Dimensions of the endometrial cavity and intrauterine device expulsion or removal for displacement: a nested case-control study.

OBJECTIVE: To evaluate the effect of the dimensions of the uterine cavity in relation to the expulsion, or removal for displacement, of intrauterine devices (IUDs) MLCu375 and TCu380A. DESIGN: A case-control study nested in a multicentre clinical trial. SETTING: Eighteen family planning clinics in China. POPULATION: Forty-eight pairs of TCu380A users and 118 pairs of MLCu375 users. METHODS: The women were classified as cases if IUD expulsion or displacement occurred during the first year of follow-up after insertion. One control was randomly selected for each case matched by IUD model, centre, age, service provider for insertion, and date of insertion. Axial length of the uterine cavity (LUC) and the largest transverse diameter of the coronal section of the uterine cavity (LTD) were measured using abdominal ultrasound. We used multivariate conditional logistic regressions to estimate the adjusted odds ratios (aORs) of expulsions or displacements among women with different sizes of uterine cavity according to the quartile of LUC and LTD, respectively. RESULTS: Among MLCu375 users, women with LTD ≥ 27 mm had a higher risk of expulsion or displacement (aOR 2.40; 95% confidence interval, 95% CI, 1.02-5.63), after adjusting for the volume of menstrual flow, dysmenorrhoea, parity, uterine position, MLCu375 type, and LUC. Among TCu380A users, the association between LTD ≥ 37 mm and expulsion or displacement (aOR 4.98; 95% CI 1.01-22.49) was statistically significant, after adjusting for LUC and potential confounding factors. CONCLUSION: Our study suggests that LTD should be considered when making the decision of which IUD model to use.

Preventive treatment of intrauterine device-induced menstrual blood loss with tranexamic acid in Chinese women.

OBJECTIVES: To investigate whether tranexamic acid (Transamin) therapy reduces the amount of menstrual blood loss (MBL) and occurrence of menorrhagia after intrauterine device (IUD) insertion. METHODS: Some 175 Chinese women attending for IUD insertion were equally assigned into 2 Transamin groups (1,000 and 500 mg, twice daily) and a placebo group. Their MBL was recorded with a pictorial chart in 3 subsequent menstrual cycles after insertion, while the MBL of 64 patients, collecting used sanitary towels, was also measured by an alkaline hematin method. RESULTS: A significant decline in post-insertion MBL and occurrence of menorrhagia was found in the 2 Transamin groups compared with the placebo group (p<0.05), whereas the difference in the results from the pictorial chart score was not statistically significant between the 1 g group and placebo group. CONCLUSION: Transamin treatment with a generally recommended dosage can effectively reduce the amount of IUD-induced MBL and prevent menorrhagia in Chinese women. A lower dosage than recommended (50% of recommended dosage) may have a similar preventive effect.

Semen quality in a residential, geographic and age representative sample of healthy Chinese men.

BACKGROUND: Population-based study of semen quality is rare in literature. METHODS: Healthy men aged 20-60 years from six Chinese provinces were invited to participate in the study between December 2000 and November 2002. Posters were distributed in the participating counties to enroll 200 subjects from each province. Medians, percentiles, and proportions below lower threshold of the WHO criteria for semen parameters were calculated. Generalized linear models were used to examine the determinants of semen quality. RESULTS: Semen samples from 1191 healthy Chinese men were collected and analysed. The medians (5th and 95th percentiles) were 2.3 ml (1.0-4.5) for semen volume, 65 x 10(6)/ml (20-150) for semen concentration, 154 x 10(6)/ejection (29-421) for sperm count, 19% (5-32) for rapid progressive motility, 46% (29-66) for progressive motility, 67% (47-81) for total motile spermatozoa, 70% (48-88) for sperm viability and 39% (23-76) for normal morphology. Many healthy Chinese men had semen parameter values below the lower threshold of the WHO criteria. Region, age, abstinence duration and season were important determinants of semen quality. CONCLUSIONS: Chinese men have lower values of semen parameters according to WHO standard, and a lower threshold for normal semen parameters for Chinese men should be considered.

[Immunocytochemical localization of fertilin beta on human sperm].

Fertilin is a kind of sperm plasma membrane protein that mimics snake venom protein. It belongs to the ADAMs family of surface proteins that contain a disintegrin and a metalloprotease domain. Fertilin functions in the sperm-egg binding process by connecting the sperm to the egg plasma membrane via a binding site in the disintegrin domain of fertilin beta (HF93). Its localization on the sperm is in the change. In this study, the monoclonal antibody against human fertilin beta was prepared and used to analyze the localization of fertilin beta on capacitated and acrosome-reacted sperm by immunofluorescence and immunoelectron microscopy techniques. The results were as follows: (1) fertilin beta became restricted to the anterior head during the course of capacitation. (2) During the course of acrosome reaction, the expression and localization of fertilin beta changed immensely on the anterior head and restricted to the lateral of posterior head at last. The restrictions of fertilin beta to the anterior head of capacitated sperm of human beings indicated that fertilin beta may be involved in the binding the sperm to the epithelial cells of the oviduct; the restrictions of fertilin beta to the posterior head domain of acrosome-reacted sperm implied its function in sperm-egg binding and fusion.

Choice and changes of contraceptive methods after primiparous delivery in Shanghai.

PIP: This study assessed the contraceptive method of choice and tendency of method switching of women after their first birth in Shanghai, China. The assessment was based on 15 months follow-up after the first delivery. Included in the study were 3701 primiparous women aged 18-43 years, with 1833 women living in an urban area and 1868 living in a rural area. Results showed that 15 months after delivery 95.46% had already used a contraceptive method. The leading first choice among urban women was the condom (50.72%), followed by the IUD (29.09%), while the leading first choice among rural women was the IUD (56.65%), followed by the condom (30.60%). Among women who had never used a contraceptive method, 33.77% of urban women and 18.52% of rural women switched method 15 months after delivery. The major reason for the contraceptive method switching was method failure attributed to improper use. Furthermore, the choice of contraceptive method after first birth varied significantly by women's characteristics. Urban, well-educated women, breast-feeding women and older women preferred the condom and the rhythm method over oral contraceptives. Family planning workers should increase women's awareness of the benefits and disadvantages of different contraceptive methods, dispel myths, and improve women's informed choice.^ieng

Application of artificial neural networks to contraception study.

PIP: The artificial neural network (ANN) is a newly developed science formed from the interaction of computer science, information science, and medicine. Its practical application has been enhanced by use of the Back Propagation NN. This network transmits information from the input to the output layer in a unidirectional manner and must be trained to make discriminant analyses. The coefficients of the ANN have a significance similar to those of statistical regression coefficients. This paper applied the ANN model to data from a cohort study of postpartum breast feeding and contraceptive behavior (especially IUD selection) in Shanghai, China. The receiver operating characteristic curves of the trained Back Propagation NNs with hidden layers were superior to the logistic regression model for both training and testing data and could be used to determine an appropriate probability level to use as a cutoff for whether women would or would not select an IUD. Not only were the regression coefficients of the logistic regression model and the regression model of Back Propagation NN almost equal, but also the errors of the two models were similar. This finding attests to the potential applicability of the ANN model to family planning and medicine. The training, validation, and testing data all should be randomly selected from the total patterns to ensure representativeness.^ieng

Infertility in a rural area of Jiangsu Province: an epidemiological survey.

Using a random stratified, multistage, and probability sampling procedure, the rate of infertility in the rural area of Jiangsu Province was determined through interviews with 2,578 married women of reproductive age. The overall infertility rate was 5.0%. A significantly higher rate was found for couples in which the husbands were engaged in cotton farming. The study also confirmed the higher infertility rate among smokers found in other studies. The infertility rate was much higher in the Northern Jiangsu Distinct than in the Southern District, suggesting a relationship between infertility and economic/educational conditions.

[A cohort analysis of the fertility of the July 1 People's Commune in Shanghai, County].

PIP: The survey was conducted in February-March 1981. The population of this commune at the end of 1980 was 18,608. The cultural and educational levels, economic condition, and work in family planning of this commune form a typical example among numerous similar communes in Shanghai County. The birthrate, natural growth rate, and average fertility rate began to decline in the later half of 1950s and reached the lowest level in 1974. The survey shows a delay in the marriage age. The fertility rate also dropped by 21.31% from 1963 to 1980. The average fertility rate dropped by 162.73% from 1963 to 1980. Among the women of childbearing age, 99% of them have a knowledge of birth control measures, 95% of them have used them before, and 78% are currently using them. All these figures show that the work in family planning in the commune has reached a high level by world standards. 3 factors which have a strong impact on fertility are: the economic and educational level, formation of population elements, and family planning work. A rise in the standard of living and improvement in education normally leads to late marriage and a decline in fertility. An increase in the number of women of childbearing age causes a rise in fertility. The population growth after 1974 is a reflection of this situation. The survey shows that the decline in fertility before 1973 was caused mainly by family planning work.^ieng