title: Effect of Immediate Compared With Delayed Insertion of Etonogestrel Implants on Medical Abortion Efficacy and Repeat Pregnancy: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To evaluate the effect of insertion of etonogestrel implants with mifepristone compared with after the abortion on the risks of medical abortion failure and repeat pregnancy over the subsequent 6 months.
  
  
  METHODS
  In a randomized trial, we assigned patients undergoing medical abortion to receive etonogestrel implants either with the mifepristone (Quickstart group) or after the abortion (Afterstart group). We followed them for 7 months to ascertain abortion outcome, pregnancies, and contraception use.
  
  
  RESULTS
  Between September 2013 and August 2014, we enrolled 236 participants in the Quickstart group and 240 in the Afterstart group. To examine abortion failure, we conducted a noninferiority analysis from which we excluded nine participants who had missing outcome data and four with specified protocol violations. Of the rest, 9 of 229 (3.9%) and 9 of 234 (3.8%) in the Quickstart and Afterstart groups, respectively, had surgery to complete the abortion; the difference of 0.08% (90% confidence interval -3.1% to 3.3%) excluded our prestipulated noninferiority margin of 5 percentage points. Among participants with pregnancy follow-up through 6 months, 1 of 213 (0.5%) and 3 of 208 (1.4%) in the Quickstart and Afterstart groups, respectively, became pregnant within that time; 6-month pregnancy rates did not differ significantly by group (exact log-rank test, P=.28). At enrollment, significantly more participants in the Quickstart group than in the Afterstart group were satisfied with their group assignments (187/236 [79%] compared with 129/240 [54%], respectively; P<.001).
  
  
  CONCLUSIONS
  Insertion of etonogestrel implants with mifepristone did not appreciably increase medical abortion failure risk and it enhanced patient satisfaction, but we found no evidence that it decreased repeat pregnancy rates.
  
  
  BACKGROUND
  ClinicalTrials.gov, www.clinicaltrials.gov, NCT01902485.
authors.affiliation: Gynuity Health Projects, New York, New York; the Departments of Medicine and Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Secretariat of Health, Mexico City, Mexico; Planned Parenthood of Southern New England, New Haven, Connecticut; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Planned Parenthood League of Massachusetts, Boston, Massachusetts; Planned Parenthood of the Pacific Southwest, San Diego, California; Planned Parenthood Northern California, San Rafael, California; and Johns Hopkins University, Baltimore, Maryland.
authors.forename: Elizabeth G
authors.initials: EG
authors.lastname: Raymond
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.forename: Yi-Ling
authors.initials: YL
authors.lastname: Tan
authors.forename: Karmen S
authors.initials: KS
authors.lastname: Louie
authors.forename: Manuel
authors.initials: M
authors.lastname: Bousiéguez
authors.forename: Elba M
authors.initials: EM
authors.lastname: Lugo-Hernández
authors.forename: Ana Gabriela
authors.initials: AG
authors.lastname: Aranguré-Peraza
authors.forename: Patricio
authors.initials: P
authors.lastname: Sanhueza
authors.forename: Clair
authors.initials: C
authors.lastname: Kaplan
authors.forename: Sarita
authors.initials: S
authors.lastname: Sonalkar
authors.forename: Alisa B
authors.initials: AB
authors.lastname: Goldberg
authors.forename: Kelly R
authors.initials: KR
authors.lastname: Culwell
authors.forename: Lisa
authors.initials: L
authors.lastname: Memmel
authors.forename: Roxanne
authors.initials: R
authors.lastname: Jamshidi
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000032:Abortion, Therapeutic / Q000379:methods*; D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003271:Contraceptive Agents, Female / Q000627:therapeutic use*; D017135:Desogestrel / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007436:Intrauterine Devices, Medicated / Q000706:statistics & numerical data*; D015735:Mifepristone / Q000627:therapeutic use*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends; D018570:Risk Assessment; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; C044815:etonogestrel; D015735:Mifepristone; D017135:Desogestrel