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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.
WASHINGTON POST HEALTH. 1993 Jan 12; 11.In the United States a total of 490,000 men obtain vasectomies each year compared to more than 600,000 women who sought sterilization in 1992 via tubal ligation. Vasectomy is often permanent, and even monogamous men avoid the procedure, partly because of the misconception that vasectomies reduce sexual prowess, fear of emasculation, and its confusion with castration. Also, there have been suggestions that vasectomy may increase the risk of prostate cancer. The World Health Organization experts in 1991 concluded there was no reason to stop recommending vasectomies. However, 2 large studies at Harvard University in Boston have added to the controversy. The 1st study involved more than 23,000 husbands of women in the Nurses' Health Study and followed the men from 1976 until 1989. A preliminary analysis found that having a vasectomy appears to increase the risk for prostate cancer by 37%. The 2nd study involved more than 51,000 men in the Health Professionals Follow-up Study. Similarly, preliminary analysis indicated that vasectomized men appear to have a 21% increased risk for prostate cancer. These findings cause concern, since 4 million American men have had the procedure. A vasectomy involves severing each vas deferens, which carries sperm from the testicles into the penis. In the new, no-scalpel vasectomy technique the doctor makes 1 tiny puncture, and for the patient there is less swelling and bleeding. 300 US doctors are trained to perform the procedure, which was pioneered in China. Failure usually occurs because the vasa reconnect by themselves. Only a small percentage of men experience complications, most commonly excess bleeding or infections. Microsurgical techniques result in a 98% chance of reconnecting the vasa, if a reversal of the procedure is desired. But only about half of those who undergo a reversal succeed in fathering children, because after a vasectomy the immune system often produces antibodies against sperm.