Fertility and Sterility. 2002 May;77(5):1065-8

Randomized trial of one versus two transcervical insertions of quinacrine pellets for sterilization.

Agoestina T, Hoesni RH, Purwara BH, Santoso BI, Siswanto P, Dasuki D, Samsulhadi A, Surya GP.

Department of Obstetrics and Gynecology, Dr. Hasan Sadikin Hospital/Medical School, Padjadaran University., Bandung, Indonesia.

OBJECTIVE: To determine the relative effectiveness of single vs. two transcervical monthly insertions of 252 mg of quinacrine for female sterilization.
DESIGN: Controlled clinical study.
SETTING: Family planning clinics of 6 academic centers.
PATIENT(S): Sexually active reproductive-age women requesting sterilization.
INTERVENTION(S): At each of six centers 70 and 30 women were randomly assigned to receive either one or two, respectively, monthly transcervical insertions to the fundus of 252 mg of quinacrine and 75 mg of diclofenac as pellets and they were followed for 1 year.
MAIN OUTCOME MEASURE(S): Complications, side effects, and pregnancy failures.
RESULT(S): There were no serious complications and side effects were transient and easily treated. There were 31 (7.4%) pregnancy failures in the single insertions group and 2 (1.1%) in the two insertions group, but with marked center variation.
CONCLUSION(S): Quinacrine sterilization using two monthly insertions of 252 mg of quinacrine appears safe and reasonably effective.
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Fertility and Sterility. 2002 Jun;77(6):1106-9

Quinacrine sterilization: the imperative need for American clinical trials.

Lippes J.

Department of Obstetrics and Gynecology, State University of New York at Buffalo.

In this editorial, Dr. Lippes makes the case for large-scale clinical trials of quinacrine sterilization in the United States.
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Contraception 2001Nov;64(5):281-6

Quinacrine non-surgical female sterilization in Bangladesh.

Bhuiyan SN, Begum R.

Department of Obstetrics and Gynecology, Chittagong Medical College, Chittagong, Bangladesh.

This study was undertaken to evaluate the efficacy, safety, and acceptability of transcervical applications of quinacrine along with other adjuvants, such as ampicillin and ibuprofen, for sterilization. The cohort consisted of 750 normal women who requested sterilization and volunteered for this method at the family planning clinic of a tertiary hospital and community clinics in Chittagong, Bangladesh. Several different protocols were followed from October 1989 to April 1999. Each woman received one or two insertions of 180 mg or 252 mg quinacrine with or without adjuvants including 55.5 mg ibuprofen or 125 mg ampicillin. Supplementary contraception was given in the form of combined oral contraceptive pills, barrier methods, or injection of depot medroxyprogesterone acetate for 3 months. Details of each protocol are described in the text. The gross pregnancy failure rate for insertion of 180 mg in 590 women was 3.9% compared to 1.9% for the 160 who received 252 mg. There were no serious complications, and side effects were transient. We conclude that quinacrine non-surgical sterilization is a safe, acceptably effective method when two insertions of 252 mg quinacrine with medroxyprogesterone injection as a supplement is used.
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Contraception 2001Nov;64(5):277-9

Quinacrine sterilization in Tripura,India.

Thakur PS.

Tripura Branch, Indian Rural Medical Association, Agartala 799 001, Tripura, India.

A 611- case clinical trial of quinacrine sterilization (QS) was conducted at Agartala, Tripura State, India, using a unique protocol. No pregnancy failures were reported after a mean of 45.8 months of follow-up. Three trans-cervical insertions of 324 mg, 288 mg, and 252 mg quinacrine pellets were used in the first, second, and third insertions, respectively. Insertions were done on Days 6-10 of the menstrual cycle with the women remaining in a slight Trendelenberg position for 2 h post insertion. Antibiotics were prescribed after each insertion, and 3 months supply of an additional contraception provided from first insertion. A unique inducement to report pregnancy failures was employed. Each woman was offered the equivalent of 5 months family income to report any pregnancy following QS and a free menstrual regulation procedure. No pregnancies were reported. An independent follow-up visit to a systematic sample of 40 women found nopregnancies.
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Fertil Steril 2000Dec;74(6):1084-91

Long-term follow-up after quinacrine sterilization in Vietnam. Part I: interim efficacy analysis.

Sokal D, Hieu DT, Weiner DH, Vinh DQ, Huu Vach T, Hanenberg R.

Family Health International, Research Triangle Park, NC 27709, USA. dsokal@fhi.org

OBJECTIVE: To determine the long-term efficacy of nonsurgical sterilization with quinacrine.
DESIGN: Observational cohort study.
SETTING: Rural provinces in northern Vietnam.
PATIENT(S): Two thousand seven hundred and nine women who had quinacrine insertions between 1989 and 1993.
INTERVENTION(S): Interviews in 1994, 1995, and 1996 and review of available medical records. Pregnancy rates were corrected for problems in detecting and confirming pregnancies.
MAIN OUTCOMEMEASURE(S): Pregnancy rates.
RESULT(S): Over 90% of women were interviewed at least once. Uncorrected cumulative pregnancy rates were 12.9% at 5 y after two insertions and 27.3% after one insertion. Effectiveness varied by age group: the partially corrected pregnancy rates after two insertions were 6.8% in women 35 or older at the time of insertion and 13.0% in women under 35. A subgroup of women who received oral papaverine at the time of quinacrine insertion had lower pregnancy rates, with a cumulative uncorrected rate of 5.3% at 4 years among women of all ages.
CONCLUSION(S): Efficacy of quinacrine appears reasonable for two insertions of quinacrine in women 35 and older. It may be possible to improve efficacy by the use of papaverine or the Hieu insertion technique.
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Fertil Steril 2000Dec;74(6):1092-101

Long-term follow-up after quinacrine sterilization in Vietnam. Part II: interim safety analysis.

Sokal D, Hieu DT, Weiner DH, VinhDQ, Huu Vach T, Hanenberg R.

Family Health International,Research Triangle Park, NC 27709, USA. dsokal@fhi.org

OBJECTIVE: To determine the long-term safety of nonsurgical sterilization with quinacrine.
DESIGN: Observational cohort study.
SETTING: Rural provinces in northern Vietnam.
PATIENT(S): Two thousand eight hundred forty women who had had quinacrine insertions and an age-matched comparison group of 1,658 women who had an intrauterine device (IUD) insertion between 1989 and 1993.Method(s): Interviews in 1994, 1995, and 1996 and review of available medical records. This is a planned interim analysis.
MAIN OUTCOME MEASURE(S): Ectopic pregnancies and the occurrence of other adverse health events.
RESULT(S): Over 90% of women were interviewed at least once. Despite matching on age, the groups differed on baseline parity. The ectopic pregnancy rates were similar after either one or two insertions and were similar to the rate of ectopic pregnancies after surgical sterilization in the United States. The quinacrine group reported more gynecologic health problems than the IUD group. However, after correcting for information bias, there was no dose-response effect between the one- and two-insertion quinacrine groups, suggesting the possibility of recall bias or differing baseline health status.
CONCLUSION(S): Ectopic pregnancies do not appear to be increased compared with U.S. surgical sterilization rates. The data on other adverse events are more difficult to interpret.
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Fertil Steril 2000Jul;74(1):169-71

Cancer risk among women sterilized with transcervical quinacrine in Chile: an update through 1996.

Sokal DC, Dabancens A,Guzman-Serani R, Zipper J.

Family Health International,Research Triangle Park, North Carolina 27709, USA.

OBJECTIVE: To determine whether further follow-up of a cohort of Chilean women would demonstrate an increased risk of invasive cancer associated with quinacrine sterilization.
DESIGN:Cohort study. Cancer cases were evaluated using cohort analyses.
SETTING: Santiago and Valdivia, Chile.
SUBJECT(S): Fourteen hundred ninety-two women who received transcervical quinacrine pellets for contraceptive sterilization between 1977 and 1989.
METHOD(S): Interviews and reviews of medical records.
MAIN OUTCOME MEASURE(S): Age- and site-specific incidence of invasive cancers.
RESULT(S): During 13,444 person-years of follow-up, 25 invasive cancers were identified, including 8 new cases. This compares with 21.9 expected cancers, based on age-specific rates from the Cali, Colombia, cancer registry. Eight cases of cervical cancer were observed, compared with the 6.3 expected. Since the initial study's confirmation of a single case of leiomyosarcoma, no other noncervical uterine cancers have been diagnosed. The number of observed person-years gives an expectation of 0.62 noncervical uterine cancers. One case of ovarian cancer was diagnosed, compared with the 0.99 expected.
CONCLUSION(S): Rates of cancer among women exposed to intrauterine quinacrineare not significantly different from population-based rates.
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AdvContracept 1999;15(3):175-8

Quinacrine sterilization: experience among women at high risk for surgery.

Sarin AR.

Department of Obstetrics and Gynecology, Government Medical College, and Aastha Medical Center, Patiala,India.

A non-surgical method of female sterilization is needed because many women are at high risk of complications with 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), a non-surgical method involving transcervical insertion of 252 mg quinacrine as pellets by a modified IUD inserter. Diclofenac (50 mg) was inserted with the quinacrine pellets. This insertion was repeated a month later and a 150-mginjection of depo medroxyprogesterone was administered at the time of the first insertion. One hundred and thirty-four women of reproductive age entered the trial. Of these, 92 were considered to be at high risk for surgery, 27 had refused surgery, and 15 had had failed surgical sterilization. Mean follow-up was 3.46 years. No pregnancies or serious complications were experienced. The main side-effect was menstrual irregularity, due probably to the depomedroxy progesterone injection. QS is a suitable option for women at high risk of surgical complications.
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