Fertility Control — Update and Trends PDF
Preview Fertility Control — Update and Trends
Th. Rabe . B. Runnebaum Fertility Control - update and trends Springer Berlin Heidelberg New York Barcelona Budapest Hong Kong London Milan Paris Singapore Tokyo Thomas Rabe . Benno Runnebaum Fertility Control - Update and Trends With 54 Figures, some in Color, and 29 Tables i Springer Thomas Rabe, Prof. Dr. med., Dr. h.c. mult. Division of Gynecology and Reproductive Medicine WHO Collaborating Centre for Research in Gynaecological Endocrinology and Reproducative Medicine University Women's Hospital Vo6strasse 9 69115 Heidelberg Germany Benno Runnebaum, Prof. Dr. med., Dr. h.c. mult. Division of Gynecology and Reproductive Medicine WHO Collaborating Centre for Research in Gynaecological Endocrinology and Reproducative Medicine University Women's Hospital VoBstrasse 9 69115 Heidelberg Germany Ubrary of CQngr~ss Cataloging.in_Publication Data. r..,rtilitycontrolllffiite<l by) Thomas Raw. p.em. Includes bibliographic.l references and index. ISBN 978_3·642_86698_2 ISBN 978.3-642-86696.8(cRookj DOl 10.10071978.3-642_866%.8 I. Contra""ption_Cong. .n .1. Rab~. T. (Thomas), 1951- RGI36.A2F481m 613.9'4·dc21 98-33842 m This work is subject to copyright. All rights ar~ .." ,rvffi. wh.th .. th~ whole t)r part t)f the material is roncerned, specifically the righl$ of translation. repriming. reu,," of illustration, redtation, broadcasting. reproduction on microfilm or in any Olher way. and .lOrage in data banks. Duplication of this publication or parIS thereof is permiued unly under the provisions t)( the Cerman Copyright law of September 9, 1965, in it. current version, and permissit)n for Ust must always b. obtainffi (rom Springer.Verl.g. Violations are liable for pro_ution under the German Copyright law. © Springer-Verlag Berlin Heidelberg 1999 Soflcover reprint of the hardcover 1st edition 1999 The use of general dCKriptive names, registered names, trademark5. etc. in this publication dMs not imply. e...,n in the aMenu 0(. s"",ilic statement, that such names are exempt from the relevam protective law. and regulations and therefore free for g~neral use. Product liability: The pUblishers cannot guarantu the a,,~uracy of any information about dosage and application conlainffi in this b<xIk. In ..... ry individual case the user mu,t check such information by consulting the relevanl literature. Cover design: E. Kirchner, Heidelberg Typesel1ing: Goldener Schnit!. Sinzheim SPIN: 1()4S4727 13131355432 I 0 -Printed On acid-free papt'r Preface Dedication to Professor Dr. med. Dr. h.c. mult. Benno Runnebaum on his 65th Anniversary The name of Benno Runnebaum is closely tied to the status of gynaecological endocrinology and reproductive medicine. Therefore, we would like to dedicate this conference book entitled "Fertility Control" to him in recognition of his achieve ments. Who is Benno Runnebaum? Benno Runnebaum was born on 22 July, 1933, in Ruschendorf, Germany. After taking his A-levels, he studied medicine in Munster, Bonn and Cologne. He graduated from Cologne University in 1961 and then prepared his doctoral thesis on the "Identificati on and quantification of progesterone, 20a-dihydroprogesterone, 20~-dihydroproge sterone and 17a-hydroxyprogesterone in the plasma of human placental blood". This Benno Runnebaum VI Preface publication was the first to describe the progestin cycle in the feto-placental unit. His thesis was supported by Professor Dr. med. Dr. h.c. Josef Zander. It was graded "sum ma cum laude" and won him a scholarship from the National Institute of Health for training in steroid biochemistry at the Biochemical Institute in Salt Lake City (Profes sor Samuels) in 1962 and 1963. After his return to Germany he worked at the Univer sity Women's Hospital of Cologne. He received his further specialist training in 1964 at the Heidelberg Women's Hospital, under the chairmanship of his teacher, Professor Zander. In 1969, Benno Runnebaum wrote his professorial thesis on the "Identificati on and quantification of progesterone and 20a-dihydroprogesterone in the human uterine muscle during pregnancy". In the same year, he became a "Facharzt" for Gynaecology and Obstetrics. In early 1970, he joined the 1st University Women's Hos pital in Munich together with Professor Zander to work there as a university lecturer and consultant. In 1971, he was appointed Head of Department for Gynaecological Endocrinology at the University Women's Hospital in Heidelberg. Since 1975., he has been the Medical Director of the Department for Gynaecological Endocrinology and Fertility Disorders. Professor Runnebaum has investigated various aspects of gynaecological endocri nology and reproductive medicine. From his first experimental studies, he has analy sed the close endocrine link between the child, the placenta and the mother and made substantial contributions with respect to endocrine regulation and maintenance of pregnancy. He has also dealt with the control of hormonal processes involving the brain stem, the pituitary and the ovaries and made a number of new findings of great relevance for special therapies, e.g. of women with cyclic disorders, myomata and en dometriosis. He has also taken an interest in research of direct clinical relevance and translated new findings quickly into patient treatment. A number of clinical sections ("Spezialsprechstunden") were set up in his divisions to look at special issues, such as hormones and infertility, virilism and hair loss, in vitro fertilisation, endometriosis, the menopause, environmental influences and fertility disorders. He has organised three international symposia in Heidelberg on "Future aspects of contraception". In this context, new ideas have emerged, advancing the development of contraceptive methods. Apart from his membership in many national professional associations and his ac tivities on the boards of several scientific societies (Deutsche Gesellschaft fUr Gyna kologie und Geburtshilfe, Deutsche Gesellschaft fUr Endokrinologie, Deutsche Me nopausegesellschaft, Deutsche Gesellschaft zum Studium fur Fertilitat und Sterilitat), he was the co-founder of a number of scientific societies and journals; in recent years, he has been a corresponding editor for the American Journal of Obstetrics and Gyne cology. As spokesman of the Working Group for Gynaecological Endocrinology and Reproductive Medicine (AGGEF) since 1992, he has managed to bring together a hete rogeneous group of gynaecological endocrinologists, experts on reproductive medici ne and micro surgeons to form a strong voice for gynaecological endocrinology and reproductive medicine. His team has always been open to international scientific exchange, especially with visiting doctors from Greece, Hungary, Rumania, Saudi-Arabia, Chile, China, Venezu ela, Turkey and Poland. The most recent exchange programme started 1 year ago with the women's hospitals of Ho Chi Minh City and Hanoi/Vietnam as a partner pro gramme with the WHO (HRP). Preface VII His clinical and research work is reflected in more than 450 original scientific publica tions. In 1987, he edited a textbook on gynaecological endocrinology. The second edition was published in 1994 as two volumes: Gynaecological Endocrinology and Reproductive Medicine. Altogether, he has published a total of 12 books and written 87 book articles. On account of his achievements in gynaecological endocrinology and reproductive medicine, he received the "Bundesverdienstkreuz" (Federal Order of Merit) in 1994. In the same year, his department was declared WHO Collaborating Centre for Research in Gynaecological Endocrinology and Reproductive Medicine. This implies a great honour since there are only 52 WHO collaborating centres for human reproduction in the world. It is an important acknowledgement, not just to his Division at the Wo men's Hospital, but also to the University of Heidelberg. As mentioned above, many young scientists and doctors from home and abroad have received their further clinical and scientific training in his department. In 1991, Benno Runnebaum was awarded the honorary doctorate of the Semmelweis Universi ty, Budapest and, in 1998, the honorary doctorate of the University of Cluj, Rumania, in recognition of his co-operation and his achievements in the field of gynaecological endocrinology and reproductive medicine. All along, he has worked to establish the discipline of gynaecological endocrinolo gy and reproductive medicine at many German University Women's Hospitals and other large outpatient clinics to provide the best diagnostic and therapeutic care avai lable to many women and couples with hormone and fertility problems. Despite all efforts of Professor Runnebaum to establish new departments for gyne cological endocrinology and reproductive medicine at German universities, no new in dependent departments for gynaecological endocrinology and reproductive medicine have been founded there so far; the number of existing departments or divisions has steadily been reduced. However, due to the enormous growth in knowledge, the importance of gynaecolo gical endocrinology and reproductive medicine has increased world-wide and cer tainly in Germany; most patients have been treated in large, well-equipped and well staffed out-patient clinics. Unfortunately, German universities have experienced an exodus of qualified doctors and scientists because of lack of employment prospects. Calls for more basic research in molecular biology and molecular genetics as a prere quisite for catching up with the international standard are big but empty words, with out an adequate structure at the women's hospitals. Best wishes of all of us! Finally, I would like to thank Professor Runnebaum as a mentor and friend for his achievements in the field of gynaecological endocrinology and reproductive medici ne, also on behalf of the Working Group on Gynaecological Endocrinology and Re productive Medicine (AGGEF). Together with the staff of the University Women's Hospital, research workers, his patients and many former colleagues and friends at home and abroad, I would like to wish Professor Benno Runnebaum good health, creativity and continued success in the future to fulfil all his wishes in family life, lifestyle and art, and also in science - and please don't forget the Chinese proverb: If we radiate goodness, we will receive goodness in return. Thomas Rabe, Heidelberg, den 22.6.1998 Contents The Contraceptive Revolution: Its Past and Future "History" E. Diczfalusy ....................................................... . 2 Decreasing Abortion: The Potential and the Constraints G. Benagiano, A. Pera ................................................ 15 3 Contraception: Historical Development, Current Status and Future Aspects Th. Rabe, E. Vladescu, B. Runnebaum .................................. 29 4 The Future of Oral Hormonal Contraception Th. Rabe, B. Runnebaum ............................................. 73 5 Cardiovascular Risks Associated with Oral Contraceptives L. A.J. Heinemann, E. Garbe. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 91 6 Injectable Contraceptives C. d'Arcangues, R. C. Snow ............................................ 121 7 Intrauterine Contraception: Past, Present, and Future H. Wagner .......................................................... 153 8 Intrauterine Hormone-Releasing Systems P. L1ihteenm1iki . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 173 9 Vaginal Rings for Contraceptive Use J. R. Newton ........................................................ 185 10 Use of Anti-progestins in Female Contraception E. E. Baulieu ........................................................ 195 11 Antiprogestins - A New Challenge for Female Contraception M. Bygdemann, K. G. Danielssohn, L. Marions, M.-L. Swahn ............... 201 12 Natural Methods of Familiy Planning G. Freundl .......................................................... 207 x Contents 13 Female and Male Sterilisation M. Filshie .......................................................... 223 14 Male Contraception: Promising New Approaches S. von Eckardstein, E. Nieschlag ....................................... 239 List of Contributers d' Arcangues, Catherine, Dr. Special Programme of Research, Development and Research, Training in Human Reproduction World Health Organization 12211 Geneva 27, Switzerland Baulieu, Etienne, Emile, Prof. College de France, 1NSERM U 33 80 rue du General Leclerc, F-94276 Le Kremlin-Bicetre Cedex, France Benagiano, Giuseppe P., Prof. Direcor General, 1stituto Superiore Di Sanita Viale Regina Elena 299, 1-00161 Roma, Italy Bydgdeman, Marc, Prof., MD, PhD Department of OB/GYN, Karolinska Hospital S-17176 Stockholm, Sweden Danielsson, Kristina Gemzell, MD, PhD Department of OB/GYN, Karolinska Hospital S-17176 Stockholm, Sweden Diszfalusy, Egon, Prof. Dr. Dr. h.c. multo R6nningevagen 21, S-14461 R6nninge, Sweden Eckardstein, Sigrid von, Dr. med. Westfalische Wilhe1ms-Universitat Zentrum fur Frauenheilkunde 1nstitut fur Reproduktionsmedizin WHO Kollaborationszentrum DomagkstraBe 11,48129 Munster, Germany Filshie, Marcus, Prof. Reader/Consultant in OB/GYN, Queen's Medical Centre University Hospital Nottingham, Nottingham NG7 2 UH, United Kingdom
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