CONTRACEPTIVE UPDATE 2014

1. CONTRACEPTIVE UPDATE2014 Thomas Ross, D.O.

3. OBJECTIVES: • Increase understanding of newer contraceptive options • Utilize recommendations for indications and contraindications of popular contraceptive options

4. Teen Pregnancy In 2012, for women ages 15-19 years, the live birth rate was 29.4 per 1,000. This is a record low for U.S. teens and a decrease of 6% from 2011. The decline appears related to a decrease in sexual intercourse and an increase in consistent contraceptive use. Source: CDC

6. However, U.S. teen. pregnancy, birth, STI, and abortion rates are substantially higher than other western industrialized nations. Source: CDC

9. Effective Contraception Highly dependent on education and counseling Still best provided by personal interaction

10. Oral Contraceptives Little recent activity with new products 2 noteworthy options

21. CDCs –U.S. Medical Eligibility Criteria for Contraceptive Use, 2010 Adapted from WHO MEC, 4th Edition

22. MEC CATEGORIES 1 – a condition with no restriction for the use of the contraceptive method 2 – a condition for which the advantages of a method generally outweigh the risks 3 – a condition for which the risks of a method usually outweigh the advantages 4 – a condition that represents an unacceptable health risk if the contraceptive method is used

24. ParaGard Underutilized, but an excellent option for those patients with contraindications to hormonal contraception.

28. EmergencyContraception

29. Bosworth MC, et al

30. Bosworth MC, et al

31. Decreased efficacy with increased BMI Risk of pregnancy increased for women over BMI 25 who used Plan B. Risk of pregnancy after unprotected intercourse was basically the same with or without taking levonorgestrel (5.8% vs. 5.6%) in two randomized trials. Evidence of decreased efficacy was also seen with ulipristal to a small degree.

32. Subsequent studies needed to clarify risk Glasier A, et al. Can we identify women at risk of pregnancy despite using EC? Data from randomized trials of ulipristal acetate and levonorgestrel. Contraception. 2011;84(4):363-367

33. Ulipristal acetate (UPA) a.k.a. ella or ellaOne EC indicated for up to 5 days after unprotected intercourse Works primarily by delaying ovulation – a Selective Progesterone Receptor Modulator Side effects similar to Plan B In clinical trial; 1.8% pregnancy rate vs. 2.6% with Plan B (n=844, 852)

34. A Vaccine Against Pregnancy? New method in development, vaccination against human chorionic gonadotropin (hCG). Antibodies are created by hCG production (when pregnancy occurs), similar to when your body fights an infection. Your immune system attacks the embryo which is producing hCG. The vaccine is effective for approximately one year. Source: Epigee, Feminist Women's Health Center

35. Male Contraception Proving to be problematic and elusive, but a new technique shows promise.

36. Male attitudes are changing! Several recent non-scientific surveys of men have shown over 50% of those responding state they would be willing to use a reversible contraceptive method. The pharmaceutical companies have been very slow to aggressively pursue what they percieve as a limited market.

37. Studies have proven very problamatic The next 3 slides were actually part of a presentation first presented 10 years ago. All 3 options have been unsuccessful, at least so far.

38. Male Hormonal Contraception A combination progestin and androgen therapy holds the most promise Organon is testing, in the U.S. and Europe, an etonogestrel subdermal implant with testosterone injections every 4-6 weeks. This will likely be the first MHC approved by the FDA. It is scheduled to be on the market by 2005, but U.S. availability may be 5 years.

39. What about a male pill? An oral pill containing desogesterel and testosterone is also in clinical trials. Results are very promising. The Population Center for Research in Reproduction at the U. of W. in Seattle is testing several male contraceptive methods.

40. A novel, non-hormonal male contraceptive! Called the “Bright Pill” Dr. Haim Breitbart in Tel Aviv is performing early testing on a compound that blocks protein synthesis by sperm, that is essential for penetration thru the egg’s cell membrane. A single pill may be effective for 1 to 3 months with no decrease in testosterone production.

41. Vas deferens injection Reversible inhibition of sperm under guidance (RISUG) developed in India by Dr. SujoyGuhais a procedure involving injecting a copolymer of styrene/maleic anhydride (SMA) into both vas deferens tubes. This does not obstruct the tubes, but rather damages the sperm as it moves past it. A solution of sodium bicarbonate can flush out this copolymer and restore fertility.

42. Vasalgel Some of the men in India have been using RISUG for highly effective contraception for more than 15 years. Reversibility studies have only been done in animals. In 2010, the Parsemus Foundation purchased the rights to develop RISUG in the U.S. The new polymer is called Vasalgel. Clinical trials were expected to start this year.

43. Best source for male contraception information Kogan P, Wald M. Male Contraception History and Development: Urology Clinics of North America:2014:145-161 Dr. Wald is a urologist at U. of I.

44. Questions and Comments

45. Thank you For everything you do for Iowa women and their families