This month’s featured editorial

Assisted reproduction and choice in the biotech age: recommendations for a way forward
Francine Coeytaux, Marcy Darnovsky, Susan Berke Fogel
pages 1-4
Over the past several decades, millions of people have used new reproductive technologies in their quest for biologically related children. Access to these technologies has enabled people who suffer from infertility, same-sex couples and single women to form biological families. At the same time, these tools can be used to select the sex of a future child or to “de-select” based on a growing number of genetic markers for disabilities and other conditions. While assisted reproductive technologies have increased parental options for those who can afford them, they pose numerous ethical challenges that the reproductive rights, health and justice communities are only beginning to address. read more >

This Month's Commentary

Nonspecific side effects of oral contraceptives: nocebo or noise?
David A. Grimes, Kenneth F. Schulz
pages 5-9
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Review Articles

Apples and oranges? Interpreting success in HIV prevention trials
Lori L. Heise, Charlotte Watts, Anna Foss, James Trussell, Peter Vickerman, Richard Hayes, Sheena McCormack
pages 10-15
Background: In the last decade, several large-scale, clinical trials evaluating the efficacy of novel HIV prevention products have been completed, and eight are currently underway or about to be reported. Little attention has been given in the literature to the level of protection sufficient to warrant introduction, and there is concern that using the term “efficacy” to describe the effect of user-controlled methods such as microbicides may mislead policymakers.
Conclusion: When making judgments on the utility of new health technologies, it is important to use standards that yield appropriate comparisons for the innovation and that take into account the local epidemic and available alternatives.
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The use of hormonal contraception among women taking anticonvulsant therapy
Mary E. Gaffield, Kelly R. Culwell, C. Rhoda Lee
pages 16-29
Background: Drug interactions between hormonal contraceptives and anticonvulsants, resulting in reduced contraceptive effectiveness and/or increased seizure activity, have been published.
Conclusions: To avoid contraceptive failure or increased seizure activity, women with epilepsy should be offered contraceptive methods that do not interact with anticonvulsant medication.
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Comprehensive analysis of the use of pre-procedure ultrasound for first- and second-trimester abortion
Regina Kulier, Nathalie Kapp
pages 30-33
Background: The use of ultrasound (US) is common in some settings before an abortion procedure. However, its positive effect on the safety or efficacy (ability to complete abortion) of the procedure has not been established. Our aim was to determine whether the use of pre-procedure US improves safety and/or efficacy of the abortion procedure.
Conclusions: Ultrasound is widely used in pregnancy to estimate gestational age and to detect any abnormalities of the pregnancy or uterus. The effect of its use among women undergoing abortion is unclear, and only indirect evidence is available.
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Original research articles

Immediate placement of intrauterine devices after first and second trimester pregnancy termination
Michelle C. Fox, Julia Oat-Judge, Kathryn Severson, Roxanne M. Jamshidi, Rameet H. Singh, Raegan McDonald-Mosley, Anne E. Burke
pages 34-40
Background: We reviewed our experience with intrauterine device (IUD) placement after surgical abortion up to 20 weeks' gestation.
Conclusions: Immediate postabortion IUD insertion is safe and effective. Given the low rate of return for interval insertion, immediate placement may be preferable.
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Contraceptive policies affect post-abortion provision of long-acting reversible contraception
Kirsten M.J. Thompson, J. Joseph Speidel, Vicki Saporta, Norma Jo Waxman, Cynthia C. Harper
pages 41-47
Background: Placement of long-acting reversible contraceptives (LARC) — intrauterine devices (IUDs) and the implant — directly after an abortion provides immediate contraceptive protection and has been proven safe.
Conclusions: Use of the most effective contraceptives immediately post-abortion is rare in the United States. State policies, high cost to patients, and the ongoing need for clinician training in the methods hinder provision and patient uptake. Contraceptive policies are an important component of abortion patient access to the most effective methods.
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Levonorgestrel-releasing intrauterine system compared to low dose combined oral contraceptive pills for idiopathic menorrhagia: a randomized clinical trial
Mamdouh M. Shabaan, Mahmoud S. Zakherah, Sherif A. El-Nashar, Gamal H. Sayed
pages 48-54
Background: This study compared the efficacy of the levonorgestrel-releasing intrauterine system (LNG-IUS) to low dose combined oral contraceptive pills (COC) in the management of idiopathic menorrhagia.
Conclusion: The LNG-IUS is a more effective therapy for idiopathic menorrhagia compared to COC.
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Steady-state pharmacokinetics of an extended-regimen oral contraceptive with continuous estrogen
Charles E. DiLiberti, Christine M. O'Leary, Christopher H. Hendy, Donald H. Waters, Marya B. Margolis
pages 55-61
Background: This study was conducted to evaluate the steady-state blood concentrations and potential accumulation of levonorgestrel (LNG) and ethinyl estradiol (EE) administered for up to 84 days and EE alone for 7 additional days as an extended-regimen 91-day oral contraceptive (OC).
Conclusion: This study demonstrated that an extended-regimen OC providing 84 days of LNG/EE and 7 days of EE alone has a PK profile similar to a 28-day conventional OC regimen and does not result in any additional accumulation of these hormones.
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A pilot study on the use of letrozole with either misoprostol or mifepristone for termination of pregnancy up to 63 days
Vivian Chi Yan Lee, Oi Sang Tang, Ernest Hung Yu Ng, William Shu Biu Yeung, Pak Chung Ho
pages 62-67
Background: Letrozole is a third-generation selective aromatase inhibitor. Animal data suggested that it might be useful in medical abortion. We performed two pilot studies to assess the feasibility of using letrozole in combination with either mifepristone or misoprostol for termination of pregnancy up to 63 days.
Conclusion: These preliminary results suggest that a regimen of letrozole and misoprostol may be useful in medical abortion, but the combination with mifepristone is less effective and takes longer. Randomized studies comparing letrozole and misoprostol to misoprostol alone are warranted.
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College student knowledge and attitudes toward emergency contraception
Laura M. Miller
pages 68-73
Background: This study explored male and female college students' knowledge of and attitudes toward emergency contraception pills (ECPs).
Conclusions: College students' knowledge level about EC is poor. There is a clear need for ECP as a pregnancy prevention method among college students and for better education about it.
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Good intentions: risk factors for unintended pregnancies in the US cohort of a microbicide trial
Courtney A. Schreiber, Sara Whittington, Liyi Cen, Lisa Maslankowski
pages 74-81
Background: The study was conducted to assess socio-behavioral and biological factors associated with unplanned pregnancy in the US cohort of a microbicide trial.
Conclusion: Within a trial that enrolls heterosexually active women, there may be ways to identify those at highest risk of becoming pregnant a priori.
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Trends in the use of contraceptive methods and voluntary interruption of pregnancy in the Spanish population during 1997–2007
José Luis Dueñas, Iñaki Lete, Rafael Bermejo, Agnès Arbat, Ezequiel Pérez-Campos, Javier Martínez-Salmeán, Isabel Serrano, José Luis Doval, Carme Coll
pages 82-87
Background: This study was designed to acquire information about the use of contraceptive methods in order to reduce the number of elective abortions.
Conclusions: The factors responsible for the increased rate of elective abortion need further investigation.
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The promise of affordable implants: is cost recovery possible in Kenya?
Katherine Tumlinson, Markus J. Steiner, Kate H. Rademacher, Alice Olawo, Marsden Solomon, John Bratt
pages 88-93
Background: Contraceptive implants are one of the most effective methods of family planning but remain underutilized due to their relatively high upfront cost. The increasing availability of a low-cost implant may reduce financial barriers and increase uptake of implants. The commodity cost of Sino-implant (II) is approximately 60% less than two other widely available implants, and a direct service delivery cost of approximately US$12 makes it one of the most cost-effective methods available. This study was conducted to assess whether implant clients in Kenya are paying as much or more than the direct service delivery cost of Sino-implant (II).
Conclusion: Patient fees in both private sectors allow for 100% recovery of the direct cost of providing Sino-implant (II). Currently in Kenya, all sectors can receive donated commodities free of charge; Sino-implant (II) has the potential to reduce reliance on donor-supplied implants and thereby improve contraceptive security.
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