Objectives

To assess risks and benefits of quinacrine sterilization (QS), a nonsurgical method for women.

Study Methods

Literature review, including www.quinacrine.com, of QS, which involves transcervical application of quinacrine 252 mg in the pro- liferative phase of two consecutive menstrual cycles.  This is compared to laparoscopic surgical sterilization in the USA.

Results

The present protocol for QS shows an estimated pregnancy failure rate of one per 100 women at 2 years of use, which is approximately twice that of surgical sterilization.  On the other hand, QS has a much lower incidence of side effects and serious complications and there are no reported case fatalities for QS in over 100,000 cases, whereas for surgical sterilization in industrialized countries, as the USA, the incidence is 3 per 100,000 procedures.  Long-term sequelae of QS, such as risk of cancer and birth defects appear to be very remote and ectopic pregnancy risk among pregnancy failures is not higher than for surgical sterilization.  Obviously, the cost of QS is lower than for surgical sterilization.

Conclusions

QS should be an option for any woman who is sure she wants no more children.  This method is now appropriate for use in private practice and service programs in the USA, where it is legal for this off label use on prescription filled by compound pharmacists.

Objectives

A nonsurgical method of female sterilization is needed because many women are at high risk of complications for standard surgical methods, especially in developing countries.  Also, some women who desire sterilization refuse it for fear of surgery.  To meet these special needs, we initiated a trial of quinacrine sterilization (QS).

Study Methods

A trial of a nonsurgical sterilization method involving transcervical insertion of 252 mg quinacrine as pellets by a modified IUD inserter plus 50 mg of diclofenac in the proliferative phase of the menstrual cycle was initiated among 134 women requesting sterilization at a medical school family planning clinic.  This insertion was repeated a month later and a 150 mg injection of depo medroxyprogesterone was administered at time of the first insertion.

Results

Among 134 women of reproductive age entering this trial, 92 were considered high risk for surgery, 27 refused surgery and 15 were cases of failed surgical sterilization.  Mean follow-up was 3.46 years.  No pregnancies or serious complications were experienced.  The main side effect was menstrual irregularities, probably due to depo medroxyprogesterone.

Conclusions

QS is a suitable option for women at high risk of surgical complications.

Objectives

To assess the safety and efficacy of a method of nonsurgical female sterilization.

Study Methods

Review of literature, including www.quinacrine.com, and unpublished reports known to the author.

Results

No deaths have been reported in over 100,000 quinacrine sterilizations performed in 25 countries.  Major complications are 1/50th that reported for surgical sterilization.  Ectopic pregnancy risk is similar to that following surgical sterilization.  Follow-up for 19 years shows no increased risk of cancer.  Pregnancy failures are 1 to 2 per 100 women after 2 years of use.

Conclusions

Quinacrine sterilization should be an option for all well-informed women who desire no more children.

Objectives

To evaluate the safety and efficacy of quinacrine nonsurgical sterilization from experience in 3 hospitals in Chile.

Study Methods

Clinical data for 2592 Chilean women receiving quinacrine sterilization involving 2 or 3 transcervical insertions of 252 mg quinacrine in the proliferative phase of the menstrual cycle between 1977 and 1998 in three public hospitals are analyzed.

Results

For the 2592 women receiving quinacrine sterilization, cumulative life-table pregnancy rates per 100 women at 10 years varied from 5.2 to 6.9.  The addition of intrauterine antiprostaglandins as adjuvants did not affect these rates.  Physicians and midwives showed similar efficacy.  No birth defects among pregnancies carried to term were detected.  There were 9 ectopic pregnancies (0.34%) among a total of 119 pregnancy failures, which is similar to our experience with IUDs and lower than for surgical sterilization.  There were no life threatening complications and side effects were mild and transient.

Conclusions

Quinacrine sterilization is a safe option for women who are sure they desire no more children.

Objectives

To observe endometrial thickness before, during and after transcervical administration of quinacrine for nonsurgical sterilization.

Study Methods

80 women out of a planned study of 150 women requesting sterilization at the family planning clinic of a medical school hospital in Bela Horizonte, Brazil volunteered to participate in this study.  Each received 2 consecutive monthly transcervical insertions of 252 mg quinacrine as pellets delivered by a modified Copper T IUD inserter in the proliferative phase of the menstrual cycle.  Follow-up visits were scheduled at 1, 3, 6 and 12 months.  Transvaginal pelvic ultrasono- graphy was performed before, during and after insertions and at each follow-up visit.

Results

Of 80 subjects admitted in the study, transient side effects were noted as follows:  headache – 4 cases, light bleeding – 12, mild abdominal pain – 12, vaginal pruritis - 8, and yellow vaginal discharge for 7 to 10 days – 64.  No major complications, infections or pregnancy failures were noted.  A decrease in endometrial thickness was observed during the first 6 months, which corresponds to incidence of oligomenorrhea.

Conclusions

Quinacrine sterilization was found safe and acceptable when offered as an option to women requesting sterilization.  A decrease in thickness of endomentrium and oligomenorrhea appears to be transient over a 6-month period.

Objectives

To evaluate the efficacy, safety and acceptability of transcervical applications of quinacrine along with adjuvants such as ampicillin or ibuprofen for sterilization.

Study Methods

Cohort study at a family planning clinic of a tertiary hospital.  Seven hundred and fifty normal women who requested sterilization and volunteered for this method were admitted from October 1989 to April 1999.  Each women received one or two monthly insertions of 180 mg or 252mg quinacrine with or without adjuvants, ibuprofen 55.5 mg or ampicillin 125mg.  Supplementary contraception included oral contraceptive pills, barrier methods or medroxyprogesterone for 3 months.

Results

The gross pregnancy failure rate for 180mg cases (N-489) was 4.4% compared to 1.5% for 252mg cases (N-261). There were no serious complications and side effects were transient.

Conclusions

Quinacrine nonsurgical sterilization is a safe and acceptably effective method when two insertion of 252mg quinacrine with medroxyprogesterone for 3 months supplementary contraception are used.