Vasectomy and Vasovasostomy - Male Contraception

Spermicides. Some condoms come prelubricated with sperm-killing substances called spermicides. The standard active ingredient in spermicides in the US is nonoxynol-9, which attacks the surface of the sperm cell. These spermicidal-coated condoms, however, are no longer recommended for a number of reasons. Side effects include irritation of the vagina or penis, particularly if used often or in large amounts. Its use may also promote yeast and urinary tract infections in women. Evidence now strongly suggests that nonoxynol-9 does not provide any additional protection against sexually-transmitted diseases. In fact, research now suggests that it actually increases the risk for HIV in women, possibly by causing injury in the vaginal area. Spermicides are no longer recommended for use with male condoms.

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A heat activated, microbe-fighting gel may offer an effective alternative, but is still undergoing early testing.

Hormonal Contraceptives for Men

Researchers are currently at work on hormonal contraceptives that reduce levels of sperm. Hormonal contraception for men is more complicated than for women and research is still very preliminary.

Progestins. Much of the research is focusing on progestins, derivatives of progesterone, a primary family hormone, which in men interfere with sperm production. Studies generally are testing progestins (such asdesogestrel, etonogestrel, or levonorgestrel) with addition of testosterone to maintain normal male hormone levels. There is a typical delay of2 to3 months before infertility is achieved. Sperm production returns to normal when the agents are stopped. Studies are promising, but there are some significant side effects, including acne, weight gain, and reductions in HDL cholesterol.

Prolactin. Prolactin, a hormone in both men and women, is also being investigated. In men, it can reduce sperm production.

Gossypol

Gossypol, a yellow pigment extracted from the roots, seeds, and stems of the cotton plant, has been used in China, African, and Brazil as a male contraceptive. Cotton root was also used as folk medicine in the American South to treat menstrual pain and to induce abortions. The chemical destroys the lining of tubules in the testicles where sperm are produced, thereby inhibiting their formation. A 2000 Brazilian study reported that a male oral contraceptive derived from gossypol suppressed sperm production within up to 16 weeks. In men who were taking lower doses, sperm production returned in most of them within a year after they stopped taking the contraceptive. Gossypol does not appear to reduce sexual desire or frequency of intercourse. In about 20% of men, sperm production does not come back, so it should be considered as potentially permanent birth control. It also may not be effective in some men, since small numbers of sperm may survive. Researchers are investigating gossypol-derived compounds that may have less toxicity. No one should take any so-called natural gossypol product without consultation with a doctor.

Reversible Vas Occlusion

Some attempts have been made to develop procedures that block sperm flow in the vas deferens using various drugs or materials but which are reversible. To date, none have been totally effective as a male contraceptive.A promising method uses a substance called styrene maleic anhydride, or SMA (Risug). This substance is injected in the vas deferens. It coats the walls and blocks the tube. It is removed by flushing the vas deferens with a solvent. It is mostly being investigated overseas.