of an inducer fourth chromosome in the inducer strain Nagasaki.

Animals

An inexpensive laparoscopy system for female sterilization.

Laparoscopy has become an established procedure for female sterilization. The cost of the equipment remains excessively high, thereby reducing its availability to all physicians and patients who desire and need it. We have described an inexpensive--but highly effective--female sterilization system utilizing equipment that should cost in the range of $400.00.

Adult

Fine mapping of the dominant female sterility gene and novel model of hybrid seed production in cabbage (Brassica oleracea L. var. capitata).

Hybrid breeding based on male sterility requires the removal of male parents, which is time- and labor-intensive; however, the use of female sterile male parent can solve this problem. In the offspring of distant hybridization between Brassica oleracea and Brassica napus, we obtained a mutant, 5GH12-279, which not only fails to generate gynoecium (thereby causing female sterility) but also has serrated leaves that could be used as a phenotypic marker in seedling screening. Genetic analysis revealed that this trait was controlled by a single dominant gene. Further analysis revealed that Bo2g005230, an orthologous gene of LATE MERISTEM IDENTITY1 (LMI1) in Arabidopsis, was predicted as the candidate gene and was renamed BoLMI1c. Sequence analysis revealed that homoeologous exchange (HE) occurred within the BoLMI1c gene body of 5GH12-279, which resulted in the generation of a novel fusion transcript. Two pairs of primers, N5230-1F/1R and N5230-2F/2R, were designed and successfully used for the identification of different genotypes of BoLMI1c. Transcriptome analysis revealed that BoLMI1c orchestrates the expression of several related biological processes and transcription factors. Furthermore, we found that self-pollination with mason bees produced no seeds in 5GH12-279, whereas the near-isogenic line 5GH12-170 produced seeds that were normal. Therefore, a new labor-saving hybrid seed production system with no need to remove the male parents, which is especially important for mechanized harvest in the future, has been proposed. Our study provides a valuable source of dominant female sterility and suggests the potential utilization of the female sterile line in hybrid breeding for mechanized harvest.

Plant Infertility

Female sterilization in small camp settings in rural India.

In an effort to provide female sterilization services in areas that lack modern surgical facilities and highly trained personnel, while avoiding the high complication rates associated with mass sterilization programs, small sterilization camps were held at six rural primary health centers (PHCs) in the Baroda District, Gujarat, India, beginning in 1972. Data collected for 2,009 women undergoing sterilization by the Pomeroy technique at these camps showed an operative and immediate postoperative complication rate of 2.1% and an early postoperative complication rate of 6.7%. These rates compare well with those found in sterilization series performed in modern, well equipped urban settings, further demonstrating that the small camp is an appropriate facility for female sterilization in rural India.

Adult

Alternatives to female sterilization.

With national policies aimed at reaching zero population growth in the shortest possible time, many countries have introduced restrictive legislation and disincentive programs in an attempt to decrease family size norms to 2 or 3 children. As a result, younger women of lower parity are being sterilized, with consequences that will be seen in the years to come. Although female sterilization is usually associated with minimal complications and side effects and is highly effective without continuing motivation or promotion, it has the disadvantage of causing permanent, essentially irreversible sterility. Therefore, it will not be readily acceptable to a large portion of the population. For many women, alternatives must be sought. Reversible methods of female or male sterilization, longacting systemic contraceptives, longacting implants, and immunization against implantation or sperm antigens are potential alternatives, but all are still in experimental stages of development. Intrauterine devices and injectables are the 2 most effective alternatives now available. The use of intrauterine devices with abortion as a backup in case of contraceptive failure ranks high as an alternative to female sterilization.

Animals

Minilaparotomy for female sterilization: a feasibility study of a new technique.

Female sterilization via a minilaparotomy incision was performed on 30 patients at Al-Azhar University Teaching Hospital in Cairo, Egypt. A uterine sound fed through a Foley catheter was used as a uterine elevator. A 2 cm suprapubic transverse laparotomy was performed and sterilization was accomplished by fimbriectomy. Twenty patients received general anesthesia and 10 patients initially received local anesthesia. Surgical time ranged from 7 to 15 min, and the average duration of hospitalization was 8 hours. Blood loss was small, and no patient was transfused. One patient had a wound infection. This pilot study indicates that this procedure is relatively simple, safe and inexpensive.

Female

Communicating through satisfied adopters of female sterilization.

Communication patterns between 127 satisfied adopters of female sterilization (agents) and 257 potential adopters of family planning (recipients) were examined in this study conducted in a rural community in southern India. The influence of satisfied adopters relative to other family planning communication agents was evaluated. Satisfied adopters were identified as the most important source of family planning information by 55 percent of agents and 74 percent of recipients. Communication usually occurred between persons of similar caste, occupation, education, and income.

Communication

Progesterone treatment increases pituitary oestradiol retention in the ovariectomized normal female rat but not in the male nor in the androgen- or oestrogen-sterilized female rat.

Pituitary retention of [3H] oestradiol in ovariectomized rats was measured following in vivo progesterone pre-treatment and found to be significantly increased after 48, 72, 96 and 120 h of pre-treatment. Increased [3H]-oestradiol retention was also observed for at least up to 72 h after removal of the progesterone pre-treatment source. This retention was measured as DPM per mg dry tissue weight. [3H] Oestradiol retention was also measured in the nuclear fraction of tissues incubated with [3H]-oestradiol in vitro. Following 72 h of in vivo progesterone pre-treatment, the nuclear fraction from the pituitary was found to retain significantly more [3H]oestradiol than corresponding fractions from non-treated animals. In contrast to ovariectomized females, no increase in [3H]oestradiol retention was found in the pituitary of orchidectomized males pre-treated with progesterone for 72 h. [3H]Oestradiol retention by pituitaries of ovariectomized rats injected on the day of birth with 200 mug oestradiol benzoate (OeB) or 500 mug testosterone propionate (TP) was significantly decreased in comparison to control animals. When the rats were pre-treated in vivo with oestradiol for 6 or 72 h and [3H]oestradiol retention was measured 6 or 24 h after this pre-treatment, the OeB and TP treated animals retained significantly less [3H]oestradiol under most treatment conditions. Progesterone pre-treatment for 24 or 72 h in vivo followed by measurement of [3H]oestradiol retention immediately or 6 or 24 h later resulted in a significant increase in [3H]oestradiol retention for the control animals. In contrast, the neonatally OeB or TP treated animals differed significantly by not showing increased retention. When [3H]oestradiol retention of the pituitary was measured in vitro following homogenization at 0 degrees C and incubation at 37 degrees C for 1 h, the nuclear fraction from both OeB and TP treated animals was found to retain less hormone per unit DNA; however, this decrease was significant only for the TP animals. Thus, males and androgen- or oestrogen-sterilized females have an altered and reduced augmentation of pituitary oestradiol retention in response to both oestrogen and progesterone pre-treatments.

Animals

Female sterilization. II. A comparison of methods.

An analysis was made of 1757 female sterilization procedures performed over a 5 1/2-year period. The majority of these were accomplished by one of 8 technics: puerperal abdominal tubal ligation (TL), cesarean section plus TL, hysterotomy plus TL, interval abdominal TL, colpotomy TL, laparoscopic TL, vaginal hysterectomy, and abdominal hysterectomy. The various technics have been compared with respect to 55 variables. The procedures having the shortest hospital stay, lowest morbidity, lowest blood loss, and shortest operating time were interval laparoscopic TL, colpotomy TO, and puerperal abdominal TL. The more major procedures were attended by significantly more morbidity and longer hospitalization and should be used only when specific indications justify the increased cost and risk.

Adolescent

Non-mendelian female sterility in Drosophila melanogaster: quantitative variations in the efficiency of inducer and reactive strains.

Crosses between various strains of Drosophila melanogaster lead in some cases to a quite typical female sterility which involves non-mendelian hereditary factors. On the basis of the fertility of F1 females, strains can be divided into three classes: Inducer, Reactive and Neutral. Females showing various degrees of sterility arise when reactive strain females are crossed to inducer males. The degree of sterility depends on the particular reactive and inducer strains used in the cross. Quantitative variations in the efficiency of inducer and reactive strains to produce sterile F1 females are studied in the present paper. The results indicate that the order which can be established within a set of reactive strains for this efficiency is largely independent of the inducer strain which is chosen for the cross.

Animals

Female sterilization via minilaparotomy.

A simple, safe, economical and potentially reversible technique for female sterilization via minilaparotomy is evaluated in 204 patients (not recently pregnant and postpartum). Only light general anesthesia is required, and the procedure is performed with only equipment normally available in any hospital or outpatient clinic. A 2cm circumumbilical or suprapubic incision is made, and the physician manipulates the uterus to bring the fallopian tube in line with the incision. As the cornu passes the incision, the release of intraabdominal pressure at the site of the wound usually pushes the tube out of the peritoneal cavity. A majority of the procedures were performed in less than five minutes. No surgical difficulties were encountered, and no immediate complications or complaints were reported. Patients were usually hospitalized for one or two nights. Early postoperative complications or complaints were reported for 8.4% of the not-recently-pregnant patients and for 4.1% of the postpartum patients at the 7-to-21-day follow-up visit. The most frequently reported complications and complaints were fever and lower abdominal pain. Further studies to determine the effectiveness of this type of sterilization and whether the procedure can be performed safely with local anesthetics and on an outpatient basis are being planned.

Adult

Risks and benefits of culdoscopic female sterilization.

This paper reviews the risks and benefits of the culdoscopic approach to female sterilization in an alnalysis of 2153 culdoscopic sterilization procedures performed at 11 centers in nine countries. Inability to occlude the tubes as planned was reported for approximately 6.0% of the cases including 1.4% in which one or both tubes could not be occluded by any technique. Surgical difficulties were reported for about 13.0% of the procedures, and surgical complications, of which the most frequent was torn or bleeding tubes, occurred in 2.0% of the cases. Pregnancy rates were significantly higher for patients whose tubes were occluded by tantalum clips (7.7 per 100 women at 12 months), indicating that this is not the preferred technique of tubal occlusion; the 12-month life table pregnancy rates were 0.1 per 100 women for tubal ring and 0.0 for Pomeroy and fimbriectomy. Comparison of these data with similar pooled data on laparoscopy and minilaparotomy indicates that culdoscopy is associated with greater technical difficulty and morbidity. Thus, abdominal procedures will continue to be preferred for use in most large-scale programs.

Culdoscopy

Isolation and characterization of sex-linked female-sterile mutants in Drosophila melanogaster.

The purpose of the experiments described was to identify X chromosome genes functioning mainly or exclusively during oogenesis. Two mutagenesis experiments were carried out with ethyl methane sulfonate. Following treatment inducing 60% lethals, 9% of the treated X chromosomes carried a female sterility mutation which did not otherwise seriously affect viability. Among--95 isolated mutants, 19 were heat-sensitive and 5 cold-sensitive. The mutants have been classified as follows: I (16 mutants; 12 complementation groups): the females laid few or no eggs; the defect concerned either ovulation or oogenesis. II (37 mutants; 18 complementation groups): the female laid morphologically abnormal eggs, often with increased membrane permeability. III A (13 mutants; at least 8 complementation groups): the homozygous females were sterile if mated to mutant males; their progeny (homo- and hemizygous) died at a late embryonic stage (11 mutants), at the larval stage (1 mutant) or at the pupal stage (1 mutant). However fertility was partly restored by breeding to wild-type males as shown by survival of some heterozygous descendants. III B (29 mutants; 22 complementation groups): the fertility of the females was not restored by breeding to a wild-type male. Most of the eggs of 13 of the mutants died at a late stage of embryogenesis. The eggs of the others ceased development earlier or, perhaps, remained unfertilized. The distribution of the number of mutants per complementation group led to an estimation of a total of about 150 X-linked genes involved in female fertility. The females of three mutants, heat-sensitive and totally sterile at 29 degrees, produced at a lower temperature descendants morphologically abnormal or deprived of germ cells. Three other mutants not described in detail showed a reduction in female fertility with many descendants lacking germ cells. A desirable mutant which was not recovered was one with normal fertile females producing descendants which, regardless of their genotype, bore specific morphological abnormalities. The value of the mutants isolated for analysis of the complex processes leading to egg formation and initiation of development is discussed.

Animals

Female sterilization.

Sterilization of the female is emerging as a popular method for the permanent regulation of family size in developed countries, and as one of the more effective methods of population management in developing countries. As women move from poor rural cultures to more affluent urban ones, cultural and religious objections to permanent family planning disappear under the pressures of greater child survival and more hope for self- (and child) improvement. Postpartum sterilization remains the most appropriate and attractive method in terms of timing and technique, but interval sterilization (done in the absence of pregnancy) has stimulated interest in minilaparotomy, laparoscopy, and particular concern as to reversibility of sterilization. The techniques of sterilization will be reviewed as to their relative appropriateness in different cultures and different practices, as well as the problems of reversibility.

Clinical Competence

Female sterilization using an elasticated silicone ring.

This paper presents the experience, in a District General Hospital, of using an elasticated silicone ring applied to the Fallopian tubes by the laparoscope. It is concluded that this is a safe and effective method of female sterilization, with good patient acceptance.

Adult