Fertility following extended depo provera treatment in sooty mangabeys (Cercocebus atys) Pubblico

Abstract

ABSTRACT
The injectable contraceptive medroxyprogesterone acetate (depo provera, DMPA), a synthetic progestin that suppresses ovulation, is currently approved for human use in over 90 countries. DMPA is also widely used for the reproductive management of animal populations. Studies examining fertility after DMPA treatment in both human and nonhuman animals have focused on the resumption of ovulation after treatment cessation, but neglected potential long-term effects of DMPA exposure on successful reproduction. DMPA is frequently administered as a contraceptive agent for adolescent girls, however, the possibility of differential long-term fertility effects of DMPA exposure during adolescence have not been explored. We investigated the effects of extended DMPA treatment on the post-treatment fertility of a species of old world nonhuman primate, the sooty mangabey (Cercocebus atys). Female sooty mangabeys (N=31) in a large breeding group at the Yerkes National Primate Research Center Field Station received DMPA treatment for between 4-8yr. At the time of first DMPA injection, females were either parous (N=14) or nulliparous (N=17), with nulliparous-treated females consisting of pubertal (N=10) and prepubertal adolescents (N=7). After cessation of DMPA treatment, nulliparous-treated females had a significantly higher incidence of stillbirth than did age-matched or experience-matched controls, whereas parous-treated females did not differ from matched controls. Looking exclusively within treated females, nulliparous-treated females placed on DMPA prepubertally had a significantly higher incidence of stillbirth than either pubertal nulliparous-treated females or parous-treated females. The majority of stillbirths to nulliparous-treated females included difficult and/or prolonged labor (dystocia) culminating in infant death. In humans, dystocia is associated with weak uterine contractions, and progestins are known to suppress uterine contractility. It is possible that exposure to elevated levels of progestin throughout puberty, a critical period of uterine development, permanently reduced uterine contractility for females placed on DMPA in early adolescence. These results indicate that the post-treatment effects of chronic DMPA exposure vary with the developmental timing of treatment onset, and raise concerns about the use of DMPA as a contraceptive for adolescent girls.

Table of Contents

TABLE OF CONTENTS

I. Introduction 1

II. Methods 4

a. Treated Subjects 4

b. Controls 6

c. Data Collection 8

d. Following Reproduction 9

e. Statistical Analyses 11

III. Results 12

a. Return of Fertility 12

b. Reproductive Output 13

c. Pregnancy Outcomes 13

IV. Discussion 16

a. Return of Fertility 17

b. Reproductive Output 17

c. Pregnancy Outcomes 19

d. Stillbirths 20

V. References 23

VI. Tables 27

VII. Figure Captions 32

VIII. Figures 34

About this Master's Thesis

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School	Laney Graduate School
Department	Psychology
Degree	MA
Submission	Master's Thesis
Language	English
Research Field	Psychology, Experimental
Parola chiave	Primates Fertility Contraception
Committee Chair / Thesis Advisor	Wallen, Kim, Emory University
Committee Members	Bliwise, Nancy, Emory University Bloomsmith, Mollie, Emory University Edwards, David A, Emory University

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