59 The menstrual regularity was maintained and women continued to have ovulatory cycles.60 No change in

bleeding profile was observed. With the approval of the Drugs Controller General of India and Institutional Ethics Committees, phase II efficacy trials were carried out with this vaccine in three major institutions: the All India Institute of Medical Sciences (AIIMS, New Delhi), Postgraduate Institute of Medical Education and Research (PGIMER, Chandigarh), and Safdarjung Hospital, New Delhi. A total of 148 sexually active women of proven fertility with two living children (of which one below 1 year to confirm their contemporary fertility) Ibrutinib mw were enrolled with their informed consent. Many of them had come to clinics earlier for medical termination of unwanted pregnancy. The available contraceptives in the family planning basket either did not

suit these women or were not used consistently. Their husbands were reluctant to use condoms. Primary immunization was given by three intramuscular injections of the HSD-TT/DT vaccine adsorbed on alum at monthly interval. Sodium phthalyl lipopolysaccharide (SPLPS), a non-pyrogenic derivative of LPS, was used at 1 mg in the first injection only. Vaccine with the TT or DT as carrier was given alternatively, Y 27632 so as to avoid carrier-induced suppression of antibody response to HSD. All women made antibodies reactive with hCG.4 However, 110 of the 148 immunized women had hCG bioneutralization titers above 50 ng/mL (a threshold fixed for testing protection against pregnancy) for 3 months or longer. All women continued to ovulate and had regular menstrual cycles. The antibody titers declined with time but booster injections raised the titers (Fig. 4). Eight women completed more than 30 cycles by voluntary intake of booster injections as and when required without becoming pregnant. Nine completed 24–29 cycles, 12 completed 18–23 cycles, 15 completed 12–17 cycles, and 21 women completed 6–11

cycles. The personal diary of women indicated without doubt that they were sexually active with a minimum of two sexual intercourses per week. The semen parameters of husbands were good with high counts of motile sperms. The fact that the women were prone to become pregnant Cyclic nucleotide phosphodiesterase is supported by the record of 26 pregnancies taking place in women at titers falling below 35 ng/mL bioneutralization capacity. Fig. 5 is an illustrative example of a 30-year-old subject with two living children and one MTP. After three primary injections of the vaccine, she took two boosters and remained protected against pregnancy for 13 cycles. In the immediate cycle, when her antibody titers had fallen below 20 ng/mL, she conceived and had a positive pregnancy test. Although most conceptions occurring at or below protective threshold were terminated at the behest of the subjects (Medical termination of pregnancy is legal in India), four women decided to continue with their pregnancy.