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World. tubal ligation 32%. vasectomy 7%. IUD 22%. condom 7%. CI/PA 13%. oral contraceptives 14%. D/P/S 5%. Germany. IUD 8%. tubal ligation 1%. oral contraceptives 77%. vasectomy 2%. condom 6%. CI/PA 4%. Nieschlag & Behre Andrology 2nd ed. - PowerPoint PPT Presentation
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7th Congress European Society ofContraception
Genova, April 12, 2002
„Hormonal male contraception:Unresolved problems“
E. NieschlagInstitute of Reproductive MedicineUniversity of Münster, Germany
World
Germany
tubal ligation 32%
vasectomy 7%
condom 7%
CI/PA 13%D/P/S 5%
oral contraceptives 14%
IUD 22%
oral contraceptives 77%
IUD 8%tubal ligation 1%
vasectomy 2%condom 6%
CI/PA 4%D/P/S 2%
EN-F1620E
Nieschlag & BehreAndrology 2nd ed.Springer 2000
GossypolConstituent of cottonseed oilSuppression of spermatogenesis to a various degreeSide effects: nausea, hypokalemia, possible irreversibility
Coutinho et al. 2000 15 mg / d in 151 men for 16 weeks,Contraception “Suppression of spermatogenesis” in 81 men. Recovery phase: 21 men did not reach sperm counts > 20 x 106 / ml, 8 remained azoospermic after 1 year of cessation.
Gu et al. 2000 10 mg / d to 12.5 mg / d in 55 men for 6 months,Asian J Androl Sperm count < 4 x 106 / ml in ca. 70 % of subjects. Recovery phase: not reported.
EN-F1767
EN-F1529E
Approaches to male contraception
Methods in use VasectomyVas occlusionCondomCoitus interruptus
Physical approach UltrasoundTemperature
Immunological Immun. against sperm approach antigens (e.g. p34h)
Pharmacological Chlorinated sugars approach Nitroimidazole derivatives
SulfasalazineGossypolTripterigium wilfordii
Hormones
Nieschlag & BehreAndrology 2nd ed.Springer 2000
EN-F1530b
Approaches to hormonal male contraception
1. Inhibition of FSH2. Testosterone (T) alone3. T + gestagens4. T + estrogens5. T + 5a-reductase inhibitors6. T + GnRH agonists7. T + GnRH antagonists
Nieschlag 2002
EN-F1519E
The Weimar Manifesto on Male ContraceptionJune 29, 1997
“... The researchers agreed that clinical research had shown that a reversible male hormonal contraceptive is feasible and effective ...”
“... Since any contraceptive method can only be brought to practical usage by pharmaceutical com-panies, the researchers urged the pharmaceutical industry to become actively involved in the develop-ment of novel male contraceptives...”
(From Nieschlag & Behre, Testosterone, 2nd ed. Springer 1998)
Results of cross-cultural questionnaire-based interviews:
"Yes, I would use a male method".
Male Pill Injectionn (% yes) (% yes)
Cape Town Black 153 55 48 White 171 83 62 Coloured 169 66 55 Hong Kong 450 44 32 Shanghai 450 50 35 Edinburgh 436 66 32
Martin et al. Hum Reprod. 15 (2000) 637-645
EN-F960
