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PIP: Although Mexico's 1965 total fertility rate of 7.1 was similar to that of populations not using contraceptives, by 1976 some 21-23% of fertile aged women (FAW) used some contraceptive method. The National Family Planning Plan was approved in 1977 (NFPP-77). Its first phase, from 1977-82, began with careful collaboration among representatives of health sector organizations to establish guidelines and procedures for family planning activities. Contraceptive usage by FAW in union increased from 23.1% according to the 1976 Mexico Fertility Survey to 41.5% according to the 1982 National Demographic Survey. The natural increase rate dropped from 3.2% in 1976 to 2.4% in 1982. The 1987 National Survey of Fertility and Health indicated that the increase in contraceptive usage between 1982 and 1987 amounted to only 7.95%, and the natural increase rate in 1988 was estimated at 2.3%. The slowing of the increase in contraceptive usage between 1982 and 1987 has not yet been fully explained, but it may have resulted from personnel changes or the country's serious economic problems. By 1992, the National Survey of Demographic Dynamics indicated that 55.0% of married FAW used a method, and the 1995 National Survey of Family Planning revealed that 57.4% did so. The role of the public sector in supplying modern contraceptives increased greatly between 1979-95, while the contribution of the private sector remained more limited. In 1979, 16.4% of couples obtained their supplies from the public sector and 15.6% from the private sector. By 1995, 41.3% of couples obtained supplies from the public sector and 16.1% from the private sector. NFPP-77 is still in place and giving results, although it has assumed a lower profile than it previously displayed.^ieng

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Since government approval of the Mexican Family Planning Program in 1977, the Mexican Social Security Institute (IMSS) has been one of the major family planning service providers in Mexico. No-scalpel vasectomy, a refined surgical vasectomy technique developed and widely used in China, has been introduced in 20 countries, including Mexico. This paper will describe the experience of the IMSS in introducing the no-scalpel vasectomy technique into its service delivery system, and will review the clinical and programmatic experience, and the impact of no-scalpel vasectomy on client and provider attitudes toward vasectomy.

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Salivary activity of N-acetyl-beta-D-glucosaminidase showed a characteristic pattern of changes during the normal menstrual cycle with a distinct peak on Day 13, 14, or 15 before the next menstruation. This peak of enzyme activity occurred withing one day of the nadir of basal body temperature and was absent in women with spontaneous or iatrogenic anovulatory cycles. These results are stongly suggestive that the salivary determination of this activity may be convenient indicatior for determining the day of ovulation.

PIP: Cyclic changes in the salivary activity of N-acetyl-beta-D-glucosaminidase were measured in 36 women, 5 of whom were using oral contraceptives (OCs) and 3 of whom exhibited evidence of anovulatory cycles. Changes in the salivary activity of the lysosomal enzyme showed a characteristic pattern, with a distinctive peak occurring on Days 13, 14, or 15 before the next menstruation. This peak correlated within 1 day of the recorded nadir in basal body temperature. Women taking OCs and those with anovulatory cycles did not exhibit such changes. The results suggest a potentially valuable method for determining the day of ovulation.

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A blind study was done in 402 endometrial biopsies of women who had intrauterine devices releasing different daily amounts of progesterone or a placebo (empty device): 175 were obtained in what presumably was the proliferative phase and 227 in the secretory stage, as all these subjects were normal, healthy women with a history of previous fertility. With all dose levels of the progesterone-releasing devices there was variation of the endometrium general pattern and the over-all picture varied from normal secretory to suppressed endometrium. In addition to these changes of the endometrial pattern, in 231 specimens there was significant inflammatory infiltration and in six cases even plasma cells were seen. Predecidual reaction was frequently seen and in 45 cases it was diffuse and marked. The significance of these data is discussed on the grounds of the frequent similarities of the changes here reported with those in women using combined oral steroids for contraception.

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PIP: 10 patients, aged 25-46, with dysfunctional menstrual bleeding, were inserted a progesterone-releasing IUD, delivering 65 mcg. of progesterone daily. Complete examinations were carried out before insertion, and after 3 and 6 months. Amount and duration of bleeding diminished in 9 patients; 2 patients presented short periods of amenorrhea. Proliferative endometria changed in secreting endometria, while vaginal cytology with previous estrogenic activity did not change in 2 cases, or insufficiently in 2 more cases. From these results it is concluded that progesterone has a local action at endometrial level, but no systemic collateral actions, and that it can be usefully employed in controlling dysfunctional bleeding.^ieng

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PIP: It has been demonstrated that preparations containing estrogens cause metabolic alterations, while such alterations do not occur or are minimal when progestogens alone are administered. Clinical studies were begun using a new polymer that makes possible the release of a constant predetermined amount of progesterone into the uterus for up to one year. The method of intrauterine release of progesterone proved to be very effective in preliminary studies: one case of pregnancy occurred among 263 women observed over 2068 months (.5 effectiveness index). The effectiveness of the method, with the release of a daily dose of 50 mcg, appears to be higher than that of other intrauterine devices and similar to that of combinations of estrogen and progestogens, that are regarded as the most effective method. A great advantage of the new method is that it does not cause systemic effects.^ieng

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PIP: Metabolic changes in human spermatozoa related to capacitation were investigated. Glycolysis, motility, oxygen uptake, survival time, and c hanges in tetracycline-binding capacity were studied in spermatozoa expo sed to the following possible capacitating agents: 1) human cervical mucus, 2) human serum, 3) hydroxalpinx fluid, and 4) follicular cyst fluid. Mucus and serum did not produce marked changes. Hydrosalpinx fluid produced an increase in oxygen uptake in the presence of citrate and succinate while follicular cyst fluid produced modifications that could be related to capacitation such as increase in oxygen uptake, increase in motility, and release of bound tetracycline. Similar changes were seen with cyclic adenosine monophosphate and adenosine triphosphate treatment but not with other related nucleotides. The parameters studied in this work are suggestive of functional capacitation.^ieng

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PIP: The fine structures of liver cells biopsies of 14 women using oral contraceptives and 8 women who were not using steroids were studied electron microscopically. In all the women studied, liver function and coagulation tests were normal. Women treated with microdoses of progestogens and with combinations of progestogens and estrogens showed dilation and vesiculation of both the rough and smooth endoplasmic reticulum. Women using sequential OC's showed more marked vesiculation. 5-10% of the mitochondria per cell of women using chlormadione and 20-40% of the mitochondria of women on combined or sequential therapy showed elongation and crystalloid inclusions in the mitochondrial matrices. Fatty degeneration was noted. This was more pronounced in women using combined and sequential OC's. The nucleus, Golgi-complex, bile canaliculi, and glycogen granules were all unmodified.^ieng

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