good but getting out of date
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This is the proceedings of the 10th world congress on human reproduction held in Salvador, Brazil in 1999. It's 43 articles cover assisted reproduction, contraception, abortion, menopause, endocrinology and endoscopy. For those generalists like myself whoare neither doctors nor specialists in reproduction, it will be an eyeopening experience.
One finds(p148) that over 300,000 human embryos were created in the UK alone in just a few years so there may have been at least two or three hundred thousand a year in the world. Most of these were from eggs(often frozen and thawed) fertilized in vitro by sperm and then frozen at the blastocyst(early embryo) stage, to be unfrozen and implanted in a uterus at a future date.
Some relevant statistics not presented here show that humans produce about 400 eggs and 200 trillion sperm every second and there are about 50 billion copulations a year. By comparison a person produces about 400 trillion hemoglobin molecules ever second.
One learns also that unwanted pregnancies alone account for an estimated 600,000 maternal deaths a year from childbirth and legal and illegal abortions. Perhaps 70,000 a year die from illegal abortions. From data presented here, I estimate that the refusal of the USA to support worldwide birthcontrol over the last 40 years has resulted in at least 350 million pregnancies, 100 million abortions(spontaneous and induced), 200,000 maternal deaths from childbirth, 300,000 dead babies, and an increase in the world population of some 250 million.
Christian fundamentalists seem to find this delightful. It would be easy for the Gates Foundation to put an end to most of this misery by distribution free birth control and `morning after' pills but of course neither they nor any other NGO has the courage to do it.
Recently hormone replacement therapy(HRT) has fallen into disfavor as it supposedly slightly increases rates of some kinds of cancer but such studies usually have severe detection/surveillance biases and articles here reviewing some 50 such studies show that with less than 5 years use, it has no proven effect on breast cancer rates and decreases cardiac problems. Furthermore, women who develop breast cancer while on HRT have a reduced risk of dying.
Although studies consistently demonstrate the safety of modern low dose oral contraceptives, it is easy to get funding so research continues. Studies seem to show that the (very small)risk of thromboembolism in normal women increases about three fold on oral contraceptives, but since the risk rises by six times during pregnancy, which has many other major consequences for health and life, this seems quite trivial. All of the studies have built in problems with severe detection/surveillance biases, preferential prescribing, attrition of susceptibles and other problems and when these can be corrected for there appears to be very little risk. Most importantly one must consider the high failure rates of alternative contraception and the very high risks of pregnancy and childbirth, to say nothing of the lifetime consequences to the couples and to society of failed contraception. Nearly all myocardial infarctions and strokes have occurred in users of the older high dose pills or in those with cardiovascular risk factors over the age of 35.
Implantable birth control devices such as Norplant and Jadelle, which slowly release hormones, have great potential, but they have been delayed significantly by the USA legalized extortion racket. Nearly all new contracptive devices have been attacked by the same morally retarded groups--fundamentalists and sometimes misguided feminists.
However this method is so effective, cheap and convenient that is growing rapidly worldwide with some 6 million users in 1997 though it is being replaced by the two implant system Jadelle.
Tamoxifen-- the first widely used Selective Estrogen Receptor Modulator(SERM-- had some negative effects, but newer ones(eg, Raloxifene) seem very promising as one study showed it reduced the incidence of breast cancer in postmenopausal women by 60%.
There is great interest in the use other hormones for long term suppression of menstruation, not merely for birth control, but to decrease the often serious side effects such as anemia, pain, migraine, and dysphoria. A 400 mg injection of DepoProvera inhibits ovulation for 6 months and had some 12 million users in 1997 and contraceptive pills inserted vaginally can maintain symptom free amenorrhea for years. Oral pills called Seasonale used on a schedule permitting three bleedings a year made their appearance in 2004. Vaginal insertion has the great advantage of bypassing the liver and delivers a large dose direct to the endometrium. Consequently use of such IUD devices as Mirena, which contains the same levonorgestrel as Norplant, is growing rapidly.
There are articles on the use of intracytoplasmic sperm injection(ie, sperm injected directly into the egg) and of many cases in which the sperm is taken directly from the epididymis. With this and other techniques totally infertile men and women with major genetic reproductive defects are having children. As with most other medical procedures, nobody thinks of the fact that, on average, the children will inherit these defects, requiring ever more of these procedures in the future.
IUDs without hormones appeared long ago and are increasingly popular, with possibly 70 million users of the copper containing device, TCU 380 in 1997. It is effective for up to 12 years
It is possible to prevent a pregnancy up to 2 weeks after fertilization with vaccines against HCG and to immunize against pregnancy but this will require booster shots and much research will have to be done.
