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  • Title: Efficacy and safety of repeated transcervical quinacrine pellet insertions for female sterilization.
    Author: el Kady AA, Nagib HS, Kessel E.
    Journal: Fertil Steril; 1993 Feb; 59(2):301-4. PubMed ID: 8425622.
    Abstract:
    OBJECTIVE: To investigate the rates of tubal occlusion, pregnancy, and side effects of repeated, monthly transcervical insertions of 252 mg quinacrine as pellets. DESIGN: Clinical trial among 159 reproductive age women receiving two monthly transcervical insertions of 252 mg of quinacrine followed by hysterosalpingograms (HSGs) 1 month after last insertion and an additional monthly insertion among women without evidence of bilateral tubal occlusion. Contraception of women's choice provided until bilateral tubal occlusion achieved, and surgical sterilization provided for women failing to achieve bilateral tubal occlusion after third quinacrine insertion. Women were followed for at least 24 months for evidence of pregnancy or side effects. RESULTS: Among the 159 women completing the protocol, 73% had evidence of bilateral tubal occlusion by HSGs after two insertions of quinacrine pellets and 94% after a third insertion. These 149 women were followed for 24 months without a pregnancy failure or serious side effect. CONCLUSION: Transcervical applications of quinacrine as pellets have potential for safe, effective, inexpensive, and easily deliverable female sterilization. Between January 1988 and April 1988, physicians inserted at least 2 252 mg quinacrine pellets into the uterus via the cervix (1 month apart during days 5 to 18 of consecutive menstrual cycles) in 159 34-to-39-year-old women at the outpatient clinic at Boulak El-Dakrour Hospital in Giza, Egypt. 1 month after each insertion, they used hysterosalpingograms to determine tubal patency. They inserted a 3rd pellet if at least 1 tube remained patent. The women used additional contraceptives from first insertion to 1 month after the last insertion to prevent unwanted pregnancy. The physicians followed the women for 24 months. Quinacrine-induced menstrual changes, e.g., intermenstrual bleeding (13.2%) and amenorrhea (26.4%), basically disappeared by 6 months. Quinacrine abated heavy or prolonged menses in women who suffered from it beforehand. 84.3% did not experience any complications or had no complaints related to quinacrine insertion. Occlusion occurred in both tubes after 2 insertions in 73% of cases and after 3 insertions in 93.7%. Women who did not have any bleeding experienced tubal occlusion more readily than those who did (after 2 insertions, 80.8% vs. 69.2%). In fact, absence of blood in the uterus resulted in 100% efficacy after 3 insertions compared to only 90.7% in those who did bleed (p = .02). After 3 insertions, women whose uterus was longer than 8 cm were less likely to have occluded tubes than those whose uterus was at the most 8 cm long (87.2% vs. 95.8%; p = .09). In fact, they had the lowest tubal occlusion rate. None of the women with 2 occluded tubes at 24 months became pregnant. They did not use any contraception beginning 1 month after last insertion. These results indicate that quinacrine pellets are an effective and safe method of nonsurgical sterilization.
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