Quinacrine sterilization (QS): time for reconsideration

Abstract

Dr. Jaime Zipper, the Chilean inventor of the quinacrine method of nonsurgical permanent contraception, was aware that when chest surgeons injected quinacrine into the pleural cavity to treat and prevent reoccurrence of pleural effusion, it resulted in the formation of fibrous adhesions between the lung and costal pleura. Zipper thought that a similar scarring effect could occur in the fallopian tubes if quinacrine was instilled into the uterine cavity. A series of refinements of the methodology culminated in the use of a modified Copper T intrauterine device inserter tube as a delivery system to introduce seven quinacrine pellets into the uterus. This approach with quinacrine sterilization (QS) was introduced into clinical practice in several countries, and a national clinical trial of over 50,000 women was conducted in Vietnam. However, in 1993, the World Health Organization raised concerns that quinacrine might be carcinogenic. This resulted in abandonment of QS in Vietnam and other countries. Subsequent epidemiologic data from extensive human studies do not support an increase in cancer risk. This paper reviews the history, limitations and clinical potential of QS.

Update on hysteroscopic sterilisation

“…Quinacrine slurry has been used in different concentrations in humans for the purpose of sterilisation and was first introduced in 1928 . Following the reports of deaths, the method was modified.…”

“…It was initially thought to be appropriate for use for sterilisation worldwide, but now only remains popular in developing countries where access to expensive technologies is limited. However, investigators have struggled to overcome the problem of chemical leakage into the peritoneum and subsequent organ damage . Instead of slurry, seven pellets of 36 mg quinacrine (total dose of 252 mg) are inserted in the uterus for two to three doses 1 month apart.…”

“…The technique was banned by WHO in 2006 because of fears over potential carcinogenicity. This has been questioned because quinacrine has been used safely for decades for a variety of other clinical conditions such as parasitic infestation, connective tissue disorders and pleurodesis with no reporting of carcinogenic effects . Lippes has called for reanalysis of the epidemiological data available and to reconsider the technique for use …”

Permanent Contraception for Women

“…45 Quinacrine Sterilization (QS), a prototype method, was introduced in many developing nations including India, Vietnam, and Chile, but concerns regarding safety of QS led to mistrust and withdrawal of the method. 46 While this demonstrates that the concept is feasible and acceptable for human medicine, it also provides a cautionary story. Although the epidemiologic data support safety of QS, 47 the enthusiasm for and promotion of strategies for fertility control in developing countries that are not approved in the United States or European Union leads to suspicion regarding the safety of methods and the goals and motives of international family planning programs.…”

Two-photon probes for in vivo multicolor microscopy of the structure and signals of brain cells

“…Table 5), and quinacrine (Bestvater et al 2002) which stains nucleic acids ( cf. Table 8) while having several therapeutic indications (Wallace 1989; Eriksson et al 2015; Lippes 2015). …”