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

2. 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

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

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

5. Condoms 5

6. 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

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

8. 8

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Vasectomy 15

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

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

18. 18

19. 19

20. 20

21. 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

22. 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

23. 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

24. 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

25. 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

26. Thank You 26
wr’07