MALE CONTRACEPTION 1 dr. Syah Mirsya Warli, SpU dr. Bungaran Sihombing, SpU Urology Division, Surgery Department Medical Faculty, University of Sumatera Utara 1

References: Guidelines on Male Infertility, European Association of Urology, March 2007 Clinical Manual of Urology, (Philip M. Hanno et al eds), McGraw-Hill Int ed, 3rd ed, 2001 Smith’s General Urology (Tanagho & McAninch eds), Lange Medical Books, 15th ed, 2000 Infertility in The Male, (Lipshultz & Howards eds), Mosby, 1997 2

Male contraseption 3 male contraceptive method : - condoms - periodic abstinence - withdrawl Typical 1st-year failure rates : - condoms 3 – 14% - periodic abstinence 20% - withdrawl 19% 3

Male contraception 4 Use of existing male contraceptives in developed region Use of existing male contraceptives in developing region 4

Condoms 5

Condoms 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 differ in such qualities as shape, color, lubrication, thickness, texture and addition of spermicide (usually nonoxynol-9) 6

Types of Condom 7 Latex (rubber) Plastic (vinyl) Natural (animal products) 7

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Mechanism of action condom Prevent sperm from gaining access to female reproductive tract Prevent micro organism (Sexual Transmitted Disease) from passing from one partner to another (latex & vinyl condom only) 9

Contraceptive benefits Effective immediately Do not affect breastfeeding Can be used as back up to other methods No method-related health risk No systemic side-effects Widely available Inexpensive 10

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 better barrier methods - produce of antisperm contraceptive vaccine - inhibit sperm-egg interactions 11

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 12

Vasectomy Is an effective method of permanent male surgical sterilization Before the procedure, the couple should be given accurate information about the benefit & risks 13

Surgical techniques 14 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 14

Vasectomy 15

Complications 16 Acute local complications : - haematoma, wound infection, epididymitis  5% cases Long term complications : - chronic testicular pain, epididymal tubal damage 16

Complications Vasectomy does not significantly alter spermatogenesis & Leydig cell function Volume of ejaculate  unchanged Rate of prostate cancer  could not increased 17

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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) 21

Counseling 22 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 22

Vasectomy 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 23

Vasectomy reversal 24 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 24

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 25

Thank You 26 wr’07