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Asian Journal of Andrology. 1999 Jun; 1:7-12.The aim was to present a personal account of the involvement of the World Health Organization (WHO) in the collaborative development in Asia of those areas of andrology concerned with male contraception and reproductive health. The andrology training through workshops and institution support undertaken by the WHO Human Reproduction Programme (HRP) and how they contributed to the strengthening of andrology research in Asia are summarised. The author's experience and the Asian scientific contributions to the global research in the following areas are reviewed: the safety of vasectomy and the development of new methods of vas occlusion; gossypol and its failure to become a safe, reversible male antifertility drug; Tripterygium and whether its pure extracts will pass through the appropriate toxicology and phased clinical studies to become acceptable contraceptive drugs; hormonal methods of contraception for men. The WHO policy of research capacity building through training and institution strengthening, together with the collaboration of Asian andrologists, has created strong National institutions now able to direct their own programmes of research in clinical and scientific andrology. (author's)
BRITISH MEDICAL BULLETIN. 1993 Jan; 49(1):210-21.The search for new, safe, effective, and reversible contraceptive methods for men as pursued by several agencies and probable future developments until the year 2000 is reviewed. A WHO consultation between vasectomy and the risk of cancer of the prostate or testis is unlikely and changes in family planning policies are unwarranted. Research in China has led to the ligation of the vas by percutaneous injection of sclerosing agents through a puncture opening. The suppression of secretion of either both luteinizing hormone and follicle-stimulating hormone (FSH) or of FSH alone; the recovery of circulating androgen to physiological levels; and the assessment of the functional capacity of residual sperm. Hormonal methods comprise the contraceptive efficacy of testosterone enanthate-induced azoospermia and oligozoospermia; and gonadotropin-releasing hormone analogue-androgen combinations. A large number of non-hormonal chemical agents lead to total spermatogenic arrest and to irreversible sterility. Gossypol was studied as an antifertility agent in clinical studies on more than 8000 Chinese men, but its use for contraception was halted owing to the high incidence of irreversibility and serious side effects such as hypokalemia. Among drugs and plant products for inhibition of sperm maturation, Chinese investigation showed that a multiglycoside extract of the plant Tripterygium wilfordii caused reductions in sperm motility and concentration in patients. A program established between Chinese, Thai, and UK centers aims to isolate pure compounds extracted from the plant for antifertility actions. In regard to contraceptive vaccines, passive or active immunization against FSH has resulted in significant decreases in sperm counts in macaque monkeys with inconsistent effects on fertility.
CONTRACEPTIVE TECHNOLOGY UPDATE. 1989 Oct; 10(10):142-3.250 men are participating in a clinical trial of a reversible male testosterone contraceptive at the University of Washington in Seattle and at 9 other centers in Europe, Asia, and Australia. Clinicians inject the WHO-developed testosterone enanthate (200 mg) into these men once a week. The testosterone contraceptive instructs the pituitary gland to deactivate 2 hormones which normally maintain the testes' function resulting in a temporary stop of spermatogenesis just like the female oral contraceptive instructs the pituitary gland to suppress ovulation. Tests of 5 ejaculates in preliminary trials have indicated that 50-60% of the men experience azoospermia. Investigators are concerned with the possibility that ejaculates during normal intercourse may contain enough sperm to impregnate the partner. An investigator at the University of Washington believes this clinical trial of 250 men will determine whether this is indeed the case. The concern about contraceptive failure is the main problem with contraceptive testosterone. The minor side effects include weight gain which may be due to increased muscle mass and some sodium retention, acne, and possible reduction of libido but that has not yet occurred in the 250 men in the clinical trial. This contraceptive testosterone does not remain active for long periods of time if administered orally. Researchers are now developing a newer form of the contraceptive which will increase the intervals between administrations from 1 week to 3 months. An investigator from Seattle guesses that this male contraceptive will not be available for marketing in the US until at least 1994.
London, England, International Planned Parenthood Federation [IPPF], 1992 Sep. 93 p.20 participants from 9 sub-Saharan countries and the UK discuss men's negative attitudes towards family planning (the leading obstacle to the success of family planning in Africa) at the November 1991 Workshop on Male Participation in Family Planning in The Gambia. Family planning programs have targeted women for 20 years, but they are starting to see the men's role in making fertility decisions and in transmitting sexually transmitted diseases (STDs). They are trying to find ways to increase men's involvement in promoting family planning and STD prevention. Some recent research in Africa shows that many men already have a positive attitude towards family planning, but there is poor or no positive communication between husband and wife about fertility and sexuality. Some family planning programs (e.g., those in Sierra Leone, Nigeria, Ethiopia, and Zimbabwe) use information, education, and communication (IEC) activities (e.g., audiovisual material, print media, film, workshops, seminars, and songs) to promote men's sexual responsibility. IEC programs do increase knowledge, but do not necessarily change attitudes and practice. Some research indicates that awareness raising must be followed by counseling and peer promotion efforts to effect attitudinal and behavioral change. The sub-Saharan Africa programs must conduct baseline research on attitudes and a needs assessment to determine how to address men's needs. In Zambia, baseline research reveals that a man having 1 faithful partner for a lifetime is deemed negative. Common effective needs assessment methodologies are focus group discussions and individual interviews. Programs have identified various service delivery strategies to meet these needs. They are integration of family planning promotion efforts via AIDS prevention programs, income-generating schemes, employment-based programs, youth programs and peer counseling, male-to-male community-based distribution of condoms, and social marketing. Few programs have been evaluated, mainly because evaluation is not included in the planning process.
NETWORK. 1992 Aug; 13(1):20-3.Researchers are pursuing 2 approaches to developing a male contraceptive drug. 1 approach centers around suppression of sperm production the other around blocking conception. Researchers are looking at introducing hormonal contraceptives into men's bodies via injections or implants to stop sperm production. Both forms of these possible male contraceptives will not be available for many years, however. A WHO study on testosterone enanthate of men in 7 countries reveals total suppression of sperm production occurred in almost all the Asian men, but only about 60% suppression occurred in other ethnic groups. A current WHO study is examining whether a hormonal contraceptive which is not 100% effective can be useful if it would be more effective than barrier methods. The Population Council is conducting research on 2 capsule implants with 1 capsule releasing luteinizing hormone releasing hormone 13 to halt sperm production while the other releases an androgen to maintain sex drive. Animal tests indicate complete contraception with no side effects. The other possible means of suppressing sperm production is administration of a cottonseed oil extract called gossypol which appears to stop sperm production thereby eliminating the need for concurrent androgen administration. Yet it does cause potassium depletion in some men which can result in arrhythmias. An antifertility vaccine comprises the 2nd approach. Several US researchers are exploring an antifertility vaccine to produce antibodies only to the specialized sperm surface needed to attach to the egg. The 1st antifertility vaccine would probably be in pill form and a woman's contraceptive since it is earlier to target the smaller number of sperm in the oviduct than in the testes.
REPRODUCTION AND CONTRACEPTION. 1990 May; 10(2):6-9.Contraceptive research is a time-consuming and expensive endeavor. It takes 15 to 25 years and 15 million US dollars to develop a new contraceptive method. Such an expensive investment made it inhibitive for developing countries to have their own contraceptive research. Most of them have to use foreign currency to import contraceptives. Besides a few pharmaceutical companies, there are 7 important organizations and agencies in the world that are engaged in sponsoring or organizing contraceptive research. Among these organizations, WHO/HRP and UNFPA have had more involvement in contraceptive research in China. The emphasis of funding from HRP in recent years has switched from supporting organizational building of research institutes to finding specific research projects. HRP has 10 task forces which reviews research proposals from over the world and funding is provided to the projects approved. UNFPA has allocated 4.5 million US dollars in contraceptive research in its 1990-1994 assistance programs to China. 3 important issues that need basic research are 1. male contraceptives 2. male infertility and 3. mechanism of female menstrual disturbance. In the past number of years, international organizations have placed great emphasis on social and behavior research related to contraceptive practice. Attention has also been given to the development of management skills in the research institutes so that the scarce resources could be used efficiently. Training of personnel has also been a major component of assistance from both HRP and UNFPA. It has been suggested that a training center be established in China to serve the need of China and Asia and Pacific region.
In: International Planned Parenthood Federation (IPPF). East and South East Asia and Oceania region. Joint consultation of regional medical committee and regional information, education and communication committee, March 2-3, 1976, Hong Kong. Kuala Lumpur, Malaysia, IPPF, (1976). p. 76-79This IPPF review discusses chemical and hormonal male contraceptive agents and their effects on the physiology of testicular control. 2 methods of physiological disruption are addressed: direct interruption of spermatogenesis and suppression of gonadotropins (steroidogenesis). Sperm production may be interrupted by 1) agents acting directly on the seminiferous tubule to arrest cell division, 2) by interference with epididymal function, 3) or by blocking secretion of follicle stimulating hormone (FSH) and luteinizing hormone on which the testis and epididymis depend. Agents now being tested for these purposes show no promise except for cyproterone acetate, given in low doses of 10 and 29 millig/day, which has biomodal action. Gonadotropin suppression requires analogues of either gonadotropin-releasing hormone or androgens, though loss of libido and potency occur with administration. Of the drugs discussed, none fulfills criteria of a desirable male contraceptive. Androgens alone or with progestagens and estrogens have been shown to be effective, but side effects and mode of administration require further study. Inhibin, a postulated FSH inhibitor, theoretically provides a novel approach in that it is a peptide and libido should not decrease; however, oral male contraception seems a decade away.