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  • Title: [Contraception and tubal sterility of infective origin].
    Author: Gayer ML, Henry-Suchet J.
    Journal: J Gynecol Obstet Biol Reprod (Paris); 1990; 19(2):155-64. PubMed ID: 2324437.
    Abstract:
    A series of 89 caucasian women, who had been operated on for non-infectious tubal infertility were studied to find out what contraceptive methods they had used before they became infertile (oral contraception, intra-uterine contraceptive device and other methods). A matched series of 178 fertile women were used as a control group. The numbers who had chlamydia were studied as a function of the method of contraception in the group of infertile women. This work shows that women with tubal infertility due originally to infection had less often used oral contraception than the matched group of fertile women had. One can conclude that oral contraception acts as a prevention against this cause of infertility. The role played by intra-uterine contraceptive devices is difficult to establish. All the same, there is a significant relationship between the use of intra-uterine devices and tubal infertility of infectious origin, whether we look at multiparae or women between 25 and 34 years of age. This study also shows that chlamydia is not associated with the use of combined preparation oral contraceptives, nor with the use of the intra-uterine device in women who have tubal factor infertility. This study all the same shows that it does seem to be important to advise oral contraception in preference to the intra-uterine device in women who are still wanting to have a pregnancy, even if they are multiparae or multigravidae. The relationship between IUD and oral contraceptive (OC) use and tubal infertility of infectious origin was retrospectively studied in 89 French women undergoing operations for tubal infertility between 1978- 87, 178 women who had spontaneously become pregnant regardless of outcome formed the control group, which was matched for age, socioprofessional status, and ethnic origin. Chlamydia trachomatis was responsible for 73% of cases of tubal infertility. 22 of the 89 women had a history of diagnosed salpingitis and 20 had had abdominal pain of unknown origin. 47 had had no symptoms of salpingitis. The average age was 29.68 years for the tubal infertility group and 29.7 for the fertile women. The socioprofessional status of the 2 groups was similar and higher than that of the general French population. 58% in the tubal infertility group and 36% in the fertile group were nulligestes. 60.1% of fertile vs. 47.2% of infertile women had used OCs. More infertile (22.5%) than fertile (14.6%) women had used IUDs, but the difference was not statistically significant. 45% of infertile women who had used IUDs had a history of diagnosed salpingitis, vs. 19% of pill and 18.5% of other contraceptive method users. The rate of chlamydia infection was similar for OC, IUD, and other method users. The rate of use of IUDs was similar for nulliparous fertile and infertile women, but for multiparous women it was significantly higher among infertile women. The finding that the infertile group had used OCs less often than controls suggest that OCs have a protective effect against this type of infertility. The role of the IUD is harder to establish, but a significant relationship was found between infectious tubal infertility and IUD use among multiparas and among women aged 25-34 years. The study also demonstrated that chlamydia infections are not related to contraceptive method used. In the light of this study it appears important to advise OCs rather than IUDs for women who are likely to desire a future pregnancy, even for multiparous women.
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