Quinacrine sterilization: a retrospective.
OBJECTIVE
To trace development of quinacrine sterilization (QS).


METHODS
Review of published reports.


RESULTS
The high prevalence of septic abortion among high parity women in Santiago, Chile, motivated Zipper to find a safe, inexpensive method of non-surgical female sterilization. Various cytotoxic drugs were tried in rats. Because quinacrine was already accepted for intrapleural injection it was chosen for the first clinical trial. A slurry consisting of quinacrine and xylocaine was instilled into the uterine cavity with a transcervical syringe. Reasonable efficacy was noted and a limited scar of the intramural tube demonstrated. However, a side effect of cortical excitation and reports of 3 deaths ended this approach. Zipper and Wheeler hypothesized that the difficulty was due to rapid absorption of quinacrine under pressure and designed a pellet form that dissolves slowly and could be delivered transcervically using a modified IUD inserter. A standard protocol of 252 mg in seven 36 mg pellets placed at the uterine fundus on two occasions a month apart has now been widely used with considerable evidence for safety and efficacy. Indeed, protection is greater than 98% at 2 years of use.


CONCLUSIONS
QS is ready for widespread use, especially where surgical sterilization is not safely available or when women are poor candidates for surgery or have such a fear of surgery that they will not seek surgical sterilization.
Zipper
J
J
Department of Obstetrics and Gynecology, Sótero del Río Hospital, University of Chile, Santiago, Chile. dzipper@entelchile.net
Kessel
E
E
D000818:Animals; D003906:Developing Countries; D005260:Female; D006801:Humans; D011796:Quinacrine / Q000008:administration & dosage*; D051381:Rats; D012102:Reproductive Control Agents / Q000008:administration & dosage*; D019035:Rural Health Services; D013246:Sterilization, Tubal / Q000379:methods*
D012102:Reproductive Control Agents; D011796:Quinacrine