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  • Title: [Male contraception in 1987].
    Author: Silvestre L, Varin C, Bouchard P.
    Journal: Rev Prat; 1987 Sep 21; 37(38):2302-11. PubMed ID: 3310192.
    Abstract:
    Male contraception apart from vasectomy and the condom is still in a virtually experimental stage. An acceptable male method must not interfere with sexual function and must meet the same demands for safety, simplicity, efficacy and reversibility as female methods. Condoms are the oldest and most effective reversible male method. Vasectomy is a simple and safe procedure, popular in some countries. Its biggest drawback is its uncertain reversibility even after successful reanastomosis. Hormonal approaches to male contraception are based on use of steroid or peptide compounds to inhibit production of the gonadotropins luteinizing hormone (LH) and follicle stimulating hormone (FSH) by the pituitary, resulting in azoospermia. The actual development of such methods has been confounded by imperfect knowledge of the hormonal mechanisms regulating spermatogenesis. The method requires 2 months to become effective because the process of human spermatogenesis is so lengthy. Rates of azoospermia greater than 70-80% have never been achieved. Among substances used, testosterone enanthate is unacceptable because of irregular efficacy and secondary effects inherent in the doses of androgens. Several progestins have been studied in combination with injectable, implanted, or percutaneous androgen therapy. Azoospermia is not usually achieved and secondary effects are significant. Medroxyprogesterone acetate has given more promising results in limited trials. Cyproterone acetate and danazol, a synthetic analog of 17 alpha ethinyl testosterone, are powerful but have significant side effects. The expectation that superanalogs to gonadotropin releasing hormone (GnRH) would provide a male hormonal method has thus far not been met. GnRH agonists have never yet produced a durable azoospermia in human males, even with continuous perfusion of elevated doses. It has recently been shown that the required androgen substitution interferes with achievement of azoospermia. GnRH antagonists appear more promising, but the androgen substitution poses a similar problem to that encountered with GnRH agonists. The first human trials are now underway. The hormonal approach may ultimately provide an interesting choice for individuals able to have regular spermograms, but does not appear feasible on a wide scale. A direct approach to male contraception at the level of the epididymis or testicles is theoretically interesting because of the rapidity of the effect. Gossypol, a phenolic compound extracted from cotton oil or seeds, provides extreme oligospermia in 99.9% of users, but the effect has been irreversible in a nonnegligible proportion of men using it for more than 2 years. Other compounds tested have been too toxic for clinical use. Immunological approaches pose major theoretical problems and all developments remain experimental. A better knowledge of the physiology of spermatogenesis and of the control of sperm movement will be required for development of a satisfactory male contraceptive method.
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