Use of etonogestrel implant beyond approved duration: prolonged contraceptive effectiveness

Abstract

Background: The subdermal etonogestrel contraceptive implant has a current approved duration of 3 years. There is, however, recent and strong evidence of its effectiveness for 2 additional years during which no pregnancies were documented.

Case: We report a case of a 28-year-old woman who had an etonogestrel implant inserted 4 years earlier and wished to get pregnant. The implant was, however, deep in the triceps muscle and could not easily be removed. Her serum levels of etonogestrel remained positive even 6 years after insertion. As infertility investigation revealed endometriosis and bilateral tubal obstruction she was referred for assisted reproduction. Despite obtaining oocytes during an ovarian stimulation cycle, the endometrium was never above 4 mm, precluding embryo transfer. It was decided to remove the implant in order to improve endometrial conditions, after which the patient achieved pregnancy.

Conclusion: This case report suggests that the etonogestrel implant is effective for even longer than the most recent studies have shown.

摘要

背景：皮下依托孕烯避孕植入剂目前批准的有效期为3年。然而, 最近强有力的证据证明了其额外2年的有效性, 在此期间没有任何怀孕记录的发生。

病例:我们报告了一例28岁的女性患者, 她在4年前放置了依托孕烯植入剂, 并希望怀孕。然而, 植入剂位于肱三头肌深处并且不容易取出。即使在放置6年后, 她的血清依托孕烯水平仍然保持阳性。由于不孕调查显示子宫内膜异位症和双侧输卵管阻塞, 她被转诊进行辅助生殖。尽管在卵巢刺激周期内获得卵母细胞, 但子宫内膜从未超过4mm, 从而妨碍了胚胎移植。为了改善子宫内膜状况, 决定移除植入剂, 之后患者成功怀孕。

结论:本病例报告表明, 依托孕烯植入剂的有效期甚至比最新的研究显示的还要长。

Keywords:

• Contraceptive effectiveness
• contraceptive implant
• etonogestrel

Disclosure statement

CINS has been an invited speaker at scientific meetings for Bayer and MSD. BCR, HA, POS and IDR have no conflicts of interest to declare. All authors contributed equally to this manuscript and all signed a statement of authorship.