MALE CONTRACEPTION

dr. Syah Mirsya Warli, SpU

dr. Bungaran Sihombing, SpU
Urology Division, Surgery Department
Medical Faculty,
University of Sumatera Utara

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 References:

z Guidelines on Male Infertility, European Association

of Urology,
Urology March 2007
z Clinical Manual of Urology, (Philip M. Hanno et al
), McGraw-Hill Int ed,, 3rd ed,, 2001
eds),
z Smith’s General Urology (Tanagho & McAninch
eds), Lange Medical Books, 15th ed, 2000
z Infertility in The Male, (Lipshultz & Howards eds),
Mosby, 1997

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 Male contraseption

z male contraceptive method :

- condoms
d
- periodic abstinence
- withdrawl
z Typical 1st-year failure rates :
- condoms 3 – 14%
- periodic abstinence 20%
- withdrawl 19%

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 Male contraception

Use of existing male

contraceptives in developed region
Use of existing male
contraceptives in developing
region
g

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 Condoms

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 Condoms

z Thin sheaths of rubber, vinyl or natural products which

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

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 Types of Condom

z Latex (rubber)
z Plastic (vinyl)
z Natural (animal products)

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 Mechanism of action condom

z Prevent sperm from gaining access to female

reproductive tract
z Prevent micro organism (Sexual Transmitted
Disease)) from ppassing
g from one p
partner to another
(latex & vinyl condom only)

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 Contraceptive benefits

z Effective immediately
z D nott affect
Do ff t breastfeeding
b tf di
z Can be used as back up to other methods
z No method
method-related
related health risk
z No systemic side-effects
z Widely available
z Inexpensive

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 Research Contraceptive :

- 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
prod ce better barrier methods
- produce of antisperm contraceptive vaccine
- inhibit sperm-egg
sperm egg interactions

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 Hormonal male contraception

z Based on suppression of gonadotrophin & the use of

testosterone substitution to maintain male sexual
function & bone mineralization & to prevent muscle
wastingg
z Research :
- testosterone monotherapy
- androgen/progestin combination
- testosterone with GnRH analogues
- selective
l ti androgen
d andd progestin
ti receptor
t
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 Vasectomy

z Is an effective method of p
permanent male surgical
g
sterilization
z Before the procedure, the couple should be given
accuratet information
i f ti about
b t the
th benefit
b fit & risks
i k

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 Surgical techniques

z various techniques
z no-scalpel
l l vasectomy
t Æ the
th lleastt iinvasive
i
approach to the vas
z cauterization of the lumen of the vas & fascial
interposition Æ most effective
occlusion technique

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 Vasectomy

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 Complications

z Acute local complications :

- haematoma, wound infection, epididymitis
Æ 5% cases
z Long
L tterm complications
li ti :
- chronic testicular pain, epididymal tubal damage

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 Complications

z Vasectomy does not significantly alter

spermatogenesis
t i & Leydig
L di cellll ffunction
ti
z Volume of ejaculate Æ unchanged
z Rate of prostate cancer Æ could not increased

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 Vasectomy failure

z Effective occlusion technique Æ risk of recanalization

< 1%
z No motile spermatozoa Æ 3 mo later
z Persistent motility Æ sign of vasectomy failure Æ
need to repeat the procedure
z Long term recanalization Æ may occur (rare)

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 Counseling

z It should be considered irreversible

z 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
z It has a low,
low but existing,
existing failure rate
z Couples should be advised to continue with other
effective contraception until clearance is
achieved
hi d
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 Vasectomy

z All available data indicate that vasectomy is safe &

not associated with any serious, long term side effect
z Fascial interposition & cauterization seem to give a
higher efficacy

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 Vasectomy reversal

z Success rate > 90%, depend on :

- the
th titime elapsed
l d after
ft vasectomy
t
- type of vasectomy (open ended or sealed)
- type of reversal (vasovasostomy or
vasoepididymostomy)
- unilateral or bilateral

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 Conclusions

z The most cost-effective approach to treatment of post-

vasectomy infertility is microsurgical reversal. This
also has the highest chance of delivery
z 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

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 Th k You
Thank Y

26 wr’07