Hormonal contraception for males--an option for adolescents?

Although effective contraceptive methods are available, the incidence of teenage pregnancies and consecutive pregnancy interruptions remains high in industrial nations, including Germany. There are several reasons for this high incidence. Apart from earlier sexual maturation, the absence of contraceptive use or the use of inefficient methods contributes mainly towards this increase. Existing contraceptive methods for men either show unsatisfying efficacy (coitus interruptus, use of condoms) or problems of reversibility (vasectomy), which limits their broader use. Of the different experimental approaches towards male contraception, the hormonal approach is closest to practical implementation. Androgens are an essential part of all experimental approaches to hormonal contraception in males; they cause suppression of spermatogenesis through gonadotropin suppression. Previous clinical trials have validated the concept of hormonal contraception in men. However, the application modalities and the ineffectiveness of all self-administered androgen preparations have been unacceptable for practical use. Therefore recent developments focus either on androgen implants or on injectable, long-acting testosterone esters in combination with progestins, which also suppress gonadotropin secretion. Over the last decades various combinations of androgen preparations with different progestins or GnRH antagonists have been tested in clinical trials. Of these, testosterone with either depot medroxyprogesterone acetate, norethisterone, desogestrel or etonogestrel have shown promising efficacy in phase II clinical trials. However, whether hormonal contraception might be given to adolescent males remains to be elucidated. This will have to be assessed once a hormonal contraceptive for men has reached the market. Special attention will need to be given to bone maturation as androgens at the prescribed doses might induce premature closure of the epiphyseal joints.     

Which psychological support for couples seeking medical assistance for procreation?

OBJECTIVES: The objective of our qualitative study was to define modalities of psychological support to be offered to couples seeking medically assisted procreation. MATERIAL AND METHODS: Forty couples participated in a semi-structured videotaped interview, which touched on themes such as personal and family histories, the couple's relationship, etc. We focused on the "narrative mobility", that is the way in which the couples transmit their personal and family history during the interview and the interviewer's impression that he may or may not share this with the couples. RESULTS: Observed differences in narrative mobility led us to distinguish three groups of couples and to propose various types of psychological support. DISCUSSION AND CONCLUSION: This exploratory study, with its interest for the narrative mobility, concerns the couples' capacity to stand back from their own story as responsible interlocutors. We made the hypothesis that this capacity is linked to their capacity to handle their emotional stress, to act as partners to the medical team and to prepare themselves for their future parenthood.     

Antiprogestins for contraception?

Antiprogestins could be a very promising group of compounds for contraception because they counteract the effects of progesterone, a key hormone for normal reproductive functioning. Great efforts have therefore been devoted to testing various ways of using these compounds for family planning. Most of this work has involved mifepristone; other antiprogestins have not been available for trials. With a few exceptions, the outcome of the studies performed to date has not met expectations. The most promising approaches seem to be the use of antiprogestins for emergency contraception, perhaps also as a daily pill when the dose is high enough to block ovulation, and in sequential regimens followed by a progestin. Given that antiprogestins differ in their affinity for target organs, better results could possibly be achieved by using more specific compounds than mifepristone. It is hoped that a wider choice of antiprogestational compounds will soon become available for research.     

Which procedure for incontinence?

Approximately 16-29% of women will complain of incontinence at the menopause. A multidisciplinary approach to treatment is essential and surgery is usually reserved for women who have failed to improve sufficiently with conservative measures, such as pelvic floor exercises. The Burch colposuspension remains the 'gold standard' procedure for stress urinary incontinence, against which all newer procedures are compared. It is normally carried out under general anaesthesia and requires an abdominal approach, most often by a low transverse incision. Tension-free vaginal tape (TVT) is the most popular procedure at present and has largely replaced colposuspension in many units. However, there are concerns about both its long-term safety and the lack of data on efficacy beyond the first few years. Initial reports of transobturator tape suggest that it may have a similar efficacy to TVT but with a lower rate of serious complications; however, large comparative studies and longterm follow-up data are currently unavailable. Collagen and silicone injected around the urethra can be used in a selected group of patients under local anaesthetic but the success rates are disappointingly low.     

hCG in screening for aneuploidy: A possible role for its glycoforms?

Fetal trisomy 21 is associated with elevated maternal serum hCG and its free beta-subunit (hCG-beta) in vivo, and abnormal placental hCG production and glycosylation in vitro. Other maternal serum markers may also be disrupted in major aneuploidies (T21, T18, T13). We evaluated our aneuploidy screening practices, focusing on hCG-beta and hCG glycoforms, and retrospectively analyzed 55 aneuploidy cases diagnosed over a 2 year period, determining maternal serum hCG glycoforms profiles using 2D-electrophoresis. Screening efficiency reached 96.7%. T21 was associated with elevated hCG-beta while T18 presented with diminished serum markers. hCG glycoforms tended to be basic in aneuploidy (mainly T13).     

First-trimester combined screening for trisomy 21 in women at risk for α-thalassemia

Objective: To report the strategy of first-trimester aneuploidy screening in pregnancies at risk for homozygous α⁰-thalassemian.

Methods: Women at risk of homozygous α⁰-thalassemia were given an ultrasound examination at 11–14 weeks’ gestation to exclude an affected pregnancy. Fetal cardiothoracic ratio (CTR) and nuchal translucence (NT) were measured. If cardiomegaly was found, chorionic villus sampling (CVS) was offered for α-thalassemia; otherwise the first-trimester combined screening test was performed on the pregnancy. The invasive testing for karyotyping was only followed in those cases with a positive aneuploidy screening test.

Results: In total, 69 of 288 pregnancies were found to be affected by homozygous α⁰-thalassemia using ultrasound, and the findings were confirmed by invasive testing. In the remaining 219 pregnancies, invasive testing was not performed for α-thalassemia because of a normal fetal CTR, and the women received the first-trimester combined screening. Nine CVS procedures were performed for karyotyping because of a positive aneuploidy screening. Totally three pregnancies with aneuploidy were diagnosed and terminated.

Conclusions: Our strategy can selectively detect aneuploidy pregnancies not affected by homozygous α-thalassemia, and, meanwhile, save on the cost of unnecessary aneuploidy screening or karyotyping in pregnancies with an affected fetus of homozygous α⁰-thalassemia.