Quinacrine Pellet Sterilization in Costa Rica Fernando Alpizar, MD, Hospital San Rafael, Alajuela, Costa Rica
Costa Rica is a Central American country of slightly over 3 million inhabitants. Sterilization is a popular family planning method used by 20.7% of women of reproductive age, 24% in urban areas and 17% in rural areas. The potential sterilization demand for women over 34 years old is around 200,000 at a cost of $500 to $800 per case in our Social Security System. Both this cost and safety factors in surgical sterilization led to our decision to conduct a trial of quinacrine sterilization (QS) as an inexpensive, nonsurgical option for our women starting in 1988. Up until 1993, 694 women accepted QS as an outpatient procedure at our hospital. Of these, 653 completed the recommended two insertions of 6 pellets of 36 mg or a total of 216 mg per insertion. An extra insertion was provided to 3 women because of traumatic bleeding on a previous insertion. All women were carefully counseled and signed a consent form. Procedures were performed after menses and within the 14 days of the cycle except for amenorrheic women. The Copper T IUD insertion technique was used. Patients continued their family planning method for 3 months after the last insertion. For 45 women using a copper IUD, the IUD was left in place during quinacrine insertions. Post-insertion symptoms, which are similar to other QS experience, are shown in Table 1. The pregnancy rate declined over time from 4.9% to 0.9% as seen in Table 2. Pregnancies were more common in lactating women. The overall cumulative pregnancy rate was 2.5%. However, performing a hysterosalpingogram raised the pregnancy rate to 4.3% in 115 cases showing occluded tubes. In 41 of these patients who were lactating, the pregnancy rate was 9.8%.
There were no major complications or ectopic pregnancies in the series. We have concluded that QS is safe, well accepted by our women and inexpensive to deliver. The overall pregnancy failure rate of 2.5% is acceptable and can be reduced by avoiding hysterosalpingograms and restricting acceptors to nonlactating women.
