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NEW RESEARCHES ON CONTRACEPTIVES,IUCD & STERILISATION: ,[object Object],[object Object],[object Object],[object Object]
Testing Can Take Years ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Methods Covered in this Seminar: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Barrier method ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The polyurethane condom (Vs latex) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contd . ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is molecular condom? ,[object Object],[object Object],[object Object],[object Object]
New Female Condoms Are Designed For Better Fit and Lower Cost   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Courtesy of PATH
Contd . ,[object Object],[object Object],[object Object],[object Object],[object Object]
Female condom – femidon, reality ,[object Object],[object Object],[object Object]
Female condom – femidon, reality ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vaginal Barrier Methods Courtesy of the Cervical Barrier Advancement Society
Diaphragm-Like Devices: Easier to Use and Appropriate for Use with Microbicide ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Courtesy of the Cervical Barrier Advancement Society Courtesy of PATH
New Cervical Caps Designed to Reduce Fitting Time ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Courtesy of the Cervical Barrier Advancement Society Courtesy of the Cervical Barrier Advancement Society
Contraceptive Sponges: No Fitting or Prescription Required   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Microbicides Jefferson Jackson Steele
Microbicides Can Reduce Transmission of HIV and other STIs ,[object Object],[object Object],[object Object],[object Object]
How Do Microbicides Work? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Microbicides with contraceptive action: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spermicides: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oral combined contraceptives: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BJOG-2008.
contd: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
↓  EE DOSE: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Regimens in OCP: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Extended regimen: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Drospirenone ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Continuous-Use Regimen Offers New Choice for Pill Users ,[object Object],[object Object],[object Object],[object Object],[object Object]
Extended Cycle Products ,[object Object],[object Object],[object Object],[object Object]
Extended Cycle Products ,[object Object],[object Object],[object Object],[object Object]
Cochrane Review. Cochrane Library 2008 (3) Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Progesterone only pills(minipill): ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cerazette(Organon): ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BJOG-2008.
Mifeprestone as contraceptive: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],WHO-2006.
Injectables: Courtesy of Schering AG
Injectable contraceptives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Combined Injectables Offer Alternative to Progestin-only Injectables ,[object Object],[object Object],[object Object],[object Object]
Combined Injectables Offer Advantages Over Progestin-Only Injectables ,[object Object],[object Object],[object Object],[object Object],BJOG-2008.
New Subcutaneous DMPA Formulation Recently Approved ,[object Object],[object Object],[object Object],Courtesy of PATH Contraception-2004.
Contraceptive Implants Karen Tweedy-Holmes, Population Council
Implantables: progestin Trade name Unit  Duration of action: Levonorgestrel  Norplant 6 capsules 5 years. Etonegestrel Implanon 1 rod 3 years. Nestrone Elcometrine 1 capsule 6 months. Nestrone Elcometrine 1 rod 2 years. Norgestrol Unilant/ Surplant 1 rod 1 year Levonorgestrel  Jedelle/Norplant II 2 rods 5 years
Implanon   ™ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
IMPLANON™ Rate-controlling membrane: (0.06 mm) 100% EVA 4 cm 2 mm Core: 40% ethylene vinyl acetate (EVA) 60% etonogestrel (68 mg) Release Rate : 60   g/day to 70   g/d initially then decreases to  25   g/d to 30   g/d by end of third year ,[object Object]
Implanon   ™ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Implanon ™  applicator
Implanon  ™ ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Implants Have Fewer Rods than Norplant ® ,[object Object],[object Object],[object Object]
New Implants: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BJOG-2008
BIODEGRADABLE IMPLANTS: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BJOG-2008
Vaginal Rings: Left: NuvaRing® (Organon). Right:Nestorone® vaginal ring.
In which way they are advantageous: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Combined Vaginal Rings Offer Better Cycle Control than Oral Contraceptives ,[object Object],[object Object],[object Object],[object Object]
Vaginal rings: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BJOG-2008.
Nuvaring ® ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Progesterone only ring: ,[object Object],[object Object],[object Object],[object Object],[object Object]
Transdermal Contraception Courtesy of Ortho McNeil Pharmaceutical
Transdermal Contraception Delivers Hormones Through the Skin ,[object Object],[object Object],[object Object],[object Object]
Combined Patches: A Good Alternative For Pill Users  ,[object Object],[object Object],[object Object],[object Object],Courtesy of Ortho McNeil Pharmaceutical
Contd. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],J Reprod Med End-2007
Contraceptive patches: Left: Evra (Ortho-McNeil). Right: Fidencia (Bayer-Schering-Pharma).
Contd. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Extended vs. cyclic use of transdermal patch: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spray-On Contraceptives: A New Technique For Hormone Delivery ,[object Object],[object Object],[object Object],Karen Tweedy-Holmes, Population Council  Contraception-2007
Gene-Based Approaches Promise Dramatic Change in Contraception ,[object Object],[object Object],[object Object],[object Object],[object Object]
Intrauterine Devices Courtesy of Berlex
Three Main IUDs Are Used Currently Copper-bearing IUDs Hormonal IUD   TCu-380A Multiload-375 LNG-IUD
New IUDs Make Insertion and Removal Easier and Reduce Side Effects ,[object Object],[object Object],[object Object],Contraception-2008
One of the Most Effective Methods of Contraception ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Progestin-Releasing Mirena IUS Offers Many Advantages Over Cu-IUDs ,[object Object],[object Object],[object Object],[object Object],Courtesy of Berlex
Levonorgestrel-releasing intrauterine systems:  Left: Mirena®; Right: “Small Mirena®”.
Mirena/ LNG 20/ Levonova ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mirena/ LNG 20/ Levonova ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other LNG-IUS: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Flexi Gard/ Cu fix IUD/ Gynefix ,[object Object],[object Object],[object Object]
Flexi Gard/ Cu fix IUD/ Gynefix ,[object Object],[object Object],[object Object]
Silverlily and Goldlily IUDs: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Other IUD under research: ,[object Object],[object Object],[object Object],[object Object],[object Object],WHO-2007
WHO Guidance Allows More Women to Use IUDs World Health Organization, 2004    PID Purulent cervicitis,  chlamydia, or gonorrhea Other STIs HIV AIDS Clinically well on ART Not well on or not taking ART Condition Exists Before Insertion Do not insert (Category 4) Do not insert (Category 4) Generally can insert (Category 2) Generally can insert (Category 2) Generally can insert (Category 2) Usually do not insert  (Category 3) Condition Develops After Insertion Generally can keep her IUD while being treated (Category 2) Generally can keep her IUD while being treated (Category 2) Generally can keep her IUD while being treated (Category 2) Generally can keep her IUD  (Category 2) Generally can keep her IUD  (Category 2) At High Individual Risk for Condition NA Usually do not insert (Category 3) NA Generally can insert (Category 2) NA NA
New Male Contraceptives Courtesy of Shepherd Medical
What can be? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Which male contraceptives  are closest to market? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Inhibitors of spermatogenesis: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hormonal methods ,[object Object],[object Object],[object Object]
Hormones: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
MHCs – What are they? ,[object Object],[object Object],[object Object]
MHCs – How are they reversed? ,[object Object],[object Object],[object Object],The Lancet  -2006.
MHCs – Side effects ,[object Object],[object Object],[object Object],[object Object],[object Object]
nonhormonal : ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Interesting leads - Adjudin ,[object Object],[object Object],[object Object],[object Object],Nature Medicine -2006,Int J Andro-2008.
Interesting leads – RAR antagonist ,[object Object],[object Object],[object Object],[object Object],[object Object]
Contd. ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Male sterilization: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Vasectomy: resection and electrocauterisation
Vasectomy: resection and ligation: A) resection, folding and ligation; B) resection and ligation; C) resection and interfascial positioning.
No-scalpel vasectomy: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],RISUG – What is it? Contraception-1998.
RISUG – How effective is it? ,[object Object],[object Object],[object Object],[object Object],Contraception-1998.
[object Object],[object Object],[object Object],RISUG – Side effects Contraception-2005.
RISUG – How is it reversed? ,[object Object],[object Object],[object Object],[object Object],Sources: Lohiya (2000)  Int J of Andrology  23(1): 36-42. Lohiya (2005)  Contraception  71(3): 214-26. Contraception-2005.
The IVD – What is it? ,[object Object],[object Object],Int J Andro-2008.
IVD – How effective is it? ,[object Object],[object Object],[object Object],[object Object]
IVD – Side effects ,[object Object],[object Object],[object Object],[object Object],Int J Andrology  -2008.
Female Sterilization ,[object Object],[object Object],[object Object],[object Object],[object Object]
Laparoscopic Sterilization: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Sterilization by laparotomy: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What is Essure? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Contd .  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
contd. ,[object Object],[object Object],[object Object],[object Object]
What is Adiana? ,[object Object],[object Object],[object Object],[object Object]
Contd. ,[object Object],[object Object],[object Object]
female sterilisation techniques.  Left: Upper figure: Essure; Lower figure: Adiana Right: Ovabloc (www.ovabloc.com/ovabloc-de/eingriff.html)
[object Object],[object Object],[object Object],[object Object],[object Object]
 
[object Object],[object Object]
THANK YOU

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New Researches On Contraceptives,Iucd & Sterilisation, Mob: 7289915430, www.drpradeepgarg.com,

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  • 12. Vaginal Barrier Methods Courtesy of the Cervical Barrier Advancement Society
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  • 39. Contraceptive Implants Karen Tweedy-Holmes, Population Council
  • 40. Implantables: progestin Trade name Unit Duration of action: Levonorgestrel Norplant 6 capsules 5 years. Etonegestrel Implanon 1 rod 3 years. Nestrone Elcometrine 1 capsule 6 months. Nestrone Elcometrine 1 rod 2 years. Norgestrol Unilant/ Surplant 1 rod 1 year Levonorgestrel Jedelle/Norplant II 2 rods 5 years
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  • 44. Implanon ™ applicator
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  • 49. Vaginal Rings: Left: NuvaRing® (Organon). Right:Nestorone® vaginal ring.
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  • 55. Transdermal Contraception Courtesy of Ortho McNeil Pharmaceutical
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  • 59. Contraceptive patches: Left: Evra (Ortho-McNeil). Right: Fidencia (Bayer-Schering-Pharma).
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  • 65. Three Main IUDs Are Used Currently Copper-bearing IUDs Hormonal IUD TCu-380A Multiload-375 LNG-IUD
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  • 69. Levonorgestrel-releasing intrauterine systems: Left: Mirena®; Right: “Small Mirena®”.
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  • 77. WHO Guidance Allows More Women to Use IUDs World Health Organization, 2004   PID Purulent cervicitis, chlamydia, or gonorrhea Other STIs HIV AIDS Clinically well on ART Not well on or not taking ART Condition Exists Before Insertion Do not insert (Category 4) Do not insert (Category 4) Generally can insert (Category 2) Generally can insert (Category 2) Generally can insert (Category 2) Usually do not insert (Category 3) Condition Develops After Insertion Generally can keep her IUD while being treated (Category 2) Generally can keep her IUD while being treated (Category 2) Generally can keep her IUD while being treated (Category 2) Generally can keep her IUD (Category 2) Generally can keep her IUD (Category 2) At High Individual Risk for Condition NA Usually do not insert (Category 3) NA Generally can insert (Category 2) NA NA
  • 78. New Male Contraceptives Courtesy of Shepherd Medical
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  • 92. Vasectomy: resection and electrocauterisation
  • 93. Vasectomy: resection and ligation: A) resection, folding and ligation; B) resection and ligation; C) resection and interfascial positioning.
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  • 110. female sterilisation techniques. Left: Upper figure: Essure; Lower figure: Adiana Right: Ovabloc (www.ovabloc.com/ovabloc-de/eingriff.html)
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Editor's Notes

  1. Duration of use: TCu-380A: up to 10 years, and may be extended to 12 years Multiload-375: up to 5 years Levonorgestrel-releasing IUD (LNG-IUD): up to 5 years, and maybe longer The U.S. Agency for International Development (USAID) supplies the TCu-380A to developing-country programs. The two other major donors of contraceptives, the United Nations Population Fund (UNFPA) and the International Planned Parenthood Federation (IPPF), provide both the TCu-380A and the Multiload-375. The LNG-IUD, marketed under the brand names Mirena ® and, in some European countries, Levonova ® , has been sold in Europe since 1990. Its high cost and the need to train providers in a new insertion technique have discouraged USAID from distributing it.
  2. Sources: TCu-380A effectiveness: United Nations Development Program, 1997 LNG-IUD effectiveness: Luukkainen, 1987; Sivin, 1984 TCu-380A vs. LNG-IUD comparative study: World Health Organization, 2003
  3. Changes to the WHO guidance now allow women with STIs other than gonorrhea, chlamydia, or purulent cervicitis to have IUDs inserted. Purulent cervicitis is an infection of the cervix with a pus-like discharge from the opening of the cervix. It may be a sign of a gonorrhea or chlamydial infection. There is concern that a woman at very high individual risk of gonorrhea or chlamydia may currently have gonorrhea or chlamydia but without any immediate symptoms. Only laboratory testing would detect these silent infections, and in many places these tests are not available. If a woman lives in a setting with a high prevalence of STIs but she herself is not at increased risk of STIs, then she generally can have an IUD inserted (category 2). WHO Medical Eligibility Criteria Classification: Category 1: Use the method in any circumstances. Category 2: Generally use the method. Category 3: Use of the method not usually recommended unless other more appropriate methods are not available or not acceptable. Category 4: Method not to be used. When clinical judgment is limited, interpretation of Categories 1 and 2: Yes (Use the method.) (shown in green in the chart on this slide) Categories 3 and 4: No (Do not use the method.) (shown in red in the chart on this slide)