Women's Health Update

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Research

Infertile women with mild or minimal endometriosis experience enhanced fecundity with laparoscopic ablation or resection of the lesions. So concluded a three and a half year study which followed 341 infertile women aged 20 to 39 in 25 hospitals throughout Canada for 36 weeks or up to 20 weeks of pregnancy.

All participants were randomly assigned to either a diagnostic-laparoscopy or surgical laparoscopy group. Those in the diagnostic group received no treatment; those in the surgical group underwent resection or ablation of visible lesions by cautery, laser, or a combination.

Tubal patency was 98 and 99 percent, respectively.
Laparascopic surgery "increased the cumulative probability of a pregnancy that lasted more than 20 weeks by 73 percent in the first 36 weeks after the procedure" (cumulative confidence ratio, 1.7; P=0.006), and fetal losses happened with the same frequency (20.6 percent in the surgical and 21.6 percent, P=0.91, in the diagnostic groups).
Fecundity rates for the 20 week pregnancies between the diagnostic and surgical groups were 4.7 and 2.4.
Simultaneous adjustments were made for several base-line characteristics and the site of endometrial lesions which had no effect on the estimates.
Cointerventions in 4 of the 79 pregnancies within the diagnostic group, if contributing to the pregnancy, would slightly increase in the effect of surgery. According to the authors, "one in eight women with minimal or mild endometriosis should benefit" from the surgical procedure, since other factors also play roles infertility. (Marcoux, S et al. NEJM 1997;337:217-222.)

Not taken into account in the study was the efficacy of treating the large percentage of women with unstaged endometriosis with newer gonadotropin-releasing hormone agonists which, theoretically, could be more effective than ablation or resection. (Gambone J, DeCherney A. NEJM 1997;337:269-270.)

Emergency contraception, to prevent pregnancy after unprotected intercourse, whether provided as needed or in advance, is cost-effective when looking at the cost of treatment and the cost and probability of it actually preventing an unintended pregnancy. The use of both progestin-only (minipills) and a single treatment of emergency contraceptive pills saves $29 - $54 in a publicly funded facility and $119 - $142 in a managed care setting in the averted birth model. A copper-T IUD has no savings, but a cost of $53 and $123 respectively. However, if then used as a contraceptive device, savings exceed cost in only 4 months. (Trussell J, et al AM J Pub Health 1997;87:932-937.)

Drug Watch

Mirapax, with the active ingredient pramipexole dihydrochloride, was approved by the FDA on 7/1/97, for treating signs and symptoms of Parkinson's Disease.

Zoloft received supplemental approval on 7/8/97 for the efficacy claim that 50 to 200 mg/day can treat panic disorder.

July 1997