Characterization of tubal occlusion after transcervical polidocanol foam (PF) infusion in baboons

Jeffrey Jensen, Carol Hanna, Shan Yao, Cassondra Bauer, Terry Morgan, Ov Slayden

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objective Our long-term goal is to develop a nonsurgical method of fallopian tubal occlusion for the purpose of permanent contraception. We have previously demonstrated that transcervical administration of 5% polidocanol foam (PF) can create tubal occlusion in macaques but that multiple treatments are required. In this study, we assessed the efficacy of various regimens of PF with and without depomedroxyprogesterone acetate (DMPA) (to control ovarian cycle phase) in the baboon. Study design Adult cycling female baboons were evaluated for tubal patency by hysterosalpingography and then received a transcervical infusion of PF with (+) or without (-) an intramuscular injection of DMPA (3.5 mg/kg). Two concentrations of PF were compared: 1% [(+) DMPA, n= 5; (-) DMPA, n= 3] and 5% [(+) DMPA, n= 4; (-) DMPA, n= 3]. Controls received (+) DMPA (n= 2) or (-) DMPA, (n= 3) only. The reproductive tracts were removed 1-3 months after treatment for examination. Results No fallopian tubal occlusion was observed in negative controls (± DMPA). Histologic complete tubal occlusion was observed in 3/8 of females treated with 1% PF and in 6/7 treated with 5% PF. Histologic evaluation suggested that 1% PF is associated with prolonged chronic inflammation (more than 2-3 months), while 5% treatment eliminates the epithelial lining, at least focally, and resolves into complete occlusion within 1-2 months. This pattern of complete occlusion was seen in all 4 females that received 5% PF (+ DMPA) and in 2/3 that received 5% PF (- DMPA). Conclusion In a baboon model of transcervical permanent contraception, a single treatment with 5% PF resulted in complete tubal occlusion more reliably (85%) than 1% PF (38%). Cotreatment with DMPA may improve treatment results with 5% PF but requires additional study. Implications A finding that a single transcervical treatment with 5% PF can occlude the fallopian tubes of baboon supports further study of this approach as a novel strategy for permanent contraception for women.

Original languageEnglish (US)
Pages (from-to)96-102
Number of pages7
JournalContraception
Volume92
Issue number2
DOIs
StatePublished - Aug 1 2015

Fingerprint

Tubal Sterilization
Papio
Acetates
Contraception
polidocanol
Therapeutics
Hysterosalpingography
Fallopian Tubes
Intramuscular Injections
Macaca
Menstrual Cycle

Keywords

  • Baboon
  • Female
  • Nonsurgical sterilization
  • Permanent contraception
  • Polidocanol

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

Cite this

Characterization of tubal occlusion after transcervical polidocanol foam (PF) infusion in baboons. / Jensen, Jeffrey; Hanna, Carol; Yao, Shan; Bauer, Cassondra; Morgan, Terry; Slayden, Ov.

In: Contraception, Vol. 92, No. 2, 01.08.2015, p. 96-102.

Research output: Contribution to journalArticle

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title = "Characterization of tubal occlusion after transcervical polidocanol foam (PF) infusion in baboons",
abstract = "Objective Our long-term goal is to develop a nonsurgical method of fallopian tubal occlusion for the purpose of permanent contraception. We have previously demonstrated that transcervical administration of 5{\%} polidocanol foam (PF) can create tubal occlusion in macaques but that multiple treatments are required. In this study, we assessed the efficacy of various regimens of PF with and without depomedroxyprogesterone acetate (DMPA) (to control ovarian cycle phase) in the baboon. Study design Adult cycling female baboons were evaluated for tubal patency by hysterosalpingography and then received a transcervical infusion of PF with (+) or without (-) an intramuscular injection of DMPA (3.5 mg/kg). Two concentrations of PF were compared: 1{\%} [(+) DMPA, n= 5; (-) DMPA, n= 3] and 5{\%} [(+) DMPA, n= 4; (-) DMPA, n= 3]. Controls received (+) DMPA (n= 2) or (-) DMPA, (n= 3) only. The reproductive tracts were removed 1-3 months after treatment for examination. Results No fallopian tubal occlusion was observed in negative controls (± DMPA). Histologic complete tubal occlusion was observed in 3/8 of females treated with 1{\%} PF and in 6/7 treated with 5{\%} PF. Histologic evaluation suggested that 1{\%} PF is associated with prolonged chronic inflammation (more than 2-3 months), while 5{\%} treatment eliminates the epithelial lining, at least focally, and resolves into complete occlusion within 1-2 months. This pattern of complete occlusion was seen in all 4 females that received 5{\%} PF (+ DMPA) and in 2/3 that received 5{\%} PF (- DMPA). Conclusion In a baboon model of transcervical permanent contraception, a single treatment with 5{\%} PF resulted in complete tubal occlusion more reliably (85{\%}) than 1{\%} PF (38{\%}). Cotreatment with DMPA may improve treatment results with 5{\%} PF but requires additional study. Implications A finding that a single transcervical treatment with 5{\%} PF can occlude the fallopian tubes of baboon supports further study of this approach as a novel strategy for permanent contraception for women.",
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AU - Hanna, Carol

AU - Yao, Shan

AU - Bauer, Cassondra

AU - Morgan, Terry

AU - Slayden, Ov

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Objective Our long-term goal is to develop a nonsurgical method of fallopian tubal occlusion for the purpose of permanent contraception. We have previously demonstrated that transcervical administration of 5% polidocanol foam (PF) can create tubal occlusion in macaques but that multiple treatments are required. In this study, we assessed the efficacy of various regimens of PF with and without depomedroxyprogesterone acetate (DMPA) (to control ovarian cycle phase) in the baboon. Study design Adult cycling female baboons were evaluated for tubal patency by hysterosalpingography and then received a transcervical infusion of PF with (+) or without (-) an intramuscular injection of DMPA (3.5 mg/kg). Two concentrations of PF were compared: 1% [(+) DMPA, n= 5; (-) DMPA, n= 3] and 5% [(+) DMPA, n= 4; (-) DMPA, n= 3]. Controls received (+) DMPA (n= 2) or (-) DMPA, (n= 3) only. The reproductive tracts were removed 1-3 months after treatment for examination. Results No fallopian tubal occlusion was observed in negative controls (± DMPA). Histologic complete tubal occlusion was observed in 3/8 of females treated with 1% PF and in 6/7 treated with 5% PF. Histologic evaluation suggested that 1% PF is associated with prolonged chronic inflammation (more than 2-3 months), while 5% treatment eliminates the epithelial lining, at least focally, and resolves into complete occlusion within 1-2 months. This pattern of complete occlusion was seen in all 4 females that received 5% PF (+ DMPA) and in 2/3 that received 5% PF (- DMPA). Conclusion In a baboon model of transcervical permanent contraception, a single treatment with 5% PF resulted in complete tubal occlusion more reliably (85%) than 1% PF (38%). Cotreatment with DMPA may improve treatment results with 5% PF but requires additional study. Implications A finding that a single transcervical treatment with 5% PF can occlude the fallopian tubes of baboon supports further study of this approach as a novel strategy for permanent contraception for women.

AB - Objective Our long-term goal is to develop a nonsurgical method of fallopian tubal occlusion for the purpose of permanent contraception. We have previously demonstrated that transcervical administration of 5% polidocanol foam (PF) can create tubal occlusion in macaques but that multiple treatments are required. In this study, we assessed the efficacy of various regimens of PF with and without depomedroxyprogesterone acetate (DMPA) (to control ovarian cycle phase) in the baboon. Study design Adult cycling female baboons were evaluated for tubal patency by hysterosalpingography and then received a transcervical infusion of PF with (+) or without (-) an intramuscular injection of DMPA (3.5 mg/kg). Two concentrations of PF were compared: 1% [(+) DMPA, n= 5; (-) DMPA, n= 3] and 5% [(+) DMPA, n= 4; (-) DMPA, n= 3]. Controls received (+) DMPA (n= 2) or (-) DMPA, (n= 3) only. The reproductive tracts were removed 1-3 months after treatment for examination. Results No fallopian tubal occlusion was observed in negative controls (± DMPA). Histologic complete tubal occlusion was observed in 3/8 of females treated with 1% PF and in 6/7 treated with 5% PF. Histologic evaluation suggested that 1% PF is associated with prolonged chronic inflammation (more than 2-3 months), while 5% treatment eliminates the epithelial lining, at least focally, and resolves into complete occlusion within 1-2 months. This pattern of complete occlusion was seen in all 4 females that received 5% PF (+ DMPA) and in 2/3 that received 5% PF (- DMPA). Conclusion In a baboon model of transcervical permanent contraception, a single treatment with 5% PF resulted in complete tubal occlusion more reliably (85%) than 1% PF (38%). Cotreatment with DMPA may improve treatment results with 5% PF but requires additional study. Implications A finding that a single transcervical treatment with 5% PF can occlude the fallopian tubes of baboon supports further study of this approach as a novel strategy for permanent contraception for women.

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KW - Female

KW - Nonsurgical sterilization

KW - Permanent contraception

KW - Polidocanol

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