Intrauterine devices and intrauterine systems

From a public health viewpoint, the intrauterine device (IUD)is the most widely used contraceptive method in the world. Prevalencerates range among countries from 2 to 80% of contraceptive users.During 5 years of IUD use, pregnancy occurs in less than 2 per100 insertions. Bleeding and pain are the most common reasonsfor removal rates of 10% in the first year and up to 50% within5 years. The contraceptive effects of IUDs may be due to a sterileinflammatory reaction in the endometrial cavity which interfereswith sperm function, so that fertilization is less likely tooccur. IUDs also interfere with implantation but the extentto which this contributes to their contraceptive action is unknown.In nulliparous women rates of expulsion and removal for bleedingand/or pain are higher than in parous women. Effective use ofIUDs for up to 10 years has the same pregnancy rate as tubalinterruption. Thus, the IUD may be an alternative to femalesterilization, especially in younger women who are more likelyto experience regret after sterilization. The levonorgestrelintrauterine system (LNG-IUS) reduces bleeding and dysmenorrhoea,provides superior effectiveness to copper IUDs, and may be auseful treatment for endometriosis or an alternative to hysterectomyfor menorrhagia.     

基于各类型材料的宫内节育器、皮下避孕埋植剂及输卵管节育器

背景：明确避孕材料特点、技术手段及对生殖健康的影响,减少非意愿妊娠,降低人工流产率有着重大意义。目的：概述避孕材料的进展、现状及使用情况,综合分析宫内节育器、皮下避孕埋植剂、输卵管避孕材料特点、效果及不良影响,为育龄妇女选择安全可靠的避孕材料提供依据。方法：分别以“宫内节育器、皮下避孕埋植剂、输卵管避孕材料、生殖、健康、避孕方式”为中文关键词,检索中国知网全文数据库1985至2015年有关文献。以“intrauterine contraceptive device,subcutaneous contraceptive implants,oviduct contraceptive,materials,reproductive health,influences”为英文关键词,检索PubMed数据库1985至2015年有关文献,最终选择44篇文章进入结果分析。结果与结论：宫内节育器发展快、受众广,材料可靠、技术成熟,在已育妇女中具有较高的认知度和使用率。皮下埋植剂具有亲和性强,恒释、缓释效果好,操作简单方便等特点。输卵管避孕栓材料生物性、记忆性、耐受性强,具有无创、可复、安全和长效等优点。研究安全、可靠、无不良反应的避孕材料及方法,对保证妇女生殖健康具有积极的现实意义。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

Intrauterine insemination

Fifty-six couples with infertility due either to subnormal sperm(n = 40), hostile cervical mucus (n = 5) or idiopathic infertility(n = 11), were treated with intrauterine insemination of washedsperm. A total of 78 treatment cycles were completed. Nine pregnanciesresulted from these insemination cycles, giving an overall pregnancyrate of 8.3% per treat ment cycle. Eight pregnancies occurredIn the andrologic group after 56 treatment cydes. One pregnancywas established in the patient group with idiopathic infertilityafter 15 treatment cycles, while no pregnancy occurred in thepatient group with infertility due to cervical mucus hostility.The mean number of years of infertility in the couples conceivingfollowing treatment was 7 years (range 3–11). The spontaneouspregnancy rate in this patient group is low. The data obtainedin this study suggest that in selected patients intrauterineinsemination will result in an acceptable pregnancy rate. Thereis a need for a randomized prospective study designed to comparethe efficacy of intrauterine insemination with that of alternativetreatment modalities.     

Intrauterine Transfusion unter Ultraschallkontrolle

Ohne Zusammenfassung     

Intrauterine Transfusion unter Ultraschallkontrolle

Zusammenfassung Bei zwei an einer Rh-Inkompatibilität schwer erkrankten Feten wurde viermal unter hauptsächlicher Benutzung des Ultraschall-Schnittbildgerätes Vidoson 635 (Fa. Siemens) eine intrauterine Transfusion durchgeführt. Die Transfusionsnadeln waren in allen Fällen auf dem Schnittbildmonitor klar erkennbar und konnten bis zur gewünschten Eindringtiefe zielgenau in die fetale Peritonealhöhle gelegt werden. Die Anwendung von Röntgenstrahlen konnte erheblich reduziert werden. Die beschriebene Methode scheint insbesondere für die ungünstigen dorso-anterioren Lagen des Feten geeignet zu sein.     

Intrauterine death from umbilical cord hematoma

Umbilical cord hematoma is a rare cause of intrauterine morbidity and mortality. There have been many theories about the etiology of this entity, but its cause remains unknown. Intrauterine death occurred in a postmature (44 weeks) fetus and was associated with an umbilical cord hematoma. Histologic examination of the cord showed a thinning of the wall of the umbilical vein with splitting of the elastic membrane.     

Intrauterine exposures and risk of endometriosis

BACKGROUND: Intrauterine environmental exposures have been adversely associated with male reproductive health in contrast to limited investigation of such exposures and female reproductive health. METHODS: To address this research gap, a cohort comprising 84 women aged 18-40 years undergoing laparoscopy was recruited prior to surgery and followed through the post-operative period for endometriosis diagnosis. Women were interviewed about environmental exposures and those of their mothers while pregnant with them (use of alcohol, caffeinated beverages and cigarettes). Endometriosis was diagnosed in 32 women from the laparoscopy cohort; 52 women had no endometriosis visualized. Using unconditional logistic regression, odds ratios (OR) and 95% confidence intervals (CIs) were estimated for the intrauterine exposures adjusting for potential confounders. RESULTS: No significant associations were seen between intrauterine exposure to alcohol or caffeine and a diagnosis of endometriosis. Adjusting for age, significant reductions in odds of an endometriosis diagnosis were observed for intrauterine cigarette exposure both in the absence (OR 0.22, 95% CI 0.06-0.82) or presence (OR 0.05, 95% CI 0.01-0.42) of women's current smoking. CONCLUSIONS: While speculative, in utero cigarette exposure may be associated with a lower risk of surgically diagnosed adult-onset endometriosis, possibly as a result of alterations in hormonal milieu or pathologic angiogensis.     

Intrauterine Insemination – eine Übersicht

Intrauterine insemination (IUI) represents a minimally invasive therapeutic option, particularly in cases of slight male subfertility, endometriosis, and idiopathic sterility, and in comparison to extended procedures is a cost-efficient method. However, IUI is frequently handled as a treatment of second choice. Patients who seem to benefit the most from IUI are women under the age of 40 with many follicles and a childwish lasting for 6 years or less without or with only a minor male factor. Ideally, IUI should be combined with gonadotrophin stimulation; only in the case of idiopathic infertility IUI in the natural cycle can be justified. Due to the risk of multiple birth following ovarian stimulation, sonographic monitoring is imperative. After four to six unsuccessful attempts with IUI, consideration should be given to further treatment with in vitro fertilization (IVF).