Objective To estimate 12-month satisfaction and continuation rates of intrauterine device (IUD) and implant users enrolled in the Contraceptive CHOICE Project and compare these measures to women using the oral contraceptive pills (OCPs). Methods We analyzed 12-month data from the first 5,087 participants enrolled in a prospective cohort study of women in the St. Louis region offered contraception at no cost for 3 years. The primary purpose of CHOICE is to promote the use of long-acting reversible contraception (IUDs and implants) and to reduce unintended pregnancies in our region. This analysis includes participants who received their baseline contraceptive method within 3 months of enrollment and who reached the 12-month follow-up phone survey time point (N=4,167). Results Sixty-eight percent of our participants chose a long-acting reversible contraception method (45% levonorgestrel intrauterine system, 10% copper IUD, and 13% subdermal implant), while 23% chose combined hormonal methods (11% OCPs, 10% vaginal ring, and 2% transdermal patch), and 8% chose depot medroxyprogesterone acetate. Long-acting reversible contraception users had higher 12-month continuation rates (86%) than OCP users (55%). The two IUDs had the highest 12-month continuation rates: levonorgestrel intrauterine system (88%) and copper IUD (84%). Women using the implant also had very high rates of continuation at 1 year (83%). Satisfaction mirrored continuation: over 80% of users were satisfied with the IUD compared to 54% satisfied with OCPs. Conclusion IUDs and the subdermal implant have the highest rates of satisfaction and 12-month continuation. Given that long-acting reversible contraception methods have the highest contraceptive efficacy, these methods should be the first-line contraceptive methods offered to patients.

A new 52-mg levonorgestrel-releasing intrauterine system is effective and safe for nulliparous and parous women for at least 3 years.

Objective To investigate whether age 14–19 years and nulliparity are associated with expulsion of the levonorgestrel and copper intrauterine devices (IUD). Methods This was a planned secondary analysis of the Contraceptive CHOICE Project. We used Kaplan-Meier survival analysis to estimate expulsion rates for the first levonorgestrel or copper IUD received during study participation. Cox proportional hazards regression models were used to investigate baseline characteristics associated with expulsion. Results A total of 5,403 females were included; 4,219 (78%) levonorgestrel IUD and 1,184 (22%) copper IUD users. There were 432 initial expulsions reported. The 36-month cumulative expulsion rate was 10.2 per 100 IUD users and did not vary by IUD type (levonorgestrel IUD 10.1 vs. copper IUD 10.7, p=0.99). In the bivariate analysis, multiple characteristics including age, nulliparity, immediate postabortion insertion, and heavy menses were associated with expulsion. The cumulative rate of expulsion was lower in nulliparous women compared to parous women (8.4 vs. 11.4, p <.001) and higher in females aged 14–19 compared to older women (18.8 vs. 9.3, p <.001). After adjusting for confounders and stratifying by IUD type, the hazards ratio (HRadj) of expulsion for females aged 14–19 years was 2.26 (95% CI 1.68–3.06) for the levonorgestrel IUD and 3.06 (95% CI 1.75–5.33) for the copper IUD. Compared to parous levonorgestrel IUD users, expulsion was lower for nulliparous levonorgestrel IUD users (HRadj 0.59, 95% CI 0.44–0.78). Conclusions IUD expulsions were not increased in nulliparous females. More expulsions were observed in females aged 14–19 compared to older women regardless of parity or IUD type.

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Objective. To analyze a nationally representative sample of women for correlates of dual-contraceptive-method use. Materials and Methods. We conducted an analysis of the National Survey of Family Growth, 2006–2008, a cross-sectional survey of reproductive-aged women in the United States. Results. Dual method use was reported by 7.3% of the 5,178 women in the sample. Correlates of higher rates of dual-contraceptive-method use included age younger than 36 years and nonmarried marital status. Lower rates of dual method use were observed for women with less than a high-school education and women without consistent health insurance in the past year. Compared to women using oral contraceptives, use of the contraceptive injection or long-acting reversible contraception was associated with lower dual-method use. Conclusions. The overall rate of dual-method use in the USA is low. Future interventions to promote dual method use should target high-risk groups with modifiable risk factors.

Trichomoniasis is the most prevalent curable sexually transmitted disease (STD). It has been associated with preterm birth and the acquisition and transmission of HIV. Recently, nucleic acid amplification tests (NAAT) have been FDA cleared in the United States for detection of Trichomonas vaginalis in specimens from both women and men. This study reports the results of a multicenter study recently conducted using the Xpert TV (T. vaginalis) assay to test specimens from both men and women. On-demand results were available in as little as 40 min for positive specimens. A total of 1,867 women and 4,791 men were eligible for inclusion in the analysis. In women, the performance of the Xpert TV assay was compared to the patient infected status (PIS) derived from the results of InPouch TV broth culture and Aptima NAAT for T. vaginalis. The diagnostic sensitivities and specificities of the Xpert TV assay for the combined female specimens (urine samples, self-collected vaginal swabs, and endocervical swabs) ranged from 99.5 to 100% and 99.4 to 99.9%, respectively. For male urine samples, the diagnostic sensitivity and specificity were 97.2% and 99.9%, respectively, compared to PIS results derived from the results of broth culture for T. vaginalis and bidirectional gene sequencing of amplicons. Excellent performance characteristics were seen using both female and male specimens. The ease of using the Xpert TV assay should result in opportunities for enhanced screening for T. vaginalis in both men and women and, hopefully, improved control of this infection.

Objectives To determine women's knowledge of contraceptive effectiveness. Study Design We performed a cross-sectional analysis of a contraceptive knowledge questionnaire completed by 4,144 women enrolled in the Contraceptive CHOICE Project prior to receiving comprehensive contraceptive counseling and choosing their method. For each contraceptive method, women were asked “what percentage would get pregnant in a year: <1%, 1-5%, 6-10%, >10%, don't know.” Results Overall, 86% of subjects knew the annual risk of pregnancy was >10% if no contraception is used. More than 45% of women overestimate the effectiveness of depo-medroxyprogesterone acetate, pills, patch, ring, and condoms. After adjusting for age, education and contraceptive history, women who chose the intrauterine device (IUD) [RRadj=6.9, 95% CI: 5.6-8.5] or implant [RRadj = 5.9, 95% CI 4.7-7.3] were significantly more likely to accurately identify the effectiveness of their method compared to women who chose either the pill, patch, or ring. Conclusions This cohort demonstrated significant knowledge gaps regarding contraceptive effectiveness and over-estimated the effectiveness of pills, patch, ring, DMPA, and condoms.

Objectives We aim to describe our experiences and identify patients who may benefit from referral to a peripheral nerve surgeon for removal of contraceptive subdermal implants in which neurovascular injury may occur and describe a treatment pathway for optimal care. Study Design We reviewed the charts of 22 patients who were referred to the Division of Family Planning for difficult removal of etonogestrel contraceptive implants between January 1, 2014 and April, 1 2016. Of these, 5 were referred to a peripheral nerve surgeon due to pain or location of the implant. We evaluated and described these cases and from our findings, developed recommendations for care in a multidisciplinary team approach. Results Two patients reported pain, including one with four previous failed removal attempts. In the two patients with pain, the implants were adherent to a sensory nerve. In another, the implant was within the biceps muscle and difficult to locate. In all cases, ultrasound imaging, general anesthesia, and a wide exposure allowed for safe removal and good outcomes. Our multidisciplinary care approach has elucidated important referral and technical considerations that improve patient care and safety. Conclusion When necessary, multidisciplinary care with a Family Planning expert and possibly a peripheral nerve surgeon may be beneficial in safely removing etonogestrel contraceptive implants that would be difficult or risky to remove in an ambulatory setting.