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Contraception Journal
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Contraception Highlights September 2013

Thinking (Re)Productively
Expert analysis on pressing issues from the Association of Reproductive Health Professionals

Delivering on MPTs: addressing the needs, rising to the challenges and making the opportunities
R. Karl Malcolm, Susan M. Fetherston
The Greek philosopher Plato famously remarked that, “necessity is the mother of invention”. Or, in more contemporary language, difficult situations inspire ingenious solutions. Let's hope this popular proverb holds true — the (re)emerging and reenergised research area of multipurpose prevention technologies (MPTs) will undoubtedly need a double measure of inspiration, creative thinking and tenacity to help begin address some of the priority issues within reproductive and sexual health. The underlying facts are both startling and sobering: each year, 40% of the > 200 million pregnancies worldwide are unintended and 448 million treatable sexually transmitted infections (STIs) [i.e. not including syphilis, HIV, herpes simplex virus (HSV), and human papillomavirus (HPV)] are contracted; > 80% of HIV infections are now acquired through sexual transmission. Young women in developing countries disproportionately bear the brunt of these health risks, although teenage pregnancy and STI rates are also worryingly high and increasing in many developed countries. Login to read the full editorial

Editorial

Featured research at the 2013 North American Forum on Family Planning
Carolyn Westhoff, Lawrence Finer, Stephanie Teal
The Society of Family Planning (SFP) and Planned Parenthood Federation of America will host the third annual North American Forum on Family Planning (the Forum) in Seattle on October 6–7, 2013. The Forum is a venue for cutting-edge research on contraception and abortion, mainly through investigators presenting results for the first time to an audience of their peers. Peers also reviewed the abstracts submitted, and the forum's scientific committee accepted 143 abstracts for presentation at the meeting. The committee selected 20 of the top-ranked abstracts for an oral presentation and chose to highlight four in a plenary session. These four abstracts span the wide range of research currently underway in our field.
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Commentaries

Controversies in family planning: arteriovenous malformation
Jennefer A. Russo, Laura Gil, Teresa DePiñeres
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Controversies in family planning: desired pregnancy, IUD in situ and no strings visible
Carter Owen, Stephanie Sober, Courtney A. Schreiber
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Surgical aspects of removal of Essure microinsert
Catherine M. Albright, Gary N. Frishman, Bala Bhagavath
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Antenatal contraception — simple, feasible, but is it safe and ethical in resource-poor environments?
Rudiger Pittrof, Veronique Filippi, Der Adolphe Somé, Georges Compaore, Nicolas Meda
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Clinical Guidelines

Interruption of nonviable pregnancies of 24–28 weeks' gestation using medical methods
Jamila B. Perritt, Anne Burke, Alison B. Edelman
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Review Article

A review of evidence for safe abortion care
Nathalie Kapp, Patti Whyte, Jennifer Tang, Emily Jackson, Dalia Brahmi
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Original Research Articles

Effect of a new oral contraceptive with estradiol valerate/dienogest on carbohydrate metabolism
Vincenzo De Leo, Franca Fruzzetti, Maria Concetta Musacchio, Valeria Scolaro, Alessandra Di Sabatino, Giuseppe Morgante
Background: Insulin resistance may be induced by both the estrogen and progestin component in hormonal contraception. When estrogen dose is reduced from 50 to 20 mcg, the extent of hyperinsulinemia decreases. Recently, the oral combination contraceptive (COC) containing estradiol valerate (E2V) in combination with dienogest (DNG) was developed in a new estrogen step-down, progesterone step-up dosing strategy (Qlaira, Bayer Healthcare Pharmaceuticals). This study was conducted to evaluate of the effect of a 3-month treatment with E2V/DNG on carbohydrate metabolism in women with polycystic ovarian syndrome (PCOS) and insulin resistance.
Conclusions: Median insulin levels at T0 and the mean difference between time 0 and 30 of insulin following OGTT were significantly reduced than values before treatment with E2V/DNG for 3 months. Median BMI and glucose levels were not significantly modified. Natural estradiol and nonandrogenic progestogen in the Qlaira formulation could be recommended as an oral contraceptive in women with PCOS who are insulin resistant or who are overweight.
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Effect of a contraceptive pill containing estradiol valerate and dienogest (E2V/DNG) in women with menstrually-related migraine (MRM)
Rossella E. Nappi, Erica Terreno, Grazia Sances, Ellis Martini, Silvia Tonani, Valentina Santamaria, Cristina Tassorelli, Arsenio Spinillo
Background: Combined hormonal contraception might worsen migraine in sensitive women, especially during the free-hormone interval, and raise concerns about the vascular risk. The characteristics of a contraceptive pill containing estradiol valerate/dienogest (E2V/DNG) might be of potential benefit in women with menstrually related migraine (MRM) who choose to use oral contraception for birth control.
Conclusions: The present diary-based pilot study indicates that the use of a pill containing EV2/DNG for six cycles has a positive effect in women with MRM and suggests an association between dysmenorrhea with COCs use as a potential feature of refractory head pain.
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“We never thought of a vasectomy”: a qualitative study of men and women's counseling around sterilization
Grace Shih, Kate Dubé, Christine Dehlendorf
Background: Sterilization is the most commonly used method of contraception in the United States; however, little is known about how providers counsel about these procedures or the information patients desire. In this study, we explore male and female experiences of sterilization counseling and their perspectives on ideal sterilization counseling.
Conclusions: Contraceptive counseling of couples who have completed childbearing does not routinely include men or the option of vasectomy, despite the advantages of this method with respect to safety, efficacy and cost. Family planning and primary care providers have an important role in ensuring that couples are aware of all their options and can make an informed decision about their contraception.
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Effect of topical vaginal products on the detection of prostate-specific antigen, a biomarker of semen exposure, using ABAcards
Margaret C. Snead, Athena P. Kourtis, Carolyn M. Black, Christine K. Mauck, Teresa M. Brown, Ana Penman-Aguilar, Johan H. Melendez, Maria F. Gallo, Denise J. Jamieson, Maurizio Macaluso
Background: Prostate-specific antigen (PSA) is a biomarker of recent semen exposure. There is currently only limited information on whether topical vaginal products affect PSA assays. We investigated this question using various dilutions of several vaginal products (lubricants and spermicides) and the Abacus ABAcard for PSA detection.
Conclusions: Some vaginal products affect PSA results obtained by using the semiquantitative ABAcard. In vivo confirmation is necessary to further optimize PSA detection when topical vaginal products are present.
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TSPY4 is a novel sperm-specific biomarker of semen exposure in human cervicovaginal fluids; potential use in HIV prevention and contraception studies
Terry A. Jacot, Irina Zalenskaya, Christine Mauck, David F. Archer, Gustavo F. Doncel
Background: Developing an objective, reliable method to determine semen exposure in cervicovaginal fluids is important for accurately studying the efficacy of vaginal microbicides and contraceptives. Y-chromosome biomarkers offer better stability, sensitivity, and specificity than protein biomarkers. TSPY4 belongs to the TSPY (testis-specific protein Y-encoded) family of homologous genes on the Y-chromosome. Using a multiplex PCR amplifying TSPY4, amelogenin, and Sex-determining region in the Y chromosome (SRY), our objective was to determine whether a gene in the TSPY family was a more sensitive marker of semen exposure in cervicovaginal fluids than SRY.
Conclusions: We have demonstrated that TSPY4 is a new sensitive, and sperm-specific biomarker. The multiplex PCR incorporating this new biomarker has potential to be an objective measure for determining semen exposure in clinical trials of vaginal products such as contraceptives and HIV pre/post-exposure prophylaxis agents.
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Women's questions after postabortion insertion of intrauterine contraception
Justin T. Diedrich, Eleanor A. Drey, Christine Dehlendorf, Jody E. Steinauer
Background: Postabortion insertion of intrauterine contraception has the potential to decrease unintended pregnancy and repeat abortions, but little is known about how to ensure that women receive appropriate counseling about this method in this setting. The goal of this investigation was to document women's questions and to assess retention of information provided during contraceptive counseling after immediate postabortion intrauterine contraceptive placement.
Conclusion: Although IUCs are highly effective and their placement in the abortion setting is safe, women frequently have questions and do not recall critical counseling information about IUCs. In order to improve IUC continuation, techniques to improve both patient knowledge retention and anticipatory guidance should be studied further.
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Self-administration of subcutaneous depot medroxyprogesterone acetate by adolescent women
Rebekah L. Williams, Devon J. Hensel, J. Dennis Fortenberry
Background: Intramuscular depot medroxyprogesterone acetate (DMPA-IM) is now available in subcutaneous (SC) formulation, potentially allowing for home-based self-administration. We examined adolescents’ interest in and proficiency at DMPA-SC self-administration.
Conclusions: Many adolescents are interested in and capable of DMPA-SC self-administration with brief education and minimal assistance.
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Examining the role of oral contraceptive users as an experimental and/or control group in athletic performance studies
Kirsty Jayne Elliott-Sale, Stephanie Smith, James Bacon, David Clayton, Martin McPhilimey, Georgios Goutianos, Jennifer Hampson, Craig Sale
Background: This study was conducted to examine the effect of oral contraceptives on endogenous reproductive hormone levels in order to assess the suitability of oral contraceptive users as experimental and/or control groups in human performance studies.
Conclusion: This study indicates that future studies should employ a single pill type and brand when using oral contraceptive users as either a control or experimental group and that comparison between oral contraceptive users as a control group and the early follicular phase of the menstrual cycle as an experimental group should be reconsidered.
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Combined oral contraceptive containing drospirenone does not modify 24-h ambulatory blood pressure but increases heart rate in healthy young women: prospective study
Angelo Cagnacci, Serena Ferrari, Antonella Napolitano, Ilaria Piacenti, Serenella Arangino, Annibale Volpe
Background: Hypertension is a primary cardiovascular risk factor. Oral contraceptives (OCs) may increase blood pressure and cardiovascular events. We evaluated whether an OC containing ethynylestradiol (EE) in association with the spironolactone-derived progestin drospirenone (DRSP) influences 24-h ambulatory blood pressure of normotensive women.
Conclusions: In normotensive women, an OC containing 30 mcg EE plus 3 mg DRSP does not modify blood pressure, and significantly increases 24-h and daytime heart rate. These data suggest a neutral effect on hypertension-associated cardiovascular risk and point out an unreported effect on heart rate of which cause and effect require further evaluation.
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Effects of progestin-only long-acting contraception on metabolic markers in obese women
Nicole M. Bender, Penina Segall-Gutierrez, Sandy Oliver Lopez Najera, Frank Z. Stanczyk, Martin Montoro, Daniel R. Mishell Jr.
Background: The metabolic effects of progestin-only long-acting reversible contraception [levonorgestrel-releasing intrauterine system (LNG-IUS) and etonogestrel implant (ENG-I)] have been studied in normal-weight women but not in obese [body mass index≥30kg/m2] women.
Conclusion: While changes in FG and insulin sensitivity were seen in the present study among obese progestin-only contraceptive users, either progestin-only LARC method may be safely used clinically.
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Characteristics of scheduled bleeding manipulation with combined hormonal contraception in university students
Hannah Lakehomer, Paul F. Kaplan, David G. Wozniak, Christopher T. Minson
Background: There is a lack of information concerning the decision factors and sources of information influencing women who purposefully deviate from the prescribed use of their combined hormone contraceptives to exert elective control of their scheduled bleeding.
Conclusions: The majority of university females who choose to modify their scheduled bleeding cycle with combined hormonal contraceptives do so for convenience rather than to avoid menstrual symptoms, and many learn from nonmedical sources. There is some disparity between the preferences of menstruation frequency and actual scheduled bleeding pattern behaviors, suggesting potential for improvement in patient education.
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Letters to the Editor

Nerve injuries related to etonogestrel implant
Sam Rowlands
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Re: Letter in response to “Neuropathy Associated with Etonogestrel Implant Insertion”
Matthew Brown
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North American Forum on Family Planning Scientific Abstracts 

These scientific abstracts are scheduled for presentation at the North American Forum of Family Planning (the Forum), the combined annual meeting of the Society of Family Planning (SFP) and the Planned Parenthood Federation of America (PPFA). This year, 173 abstracts were submitted for consideration, of which 20 were selected for oral presentation and 123 were selected for poster presentation.
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