MALE CONTRACEPTION

Urology Division, Surgery Department

Medical Faculty,
University of Sumatera Utara
 male contraceptive method :
- condoms
- periodic abstinence
- withdrawl
 Typical 1st-year failure rates :
- withdrawl 19%
- periodic abstinence 20%
- condoms 3 – 14%
Definition

 Thin sheaths of rubber, vinyl or natural

products which may be treated with a
spermicide for added protection. They are
placed on the penis once it is erect
 Condoms deiffer in such qualities as shape,
color, lubrication, thickness, texture and
addition of spermicide (usually nonoxynol-9)
Types

 Latex (rubber)
 Plastic (vinyl)
 Natural (animal products)
 Research :
- prevent sperm production (use of androgen,
progesteron, GnRH)
- interfere with the ability of sperm to mature and
carry out fertilization by using an epididymal
approach to create a hostile environment for
sperms
- produce better barrier methods
- produce of antisperm contraceptive vaccine
- inhibit sperm-egg interactions
Use of existing male Use of existing male
contraceptives in developed contraceptives in developing
region region
Hormonal male contraception

 Based on suppression of gonadotrophin & the use

of testosterone substitution to maintain male
sexual function & bone mineralization & to prevent
muscle wasting
 Research :
- testosterone monotherapy
- androgen/progestin combination
- testosterone with GnRH analogues
- selective androgen and progestin receptor
modulation
VASECTOMY
 Is an effective method of permanent male
surgical sterilization
 Before the procedure, the couple should be
given accurate information about the benefit &
risks
Surgical techniques

 various techniques
 no-scalpel vasectomy  the least invasive
approach to the vas
 cauterization of the lumen of the vas &
fascial interposition  most effective
occlusion technique
Complications

 Acute local complications :

- haematoma, wound infection, epididymitis
 5% cases
 Long term complications :
- chronic testicular pain, epididymal tubal
damage
 Vasectomy does not significantly alter
spermatogenesis & Leydig cell function
 Volume of ejaculate  unchanged
 Rate of prostate cancer  could not increased
Vasectomy failure

 Effective occlusion technique  risk of

recanalization < 1%
 No motile spermatozoa  3 mo later
 Persistent motility  sign of vasectomy
failure  need to repeat the procedure
 Long term recanalization  may occur (rare)
 Counseling
 It should be considered irreversible
 It has a low complication rate. However,
because vasectomy is an elective operation
even small risks should be explained as men
may wish to consider these before giving their
consent
 It has a low, but existing, failure rate
 Couples should be advised to continue with
other effective contraception until clearance is
achieved
 All available data indicate that vasectomy is
safe & not associated with any serious, long
term side effect
 Fascial interposition & cauterization seem to
give a higher efficacy
Vasectomy reversal

 Success rate > 90%, depend on :

- the time elapsed after vasectomy
- type of vasectomy (open ended or sealed)
- type of reversal (vasovasostomy or
vasoepididymostomy)
- unilateral or bilateral
Conclusions

 The most cost-effective approach to treatment

of post-vasectomy infertility is microsurgical
reversal. This also has the highest chance of
delivery
 Couples can have a family after successful
vasectomy reversal. There is no need for
hormonal treatment of the female partner, with
its associated risks of ovarian hyperstimulation
and multiple pregnancies