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Yu X, Shuai J, Meng G, Zhou S, Wijayaraja AU, Zhao Y, Yao L, Yao R, Yang X, Zhang T, Wang L, Gu P, Zhang P, Sun F. Ferritin-nanocaged aggregation-induced emission nanoaggregates for NIR-II fluorescence-guided noninvasive, controllable male contraception. Mater Today Bio 2024; 25:100995. [PMID: 38384792 PMCID: PMC10879778 DOI: 10.1016/j.mtbio.2024.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/23/2024] Open
Abstract
Controllable contraception in male animals was demonstrated through the utilization of gold nanorods' photothermal effect to accomplish mild testicular hyperthermia. However, the challenges arising from testicular administration and the non-biodegradability of nanoparticles hinder further clinical implementation. Therefore, a straightforward, non-invasive, and enhanced contraception approach is required. This study explores the utilization of human heavy chain ferritin (HFn) nanocarriers loaded with aggregation-induced emission luminogens (AIEgens) for noninvasive, controllable male contraception guided by Near-Infrared-II (NIR-II) fluorescence imaging. The HFn-caged AIEgens (HFn@BBT) are delivered via intravenous injection and activated by near-infrared irradiation. Lower hyperthermia treatment induces partial damage to the testes and seminiferous tubules, reducing fertility indices by approximately 100% on the 7th day, which gradually recovers to 80% on the 60th day. Conversely, implementation of elevated hyperthermia therapy causes total destruction of both testes and seminiferous tubules, leading to a complete loss of fertility on the 60th day. Additionally, the use of AIEgens in NIR-II imaging offers improved fluorescence efficiency and penetration depth. The findings of this study hold significant promise for the advancement of safe and effective male contraceptive methods, addressing the need for noninvasive and controllable approaches to reproductive health and population control.
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Affiliation(s)
- Xinghua Yu
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Jiaxue Shuai
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Ge Meng
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Shumin Zhou
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Amali Upekshika Wijayaraja
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Yixiang Zhao
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Lei Yao
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Rui Yao
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Xing Yang
- Guangdong Key Laboratory of Nanomedicine, Shenzhen Engineering Laboratory of Nanomedicine and Nanoformulations, CAS-HK Joint Lab for Biomaterials, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Tianfu Zhang
- School of Biomedical Engineering, Guangzhou Medical University, Guangzhou, 511495, China
| | - Liying Wang
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Pengyu Gu
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
| | - Pengfei Zhang
- Guangdong Key Laboratory of Nanomedicine, Shenzhen Engineering Laboratory of Nanomedicine and Nanoformulations, CAS-HK Joint Lab for Biomaterials, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Fei Sun
- Department of Urology & Andrology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310016, China
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Nguyen BT. The demand for male contraception: Estimating the potential market for users of novel male contraceptive methods using United States National Survey of Family Growth data. Contraception 2024:110438. [PMID: 38555051 DOI: 10.1016/j.contraception.2024.110438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/07/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To estimate the potential market for novel male contraceptives (NMCs) using United States National Survey of Family Growth (NSFG) data, 2015-2017. STUDY DESIGN We described the market for NMCs via secondary analysis of the 2015-2017 NSFG's weighted male respondent data, utilizing surrogate markers for contraceptive switching (NSFG) and contraceptive discontinuation data from the Contraceptive CHOICE project. Potential NMC users included men relying on: (1) no methods or less effective methods but who reported that they would be "very upset" if they got someone pregnant, (2) permanent methods but who reported that they might still want more children, (3) a female partner's method that she might discontinue in the next year, (4) a male method even when his partner uses her own contraceptive. RESULTS Of 3340 respondents-representing 55,890,830 sexually active, reproductive-age men-23.2% used no contraception at last intercourse, 15.8% condoms, 5.1% withdrawal, and 5.1% vasectomy. Among respondents relying solely on condoms, withdrawal, or no method, 19.7%, 3.8%, and 4.4% would be "very upset" if they got someone pregnant. For permanent contraceptive users, 17.3%-20.5% wanted another child. For men reliant on their partner's long-acting reversible or combined hormonal contraceptive, 12-17% and 45-51% of partners might discontinue their method. These data conservatively suggest that 13% or more than 7 million men would potentially use NMCs, rising to 15.5 million with less restrictive contraceptive switching criteria. CONCLUSION Adjusting for pregnancy attitudes and likelihood of contraceptive switching, a substantial portion (between 7-15.5 million) of reproductive age men in the US are potential NMC users. IMPLICATIONS The population of potential novel male contraceptive users extends beyond just users of condoms, withdrawal and vasectomy and should include couples practicing dual-partner contraception and female partners using contraceptive methods that they may become dissatisfied with and discontinue.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Department of Obstetrics and Gynecology, Los Angeles General Medical Center, Los Angeles, CA, United States.
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Paik J, Haenisch M, Kim A, Snyder JM, Amory JK. Return to fertility, toxicology, and transgenerational impact of treatment with WIN 18,446, a potential male contraceptive, in mice. Contraception 2024; 129:110306. [PMID: 37813273 PMCID: PMC10959076 DOI: 10.1016/j.contraception.2023.110306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/02/2023] [Accepted: 10/05/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVES We examined the return to fertility and transgenerational impact of treatment with WIN 18,446, an experimental male contraceptive, in mice. STUDY DESIGN We paired male mice treated with WIN 18,446 for 4 weeks to suppress spermatogenesis, followed by a 9-week recovery, and mated them with normal females to assess fertility. F1 generation mice were subsequently mated to ascertain any transgenerational impact of treatment on fertility. Testes were examined histologically. RESULTS WIN 18,446-treated mice and their progeny produced normally sized litters (6.5 pups per litter after treatment and 7.3 pups per litter from the progeny). However, testes histology revealed rare residual intratesticular foci of mineralization after treatment. CONCLUSIONS Fertility normalizes after WIN 18,446 treatment, and progeny also have normal fertility.
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Affiliation(s)
- Jisun Paik
- Department of Comparative Medicine, University of Washington, Seattle, WA, United States
| | - Michael Haenisch
- Department of Comparative Medicine, University of Washington, Seattle, WA, United States
| | - Andy Kim
- Department of Comparative Medicine, University of Washington, Seattle, WA, United States
| | - Jessica M Snyder
- Department of Comparative Medicine, University of Washington, Seattle, WA, United States
| | - John K Amory
- Department of Medicine, University of Washington, Seattle, WA, United States.
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Al Noman MA, Cuellar RAD, Kyzer JL, Chung SSW, Cheryala N, Holth TAD, Maitra S, Naqvi T, Wong HL, Schönbrunn E, Hawkinson JE, Wolgemuth DJ, Georg GI. Strategies for developing retinoic acid receptor alpha-selective antagonists as novel agents for male contraception. Eur J Med Chem 2023; 261:115821. [PMID: 37776573 PMCID: PMC10841505 DOI: 10.1016/j.ejmech.2023.115821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 10/02/2023]
Abstract
Reported here are the synthesis and in vitro evaluation of a series of 26 retinoic acid analogs based on dihydronaphthalene and chromene scaffolds using a transactivation assay. Chromene amide analog 21 was the most potent and selective retinoic acid receptor α antagonist identified from this series. In vitro evaluation indicated that 21 has favorable physicochemical properties and a favorable pharmacokinetic PK profile in vivo with significant oral bioavailability, metabolic stability, and testes exposure. Compound 21 was evaluated for its effects on spermatogenesis and disruption of fertility in a mouse model. Oral administration of compound 21 at low doses showed reproducibly characteristic albeit modest effects on spermatogenesis, but no effects on fertility were observed in mating studies. The inhibition of spermatogenesis could not be enhanced by raising the dose and lengthening the duration of dosing. Thus, 21 may not be a good candidate to pursue further for effects on male fertility.
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Affiliation(s)
- Md Abdullah Al Noman
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Rebecca A D Cuellar
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Jillian L Kyzer
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | | | - Narsihmulu Cheryala
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Trinh A D Holth
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Soma Maitra
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Tahmina Naqvi
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Henry L Wong
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Ernst Schönbrunn
- Department of Drug Discovery, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, 33612, USA
| | - Jon E Hawkinson
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA
| | - Debra J Wolgemuth
- Department of Genetics and Development, USA; Department of Obstetrics and Gynecology, USA; The Institute of Human Nutrition, USA; The Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, 1150 St. Nicholas Avenue, New York, NY, 10032, USA
| | - Gunda I Georg
- Department of Medicinal Chemistry and Institute for Therapeutics Discovery and Development, College of Pharmacy, University of Minnesota, 717 Delaware Street SE, Minneapolis, MN, 55414, USA.
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Louwagie EJ, Quinn GFL, Pond KL, Hansen KA. Male contraception: narrative review of ongoing research. Basic Clin Androl 2023; 33:30. [PMID: 37940863 PMCID: PMC10634021 DOI: 10.1186/s12610-023-00204-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Since the release of the combined oral contraceptive pill in 1960, women have shouldered the burden of contraception and family planning. Over 60 years later, this is still the case as the only practical, effective contraceptive options available to men are condoms and vasectomy. However, there are now a variety of promising hormonal and non-hormonal male contraceptive options being studied. The purpose of this narrative review is to provide clinicians and laypeople with focused, up-to-date descriptions of novel strategies and targets for male contraception. We include a cautiously optimistic discussion of benefits and potential drawbacks, highlighting several methods in preclinical and clinical stages of development. RESULTS As of June 2023, two hormonal male contraceptive methods are undergoing phase II clinical trials for safety and efficacy. A large-scale, international phase IIb trial investigating efficacy of transdermal segesterone acetate (Nestorone) plus testosterone gel has enrolled over 460 couples with completion estimated for late 2024. A second hormonal method, dimethandrolone undecanoate, is in two clinical trials focusing on safety, pharmacodynamics, suppression of spermatogenesis and hormones; the first of these two is estimated for completion in December 2024. There are also several non-hormonal methods with strong potential in preclinical stages of development. CONCLUSIONS There exist several hurdles to novel male contraception. Therapeutic development takes decades of time, meticulous work, and financial investment, but with so many strong candidates it is our hope that there will soon be several safe, effective, and reversible contraceptive options available to male patients.
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Affiliation(s)
- Eli J Louwagie
- University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA.
| | - Garrett F L Quinn
- University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA
| | - Kristi L Pond
- University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD, 57105, USA
| | - Keith A Hansen
- Chair and Professor, Dept. of Obstetrics and Gynecology, University of South Dakota Sanford School of Medicine; Reproductive Endocrinologist, Sanford Fertility and Reproductive Medicine, 1500 W 22nd St Suite 102, Sioux Falls, SD, 57105, USA
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Martins SL, Boraas CM. Willingness to use novel reversible methods of male birth control: a community-based survey of cisgender men in the United States. Contracept Reprod Med 2023; 8:41. [PMID: 37563690 PMCID: PMC10413635 DOI: 10.1186/s40834-023-00242-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND There is high global demand for new methods of male birth control (MBC). However, contemporary evidence regarding men's method-specific attitudes and their determinants is sparse. METHODS Non-sterilized cisgender men ages 18-45 with recent history of female sex partners were surveyed at a large community event in the Midwestern US. We examined variation in participants' willingness to use MBC by method (gel, pill, injection, implant, and vas occlusion), potential side effects, and potential barriers. We estimated crude and adjusted prevalence ratios (aPRs) for associations between participant characteristics and willingness to use ≥ 1 MBC method. RESULTS Overall, 72% of participants (n = 187; mean age, 29) were very willing to use ≥ 1 MBC method although support for individual methods ranged widely from 62% (pill) to 24% (vas occlusion). In bivariate analysis of sociodemographic and health characteristics, few demonstrated associations with MBC willingness. In a multivariable model, willingness was independently related to age (30-39 vs. 18-29 years old, aPR = 1.24, 95% CI 1.04-1.48) and having ever been tested for HIV (aPR = 1.27, 95% CI 1.07-1.51). Willingness to tolerate side effects was < 10% for most items. The most commonly endorsed barriers to MBC use were high cost (77%) and side effects (66%). CONCLUSIONS Enthusiasm for MBC was high but waned in the context of potential side effects and barriers. Additional research on MBC attitudes in socioeconomically and culturally diverse populations worldwide is sorely needed.
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Affiliation(s)
- Summer L Martins
- Allina Health, 2925 Chicago Avenue, MS 10105, Minneapolis, MN, 55455, USA
| | - Christy M Boraas
- Department of Obstetrics, Gynecology & Women's Health, University of Minnesota Medical School, Riverside Professional Building, 606 24th Ave. S., Minneapolis, MN, 55454, USA.
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Hupertan V, Graziana JP, Schoentgen N, Boulenger De Hauteclocque A, Chaumel M, Ferretti L, Methorst C, Huyghe E. [Recommendations of the Committee of Andrology and Sexual Medicine of the AFU concerning the management of Vasectomy]. Prog Urol 2023; 33:223-236. [PMID: 36841700 DOI: 10.1016/j.purol.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/22/2022] [Indexed: 02/27/2023]
Abstract
OBJECTIVES To answer the main clinical questions asked by practitioners and men consulting for a vasectomy request. METHOD The CPR method was used. The clinical questions were formulated according to the PICO methodology. A Pubmed literature search for the period 1984-2021 identified 508 references, of which 79 were selected and analyzed with the GRADE grid. RECOMMENDATIONS Vasectomy is a permanent, potentially reversible contraception. It is a safe procedure. A second vasectomy is necessary in only 1 % of cases. Surgical complications (hematoma, infection, pain, etc.) are rare. The frequency of prolonged scrotal pain after vasectomy is about 5 %, and less than 2 % describe a negative impact of this pain on their quality of life. Vasectomy does not have negative consequences on sexuality. The only contraindication to vasectomy is the minor patient. Patients at increased risk of remorse are single, divorced or separated men under the age of 30. Sperm storage may be particularly appropriate for them. Whatever the reason, the law allows the surgeon to refuse to perform the vasectomy. He must inform the patient of this at the first consultation. The choice of the type of anesthesia is left to the discretion of the surgeon and the patient. It must be decided during the preoperative consultation. Local anesthesia should be considered first. General anesthesia should be particularly considered in cases of anxiety or intense sensitivity of the patient to palpation of the vas deferens, difficulty palpating the vas deferens, or a history of scrotal surgery that would make the procedure more complex. Concerning the vasectomy technique, 2 points seem to improve the efficiency of the vasectomy: coagulation of the deferential mucosa and interposition of fascia. Leaving the proximal end of the vas deferens free seems to reduce the risk of post-vasectomy syndrome without increasing the risk of failure or complications. No-scalpel vasectomy is associated with a lower risk of postoperative complications than conventional vasectomy. Regarding follow-up, it is recommended to perform a spermogram at 3 months post-vasectomy and after 30 ejaculations. If there are still a few non-motile spermatozoa at 3 months, it is recommended that a check-up be performed at 6 months post-vasectomy. In case of motile spermatozoa or more than 100,000 immobile spermatozoa/mL at 6 months (defining failure), a new vasectomy should be considered. Contraception must be maintained until the effectiveness of the vasectomy is confirmed.
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Affiliation(s)
- V Hupertan
- Cabinet médical Paris Batignolles, Paris, France
| | - J P Graziana
- Clinique mutualiste de la porte de l'Orient, Lorient, France
| | - N Schoentgen
- Hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, Paris, France
| | | | - M Chaumel
- Service d'urologie, CHU de Tours, Tours, France
| | - L Ferretti
- Maison de santé pluridisciplinaire Bordeaux Bagatelle, Talence, France
| | - C Methorst
- Service d'urologie, CH des quatre villes, Saint-Cloud, France
| | - E Huyghe
- Département d'urologie, transplantation rénale et andrologie, CHU de Toulouse, site de Rangueil, Toulouse, France; Service de médecine de la reproduction, CHU de Toulouse, site de l'hôpital Paule-de-Viguier, 31059 Toulouse, France; UMR DEFE Inserm 1203, université de Toulouse 3, université de Montpellier, Toulouse, France.
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Lue Y, Swerdloff R, Pak Y, Nguyen BT, Yuen F, Liu PY, Blithe DL, Wang C. Male contraception development: monitoring effective spermatogenesis suppression utilizing a user-controlled sperm concentration test compared with standard semen analysis. Fertil Steril 2023; 119:208-217. [PMID: 36347310 PMCID: PMC9898087 DOI: 10.1016/j.fertnstert.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether a user-controlled sperm concentration test compared with standard semen analysis can effectively monitor spermatogenesis suppression for male contraception. DESIGN Single center, prospective sub study of the ongoing clinical trial: "Study of daily application of Nestorone and testosterone combination gel for male contraception." SETTING Research institute at an academic medical center. PARTICIPANT(S) Couples participating in the male contraceptive clinical trial. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) The ability by participants to monitor sperm suppression to a threshold compatible with contraceptive efficacy utilizing a user-controlled test verified by sperm concentration determined by standard laboratory methods. RESULT(S) Thirty-eight men participating in a hormonal male contraceptive clinical trial provided multiple samples during spermatogenesis suppression for this substudy. Participants, employing a user-controlled test, correctly identified the absence of sperm (a negative test) in 100% of their laboratory-confirmed azoospermic samples (n = 122). Participants also identified 100% of samples (n = 73) with sperm >0.2 million/mL as positive. Sperm counts between 0.01 and 0.2 million/mL were identified as negative in 96% of samples. Trial participants noted the overall ease of using the test with respect to sample preparation, test timing, and result interpretation, and that they could accurately use this test at home without difficulty. CONCLUSION(S) Participants undergoing spermatogenesis suppression in a hormonal male contraceptive trial performed user-controlled test to determine whether their semen sperm concentration was ≤ or >0.2 million/mL. Compared with standard semen analyses, participants correctly identified 100% of samples with sperm counts >0.2 million/mL as positive (Sensitivity 100%). A positive result when the couple is using a male contraceptive method triggers the need for semen analysis by a laboratory while the couple uses another method of contraception. Participants correctly diagnosed samples ≤0.2 million sperm/mL as negative in 99% of samples (specificity 99%). A negative result indicates a sperm concentration ≤0.2 million/mL, well below the threshold of ≤1 million/mL offering contraceptive efficacy demonstrated by prior studies. At-home sperm concentration test would minimize the need for users to return to the clinic to monitor suppression of spermatogenesis, decreasing cost and burden of male contraception trials and increasing practicality of the method. CLINICAL TRIAL REGISTRATION NUMBER NCT: 03452111.
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Affiliation(s)
- Yanhe Lue
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Ronald Swerdloff
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Youngju Pak
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California; Clinical and Translational Science Institute, The Lundquist Institute at Harbor-University of California, Los Angeles, Medical Center, West Carson, California
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Fiona Yuen
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, THarbor-UCLA Medical Center, Medical Center, West Carson, California; Clinical and Translational Science Institute, The Lundquist Institute at Harbor-University of California, Los Angeles, Medical Center, West Carson, California.
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Leiber-Caspers C. Why Is There Still No "Pill for Men"? Current Developments in Hormonal and Nonhormonal Medical Contraception for Men. Eur Urol Focus 2023; 9:25-27. [PMID: 36443200 DOI: 10.1016/j.euf.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/10/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
Although hormonal contraception has been available to women for more than 60 yr, the only contraceptive options for men are still either a condom or vasectomy. This review presents current developments in hormonal and nonhormonal medical contraception for men, and perspectives for the future. Although a lot of scientific effort has been spent in identifying hormonal male contraception options in the past 40 yr, insufficient effectiveness and possible side effects mean that no official approvals have been obtained to date. Against this background, nonhormonal options for male contraception are the new field of interest. PATIENT SUMMARY: This review describes attempts to develop a reliable medical contraceptive for men, explains why there is still no "pill for men", and highlights how the future of medical contraception for men might look. For many reasons, there is an urgent need for male contraception in Europe and around the world.
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Bennetts FM, Mobbs JI, Ventura S, Thal DM. The P2X1 receptor as a therapeutic target. Purinergic Signal 2022; 18:421-33. [PMID: 35821454 DOI: 10.1007/s11302-022-09880-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/25/2022] [Indexed: 01/14/2023] Open
Abstract
Within the family of purinergic receptors, the P2X1 receptor is a ligand-gated ion channel that plays a role in urogenital, immune and cardiovascular function. Specifically, the P2X1 receptor has been implicated in controlling smooth muscle contractions of the vas deferens and therefore has emerged as an exciting drug target for male contraception. In addition, the P2X1 receptor contributes to smooth muscle contractions of the bladder and is a target to treat bladder dysfunction. Finally, platelets and neutrophils have populations of P2X1 receptors that could be targeted for thrombosis and inflammatory conditions. Drugs that specifically target the P2X1 receptor have been challenging to develop, and only recently have small molecule antagonists of the P2X1 receptor been available. However, these ligands need further biological validation for appropriate selectivity and drug-like properties before they will be suitable for use in preclinical models of disease. Although the atomic structure of the P2X1 receptor has yet to be determined, the recent discovery of several other P2X receptor structures and improvements in the field of structural biology suggests that this is now a distinct possibility. Such efforts may significantly improve drug discovery efforts at the P2X1 receptor.
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Nguyen BT, Jacobsohn TL. Post-abortion contraception, an opportunity for male partners and male contraception. Contraception 2022; 115:69-74. [PMID: 35870483 PMCID: PMC9561074 DOI: 10.1016/j.contraception.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 07/13/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Men who accompany their female partners at the time of an abortion represent a unique population who may be amenable to receiving postabortion contraceptive services. We sought to examine their interest in receiving both counseling and contraception when available. STUDY DESIGN We analyzed a subset of survey data on the experience of accompanying male partners at the time of an abortion at two urban family planning clinics. We examined their beliefs about shared contraceptive responsibility, attitudes towards participating in contraceptive counseling, and willingness to use novel male contraceptives. We conducted bivariate analyses and logistic regressions for sociodemographic and reproductive factors linked to these outcomes. RESULTS Of 210 male partners surveyed at the time of an abortion, nearly three-quarters characterized preventing unwanted pregnancy as a shared responsibility, believed in the importance of attending contraceptive counseling with their female partner, and reported willingness to use novel male contraceptives. Contraceptive method used when discovering the pregnancy was neither linked to men's attitudes towards counseling nor interest in using novel male contraceptives. Individuals between the ages of 25 to 34 (aOR: 2.69; 95%CI: 1.32-5.48), those with a college education (aOR: 5.49; 95%CI: 1.31-22.94), and those who had never experienced abortion (aOR: 2.21; 95%CI: 1.08-4.55) exhibited greater interest in using novel male contraceptives. Black respondents (aOR: 2.33; 95%CI: 1.01-5.38) exhibited greater interest in receiving contraceptive counseling with their partner and a counselor following the abortion. CONCLUSION For male partners, abortion may be an opportunity to engage men in contraceptive counseling and when available, offer new male contraceptives. IMPLICATIONS As few men receive comprehensive contraceptive counseling, engaging men when they accompany their female partners to family planning clinics may be an additional strategy to prevent unwanted pregnancy.
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Affiliation(s)
- Brian T Nguyen
- Section of Family Planning, Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States.
| | - Tamar L Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
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Jacobsohn T, Nguyen BT, Brown JE, Thirumalai A, Massone M, Page ST, Wang C, Kroopnick J, Blithe DL. Male contraception is coming: Who do men want to prescribe their birth control? Contraception 2022; 115:44-48. [PMID: 35550379 PMCID: PMC9560967 DOI: 10.1016/j.contraception.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess men's preferences for healthcare provider from whom they would obtain hormonal male contraceptive (HMC) methods. STUDY DESIGN We asked participants from 3 clinical trials of investigational HMC methods-an oral pill (11β-Methyl-19-nortestosterone-17β-dodecylcarbonate, 11β-MNTDC), intramuscular or subcutaneous injection (Dimethandrolone undecanoate), and transdermal gel (Nestorone and testosterone)-to rank their top 3 preferred HMC providers from a list including: men's health doctor (urologist/andrologist), hormonal doctor (endocrinologist), reproductive health doctor (OB/GYN), family planning clinician (community health worker, midwife, nurse practitioner), regular doctor (family medicine/internal medicine), and community pharmacist. We examined preferences based on their rankings and conducted bivariate analyses. Collapsing the various specialists (men's health doctor, hormonal doctor, reproductive health doctor, and family planning clinician) into a single provider type, we examined participant demographics against provider preference (regular doctor, pharmacist, or specialist). RESULTS Participants across the 3 trials (n = 124) ranked their regular doctor (44%) and community pharmacist (18%) as their most preferred HMC provider; these preferences did not differ significantly by trial and drug formulation. Specialists in family planning (13%), men's health (12%), reproductive health (10%), and hormones (4%) were least frequently ranked as their preferred provider. Older and higher educated participants more often preferred specialists over regular doctors and pharmacists (p = 0.02 and p = 0.01). CONCLUSIONS Despite receiving contraceptive steroid hormones and care from endocrinologists and family planning specialists in a clinical trial, participants would prefer to obtain contraception from their regular doctor. IMPLICATIONS As most men expect to obtain hormonal male contraceptives from their regular doctor when commercially available, primary care physicians should become familiar with HMCs and be prepared to provide counseling and options accordingly.
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Affiliation(s)
- Tamar Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States.
| | - Jill E Brown
- Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Massone
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Jeffrey Kroopnick
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
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13
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Agarwal A, Gupta S, Sharma RK, Finelli R, Kuroda S, Vij SC, Boitrelle F, Kavoussi P, Rambhatla A, Saleh R, Chung E, Mostafa T, Zini A, Ko E, Parekh N, Martinez M, Arafa M, Tadros N, de la Rosette J, Le TV, Rajmil O, Kandil H, Blecher G, Liguori G, Caroppo E, Ho CCK, Altman A, Bajic P, Goldfarb D, Gill B, Zylbersztejn DS, Molina JMC, Gava MM, Cardoso JPG, Kosgi R, Çeker G, Zilaitiene B, Pescatori E, Borges E, Duarsa GWK, Pinggera GM, Busetto GM, Balercia G, Franco G, Çalik G, Sallam HN, Park HJ, Ramsay J, Alvarez J, Khalafalla K, Bowa K, Hakim L, Simopoulou M, Rodriguez MG, Sabbaghian M, Elbardisi H, Timpano M, Altan M, Elkhouly M, Al-Marhoon MS, Sadighi Gilani MA, Soebadi MA, Nasr-Esfahani MH, Garrido N, Vogiatzi P, Birowo P, Patel P, Javed Q, Ambar RF, Adriansjah R, AlSaid S, Micic S, Lewis SE, Mutambirwa S, Fukuhara S, Parekattil S, Ahn ST, Jindal S, Takeshima T, Puigvert A, Amano T, Barrett T, Toprak T, Malhotra V, Atmoko W, Yumura Y, Morimoto Y, Lima TFN, Kunz Y, Kato Y, Umemoto Y, Colpi GM, Durairajanayagam D, Shah R. Post-Vasectomy Semen Analysis: Optimizing Laboratory Procedures and Test Interpretation through a Clinical Audit and Global Survey of Practices. World J Mens Health 2022; 40:425-441. [PMID: 35021311 PMCID: PMC9253792 DOI: 10.5534/wjmh.210191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/16/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The success of vasectomy is determined by the outcome of a post-vasectomy semen analysis (PVSA). This article describes a step-by-step procedure to perform PVSA accurately, report data from patients who underwent post vasectomy semen analysis between 2015 and 2021 experience, along with results from an international online survey on clinical practice. MATERIALS AND METHODS We present a detailed step-by-step protocol for performing and interpretating PVSA testing, along with recommendations for proficiency testing, competency assessment for performing PVSA, and clinical and laboratory scenarios. Moreover, we conducted an analysis of 1,114 PVSA performed at the Cleveland Clinic's Andrology Laboratory and an online survey to understand clinician responses to the PVSA results in various countries. RESULTS Results from our clinical experience showed that 92.1% of patients passed PVSA, with 7.9% being further tested. A total of 78 experts from 19 countries participated in the survey, and the majority reported to use time from vasectomy rather than the number of ejaculations as criterion to request PVSA. A high percentage of responders reported permitting unprotected intercourse only if PVSA samples show azoospermia while, in the presence of few non-motile sperm, the majority of responders suggested using alternative contraception, followed by another PVSA. In the presence of motile sperm, the majority of participants asked for further PVSA testing. Repeat vasectomy was mainly recommended if motile sperm were observed after multiple PVSA's. A large percentage reported to recommend a second PVSA due to the possibility of legal actions. CONCLUSIONS Our results highlighted varying clinical practices around the globe, with controversy over the significance of non-motile sperm in the PVSA sample. Our data suggest that less stringent AUA guidelines would help improve test compliance. A large longitudinal multi-center study would clarify various doubts related to timing and interpretation of PVSA and would also help us to understand, and perhaps predict, recanalization and the potential for future failure of a vasectomy.
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Affiliation(s)
- Ashok Agarwal
- American Center for Reproductive Medicine, Cleveland, OH, USA.
| | - Sajal Gupta
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Rakesh K Sharma
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | - Renata Finelli
- American Center for Reproductive Medicine, Cleveland, OH, USA
| | | | - Sarah C Vij
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France
- Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Parviz Kavoussi
- Austin Fertility and Reproductive Medicine/Westlake IVF, Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Ramadan Saleh
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Eric Chung
- Department of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Taymour Mostafa
- Department of Andrology, Sexology & STIs, Faculty of Medicina, Cairo University, Cairo, Egypt
| | - Armand Zini
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Edmund Ko
- Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
| | - Neel Parekh
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Marlon Martinez
- Section of Urology, University of Santo Tomas Hospital, Manila, Philippines
| | - Mohamed Arafa
- American Center for Reproductive Medicine, Cleveland, OH, USA
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | - Nicholas Tadros
- Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Jean de la Rosette
- Department of Urology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Tan V Le
- Department of Andrology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
- Department of Urology and Andrology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Osvaldo Rajmil
- Department of Andrology, Fundacio Puigvert, Barcelona, Spain
| | | | - Gideon Blecher
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | | | - Christopher C K Ho
- Department of Surgery, School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
| | - Andrew Altman
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Petar Bajic
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - David Goldfarb
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bradley Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Marcello M Gava
- Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
| | - Joao Paulo Greco Cardoso
- Divisao de Urologia, Hospital das Clínicas HCFMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Raghavender Kosgi
- Department of Urology and Andrology, AIG Hospitals, Gachibowli, Hyderabad, India
| | - Gökhan Çeker
- Department of Urology, Samsun Vezirköprü State Hospital, Samsun, Turkey
| | - Birute Zilaitiene
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edoardo Pescatori
- Andrology and Reproductive Medicine Unit, Gynepro Medical, Bologna, Italy
| | | | - Gede Wirya Kusuma Duarsa
- Department of Urology, Faculty of Medicine, Sanglah General Academic Hospital, Udayana University, Denpasar, Indonesia
| | | | - Gian Maria Busetto
- Department of Urology and Organ Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy
| | - Giancarlo Balercia
- Department of Endocrinology and Metabolic Diseases, Polytechnic University of Marche, Ancona, Italy
| | - Giorgio Franco
- UOC Urologia, Department Materno-Infantile e Scienze Urologiche, AOU Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Gökhan Çalik
- Department of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Hassan N Sallam
- Department of Obstetrics and Gynaecology, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | - Hyun Jun Park
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute of Pusan National University Hospital, Busan, Korea
| | | | | | | | - Kasonde Bowa
- Department of Urology, School of Medicine and Health Sciences, University of Lusaka, Lusaka, Zambia
| | - Lukman Hakim
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Mara Simopoulou
- Department of Experimental Physiology, School of Health Sciences, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Marcelo Gabriel Rodriguez
- Departamento Docencia e Investigación, Hospital Militar Campo de Mayo, Universidad Barcelo, Buenos Aires, Argentina
| | - Marjan Sabbaghian
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Haitham Elbardisi
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Department of Urology, Weill Cornell Medical-Qatar, Doha, Qatar
| | | | - Mesut Altan
- Department of Urology, Hacettepe University, Ankara, Turkey
| | | | | | - Mohammad Ali Sadighi Gilani
- Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad Ayodhia Soebadi
- Department of Urology, Universitas Airlangga/Rumah Sakit Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Mohammad Hossein Nasr-Esfahani
- Department of Animal Biotechnology, Reproductive Biomedicine Research Center, Royan Institute for Biotechnology, ACECR, Isfahan, Iran
| | - Nicolas Garrido
- IVI Foundation, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Paraskevi Vogiatzi
- Andromed Health & Reproduction, Fertility Diagnostics Laboratory, Maroussi, Greece
| | - Ponco Birowo
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Qaisar Javed
- Department of Urology, Ahalia Hospital, Hamdan Street Branch, Abu Dhabi, UAE
| | - Rafael F Ambar
- Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo André, Brazil
- Department of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil
| | - Ricky Adriansjah
- Department of Urology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Sami AlSaid
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Sava Micic
- Department of Andrology, Uromedica Polyclinic, Belgrade, Serbia
| | - Sheena E Lewis
- Examenlab Ltd., Weavers Court Business Park, Linfield Road, Belfast, Northern Ireland, UK
| | - Shingai Mutambirwa
- Division of Urology, Safeko Makgatho Health Scienses University and Dr George Mukhari Academic Hospital, Pretoria, South Africa
| | - Shinichiro Fukuhara
- Department of Urology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Sijo Parekattil
- Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
| | - Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sunil Jindal
- Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
| | - Teppei Takeshima
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Ana Puigvert
- Fundació Puigvert, Hospital de la Santa Cruz y San Pablo, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Toshiyasu Amano
- Department of Urology, Nagano Red Cross Hospital, Nagano, Japan
| | | | - Tuncay Toprak
- Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey
| | - Vineet Malhotra
- Department of Andrology and Urology, Diyos Hospital, New Delhi, India
| | - Widi Atmoko
- Department of Urology, Cipto Mangunkusumo General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yasushi Yumura
- Department of Urology, Reproduction Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | | | - Yannic Kunz
- Department of Urology, Innsbruck Medical University, Innsbruck, Austria
| | - Yuki Kato
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yukihiro Umemoto
- Department of Nephro-Urology, Nagoya City West Medical Center, Nagoya, Japan
| | | | - Damayanthi Durairajanayagam
- Department of Physiology, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
| | - Rupin Shah
- Division of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India
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Degraeve A, Roumeguere T, Tilmans G, Marotta ML, Huyghe E, Fournier G, Faix A, Spinoit AF, Decaestecker K, Herve F, Boitrelle F, Lahdensuo K, Van Damme J. European Countries have different rates of sperm cryopreservation before vasectomy and at the time of reversal. Andrology 2022; 10:1286-1291. [PMID: 35396922 DOI: 10.1111/andr.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/15/2022] [Accepted: 04/04/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Effective male contraceptive options are condoms and vasectomy. Vasectomy should not be considered as a reversible method of contraception even if vasovasostomy can be offered to men to restore fertility after vasectomy. Therefore, there is a real questioning among urologist concerning cryopreservation before vasectomy. We carried out an international survey concerning the practice of cryopreservation before vasectomy and during vasovasostomy. MATERIAL AND METHODS An online anonymous survey was submitted from January to June 2021 to 6 European urological societies. The 31-items questionnaire included questions about demography, habits of cryopreservation before vasectomy or during vasectomy reversal and in case of urogenital cancers. RESULTS 228 urologists from six urological societies in five different countries (Belgium, Netherlands, Luxembourg, France, Finland) answered the questionnaire. French urologists were more in favor of cryopreservation before vasectomy than other European urologists (p<0,0001). They also significantly found that not talking about cryopreservation before vasectomy is a medical fault unlike other urologists (p<0,0001). The specialization in andrology did not influence the choice of cryopreservation before vasectomy (p = 0,9452). The majority of urologists did not perform intraoperative sperm extraction during vasovasostomy (81%; n = 127) with a significant difference between urologists with or without andrology training (p = 0,0146). Success rates after vasovasostomy are significantly better for robot-assisted surgery (p = 0.0159) or with microscope (p = 0.0456) versus without microscope. CONCLUSION Cryopreservation before definitive sterilization significantly varies among European urologists and seems to be mostly dictated by habits than by knowledge. An international consensus is needed to standardize practices and guide patient's choice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Amandine Degraeve
- Department of Urology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | - Thierry Roumeguere
- Department of Urology, University Clinics Brussels, Erasme hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilles Tilmans
- Unit of Abdominal Surgery, Saint-Luc University Clinics, Université Catholique de Louvain, Brussels, Belgium
| | - Marie-Laura Marotta
- Department of Andrology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
| | - Eric Huyghe
- Department of Urology - Kidney transplantation - Andrology - Rangueil Hopital, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Department of Reproductive Medicine, Paule de Viguier Hospital, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,UMR 1203 « DEFE » (Development - Embryo - Fertility - Environment) - INSERM - Université de Toulouse - Université de Montpellier, France
| | | | - Antoine Faix
- Department of Urology, Clinique Beau Soleil, Montpellier, France
| | | | | | - François Herve
- Department of Urology, Ghent University Hopsital, Ghent, Belgium.,Department of Urology, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Florence Boitrelle
- Reproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.,Paris Saclay University, UVSQ, INRAE, BREED, Jouy-en-Josas, France
| | - Kanerva Lahdensuo
- Department of Urology and Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Julien Van Damme
- Department of Urology, Centre Hospitalier Universitaire, Université Catholique de Louvain, Namur, Belgium
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15
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ChoGlueck C. Still no pill for men? Double standards & demarcating values in biomedical research. Stud Hist Philos Sci 2022; 91:66-76. [PMID: 34879317 DOI: 10.1016/j.shpsa.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/26/2021] [Accepted: 11/16/2021] [Indexed: 06/13/2023]
Abstract
Double standards are widespread throughout biomedicine, especially in research on reproductive health. One of the clearest cases of double standards involves the feminine gendering of reproductive responsibility for contraception and the continued lack of highly effective, reversible methods for cisgender men. While the biomedical establishment accepts diversity and inclusion as important social values for clinical trials, their continued use of inequitable standards undermines their ability to challenge unfair social hierarchies by developing male contraception. Thus, the gender/sex bias present in contraceptive research raises the "New Demarcation Problem": If we accept that values can and will play important roles in science, how can we nevertheless distinguish positive influences of values from more corrosive bias? I argue that biomedical researchers ought to aim their clinical trials at equity and utilize methodologies that actually achieve that aim. More specifically, I contend that we can avoid the problem of double standards by gender/sex in contraceptive research by utilizing more equitable standards. My demarcation strategy captures dynamic interplay between values and their effects, with direct policy implications for institutions conducting, funding, and evaluating clinical trials. For male contraceptive trials, this involves shifting risk assessment from an individual model to a shared model for sexual partners.
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Affiliation(s)
- Christopher ChoGlueck
- Department of Communication, Liberal Arts, and Social Sciences (CLASS), New Mexico Institute of Mining and Technology (New Mexico Tech), 215 Finch Hall, 801 Leroy Place, Socorro, 87801, New Mexico, USA.
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16
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Richard C, Pourchasse M, Freton L, Esvan M, Ravel C, Peyronnet B, Mathieu R, Chhor S. Male contraception: What do women think? Prog Urol 2021; 32:276-283. [PMID: 34924309 DOI: 10.1016/j.purol.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/29/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Women currently bear the most responsibility in contraception, with a wide choice of methods, while only a few existing male contraceptives are available. However, it has been shown that men are willing to get involved in birth control and to control their own fertility. Our research was focused on female population and a survey was carried out to explore women's perceptions of male contraception. METHODS An observational quantitative cross-sectional study using a self-administered-questionnaire was carried out between November 2019 and February 2020. All women aged from 16-years-old to menopause completing the questionnaire were included. Descriptive statistical analyses were conducted, qualitative variables were expressed as counts and frequency. RESULTS In total, 379 interpretable completed questionnaires were included. Among the women, 69.7% were in favour of letting men deal with contraception, without referring to a specific method. After having been made aware of the medical information concerning existing male contraceptives and those in development, the proportion of women in favour dropped to 46.7%. The most acceptable method for a majority of women was the male pill, which is still being developed. The majority (78.4%) of the women in our survey felt insufficiently informed about male contraception. DISCUSSION In our study, women seemed to want to share contraceptive responsibility with men, but the lack of information and of acceptable contraception methods available remained an obstacle. Although larger-scale studies are needed to confirm these results, the development of a wider range of male contraception methods seems to be what both men and women have long been expecting.
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Affiliation(s)
- C Richard
- Department of Urology, University of Rennes, Rennes, France.
| | - M Pourchasse
- Department of General Medicine, University of Rennes, Rennes, France
| | - L Freton
- Department of Urology, University of Rennes, Rennes, France
| | - M Esvan
- Clinical Investigation Department, University of Rennes, Rennes, France
| | - C Ravel
- CECOS, University of Rennes, Rennes, France
| | - B Peyronnet
- Department of Urology, University of Rennes, Rennes, France
| | - R Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - S Chhor
- Department of General Medicine, University of Rennes, Rennes, France; Clinical Investigation Department, University of Rennes, Rennes, France
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Nguyen BT, Yuen F, Farrant M, Thirumalai A, Fernando F, Amory JK, Swerdloff RS, Anawalt BD, Blithe DL, Long JE, Liu PY, Page ST, Wang C. Acceptability of the oral hormonal male contraceptive prototype, 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC), in a 28-day placebo-controlled trial. Contraception 2021; 104:531-537. [PMID: 34153318 PMCID: PMC8995005 DOI: 10.1016/j.contraception.2021.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/24/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine men's satisfaction with and the potential acceptability of 11β-methyl-19-nortestosterone dodecylcarbonate (11β-MNTDC) when used for 28 days as an experimental, once-daily, oral hormonal male contraceptive (HMC). STUDY DESIGN We surveyed participants from a double-blind, randomized, placebo-controlled, phase 1 clinical trial, examining their experience with and willingness to use daily oral 11β-MNTDC for male contraception. RESULTS Of 42 trial participants, 40 (30 11β-MNTDC, 10 placebo) completed baseline and end-of-treatment surveys. Based on a 28-day experience, few cited any baseline concerns about safety and drug adherence. Following treatment, nearly three-quarters (72.5%) of participants reported satisfaction with the study drug and nearly all (92.5%) would recommend the method to others. More than half of participants would be willing to pay for the study drug (62.5%) and indicated that the method exceeded initial expectations (53.9%). Nearly 90% reported that taking the pill was easy to remember and did not interfere with their daily routines. Approximately one-third of participants reported bothersome side effects (37% 11β-MNTDC vs. 20% placebo, p = 0.45). Given the option, 42% of participants would prefer a daily HMC pill over injectable regimens or a daily topical gel. CONCLUSION A majority of participants in this short-term trial of daily oral 11β-MNTDC reported satisfaction with the regimen, would recommend it to others, and would pay to use the drug as HMC despite some bothersome side effects. IMPLICATIONS Oral 11β-MNTDC would be an acceptable and preferable method among men desiring reversible hormonal male contraception (HMC). These data support further trials of novel oral HMCs such as 11β-MNTDC.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States.
| | - Fiona Yuen
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Maritza Farrant
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Frances Fernando
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Ronald S Swerdloff
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Bradley D Anawalt
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Diana L Blithe
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Jill E Long
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, United States
| | - Peter Y Liu
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- Division of Endocrinology, Department of Medicine, The Lundquist Institute and Harbor UCLA Medical Center, Torrance, CA, United States
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Nguyen BT, Brown AL, Jones F, Jones L, Withers M, Ciesielski KM, Franks JM, Wang C. "I'm not going to be a guinea pig:" Medical mistrust as a barrier to male contraception for Black American men in Los Angeles, CA. Contraception 2021; 104:361-366. [PMID: 34118271 DOI: 10.1016/j.contraception.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Racial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans' adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans' experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity. STUDY DESIGN Working with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives. RESULTS Just over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns. CONCLUSIONS Black men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans' history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency. IMPLICATIONS While the development of reversible, hormonal male contraception intends to fulfill unmet global needs for contraception, the utility of these hormonal male contraceptive methods among Black men living on low incomes in Los Angeles, California cannot be fully realized until developers address and overcome historical and ongoing medical mistrust.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA.
| | | | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Mellissa Withers
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Katharine M Ciesielski
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Jennifer M Franks
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA; Department of Obstetrics & Gynecology, Kern Medical Center, Bakersfield, CA
| | - Christina Wang
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
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19
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Velez D, Pagani R, Mima M, Ohlander S. Vasectomy: a guidelines-based approach to male surgical contraception. Fertil Steril 2021; 115:1365-1368. [PMID: 33879342 DOI: 10.1016/j.fertnstert.2021.03.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/29/2021] [Indexed: 11/28/2022]
Abstract
Except for condom use, vasectomy is the only approved form of male contraception. The American Urological Association published guidelines on vasectomy in 2012, which clearly outlined patient counseling, vasectomy techniques to maximize successful occlusion, and postvasectomy care. However, there are certainly areas of further improvement to be addressed. Vasectomy is severely underutilized compared with tubal ligation for sterilization, likely due to lack of patient awareness. Although the majority of vasectomies are performed in the office with local anesthesia, some patients are still routinely prescribed narcotics for postprocedural pain, despite the well-described opioid pandemic. Finally, although patients are counseled on the necessity of a postvasectomy semen analysis to confirm sterility prior to the discontinuation of alternative contraceptives, more than 50% of men do not complete this test. Therefore, alternative strategies must be pursued to improve patient compliance.
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Affiliation(s)
- Danielle Velez
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois.
| | - Rodrigo Pagani
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Mahmoud Mima
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
| | - Samuel Ohlander
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois
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Dominiak Z, Huras H, Kręcisz P, Krzeszowski W, Szymański P, Czarnecka K. Promising results in development of male contraception. Bioorg Med Chem Lett 2021; 41:128005. [PMID: 33798701 DOI: 10.1016/j.bmcl.2021.128005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/17/2022]
Abstract
Nowadays, conscious planning of the family is very important for many people. The possibility of using protective measures against unplanned pregnancy is a great comfort. Most forms of contraceptives are intended for women, although their use can be ruled out in various health conditions. Scientists have been trying to develop a different type of method for men for many years. More and more research is being done and there have been promising results. It is hoped that soon both genders will have a similar range of contraceptive options to enable responsible family planning.
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Affiliation(s)
- Zuzanna Dominiak
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, 1 Muszyńskiego St., 90-151 Lodz, Poland
| | - Hubert Huras
- Department of Obstetrics and Perinatology, Faculty of Medicine, Jagiellonian University Medical College, 31-007 Krakow, Poland
| | - Paweł Kręcisz
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, 1 Muszyńskiego St., 90-151 Lodz, Poland
| | | | - Paweł Szymański
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, 1 Muszyńskiego St., 90-151 Lodz, Poland; Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163 Warsaw, Poland.
| | - Kamila Czarnecka
- Department of Pharmaceutical Chemistry, Drug Analyses and Radiopharmacy, Faculty of Pharmacy, Medical University of Lodz, 1 Muszyńskiego St., 90-151 Lodz, Poland; Department of Radiobiology and Radiation Protection, Military Institute of Hygiene and Epidemiology, 4 Kozielska St., 01-163 Warsaw, Poland.
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21
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Latack KR, Yuen F, Wang C, Nguyen BT. Online community queries on hormonal male contraception: An analysis of the Reddit "Ask Me Anything" experience. Contraception 2021; 104:159-164. [PMID: 33617839 DOI: 10.1016/j.contraception.2021.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/11/2021] [Accepted: 02/11/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Reddit is one of the most popular websites in the United States because of its user-driven aggregation and community-based curation of online content. We describe the use and impact of Reddit's Ask Me Anything platform, for public engagement and education about developments in hormonal male contraception (HMC). METHODS We analyzed the content from and user engagement with 2 Reddit Ask Me Anything events that answered user queries about HMC in June 2018 and March 2019. Clinical trial investigators provided real-time responses throughout the events. We examined the 25 most popular posts from each event, analyzing content for salient themes via an inductive approach. To quantify event impact, we examined Google Trends data and subsequent traffic to the investigator website. RESULTS Over 18,000 registered Reddit users interacted with each of the 2 Ask Me Anything events, with each generating over 1600 comments. The most popular posts of each Ask Me Anything event expressed interest in off-target effects associated with the use of HMCs. Additional themes included queries about previous and ongoing clinical trials, HMC physiology, and market analyses and projections of public willingness to use HMCs. The events coincided with a spike in both Google searches for "male birth control" and first-time visits to the study's website where users could express interest in participating in clinical trials. CONCLUSION Reddit Ask Me Anything events conducted by HMC investigators revealed wide public interest in HMCs. The events prompted further searches for more information on male contraception, while driving traffic to the investigator website for trial recruitment purposes. IMPLICATIONS Reddit Ask Me Anything events are a popular, cost-free online platform for publicly responding to a range of HMC-related queries, while providing investigators with insight into stakeholder priorities and preoccupations.
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Affiliation(s)
- Kyle R Latack
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States
| | - Fiona Yuen
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Christina Wang
- Division of Endocrinology, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Brian T Nguyen
- University of Southern California, Department of Obstetrics and Gynecology, Section of Family Planning, Los Angeles, CA, United States.
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22
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Campelia GD, Abbe C, Nickels LM, McElmeel E, Amory JK. "Shared risk": Reframing risk analysis in the ethics of novel male contraceptives. Contraception 2020; 102:67-69. [PMID: 32474061 DOI: 10.1016/j.contraception.2020.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Carmen Abbe
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | | | | | - John K Amory
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States.
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23
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Mariani NAP, Camara AC, Silva AAS, Raimundo TRF, Andrade JJ, Andrade AD, Rossini BC, Marino CL, Kushima H, Santos LD, Silva EJR. Epididymal protease inhibitor (EPPIN) is a protein hub for seminal vesicle-secreted protein SVS2 binding in mouse spermatozoa. Mol Cell Endocrinol 2020; 506:110754. [PMID: 32044375 DOI: 10.1016/j.mce.2020.110754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022]
Abstract
EPPIN is a sperm-surface drug target for male contraception. Here we investigated EPPIN-interacting proteins in mouse spermatozoa. We showed that EPPIN is an androgen-dependent gene, expressed in the testis and epididymis, but also present in the vas deferens, seminal vesicle and adrenal gland. Mature spermatozoa presented EPPIN staining on the head and flagellum. Immunoprecipitation of EPPIN from spermatozoa pre-incubated with seminal vesicle fluid (SVF) followed by LC-MS/MS or Western blot revealed the co-immunoprecipitation of SVS2, SVS3A, SVS5 and SVS6. In silico and Far-Western blot approaches demonstrated that EPPIN binds SVS2 in a protein network with other SVS proteins. Immunofluorescence using spermatozoa pre-incubated with SVF or recombinant SVS2 demonstrated the co-localization of EPPIN and SVS2 both on sperm head and flagellum. Our data show that EPPIN's roles in sperm function are conserved between mouse and human, demonstrating that the mouse is a suitable experimental model for translational studies on EPPIN.
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Affiliation(s)
- Noemia A P Mariani
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Aline C Camara
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Alan Andrew S Silva
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Tamiris R F Raimundo
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Juliana J Andrade
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Alexandre D Andrade
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Bruno C Rossini
- Biotechnology Institute (IBTEC), São Paulo State University (UNESP), Botucatu-SP, Brazil; Department of Genetics, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Celso L Marino
- Biotechnology Institute (IBTEC), São Paulo State University (UNESP), Botucatu-SP, Brazil; Department of Genetics, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Hélio Kushima
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Lucilene D Santos
- Center for the Study of Venoms of Venomous Animals (CEVAP), São Paulo State University (UNESP), Botucatu-SP, Brazil; Graduate Program in Tropical Diseases, Botucatu Medical School (FMB), São Paulo State University (UNESP), Botucatu-SP, Brazil
| | - Erick J R Silva
- Department of Pharmacology, Institute of Biosciences, São Paulo State University (UNESP), Botucatu-SP, Brazil.
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24
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Nguyen BT, Farrant MT, Anawalt BD, Yuen F, Thirumalai A, Amory JK, Swerdloff RS, Bremner WJ, Liu PY, Blithe DL, Page ST, Wang C. Acceptability of oral dimethandrolone undecanoate in a 28-day placebo-controlled trial of a hormonal male contraceptive prototype. Contraception 2020; 102:52-7. [PMID: 32298717 DOI: 10.1016/j.contraception.2020.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/15/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine men's satisfaction with and acceptability of a once-daily, oral regimen of dimethandrolone undecanoate (DMAU) versus placebo when used for 28 days. STUDY DESIGN After a Phase I double-blind, randomized, placebo-controlled, dose-escalating trial of oral DMAU for 28-days, 57 healthy male volunteers completed a survey assessing their experience and satisfaction with the regimen. In the trial, participants were randomized to receive up to 4 DMAU capsules daily versus placebo and instructed to ingest them within 30 min of consuming a high fat meal. Pharmacokinetic and pharmacodynamic profiles were performed, followed by a 6-week recovery phase. Participants were counseled that they could not rely on the drug for contraception. RESULTS Fifty-seven participants were offered acceptability surveys (39 DMAU, 18 placebo). Most respondents, 80% (45/56), reported satisfaction with the method; 77% (44/57) would recommend it. 54% (31/57), reported that, if available, they would use the method as their primary contraceptive. More respondents reported satisfaction with active DMAU than placebo (87% vs. 67%; p = 0.05). Most respondents, 91% (52/57), reported no difficulty with having to take up to 4 pills within 30 min of ingesting a high-fat meal. CONCLUSION Most participants reported that the study method, daily oral DMAU or placebo, was satisfactory and acceptable. Having to take the drug after a high-fat meal did not detract from acceptability. IMPLICATIONS Most participants in a 4-week trial of daily DMAU capsules would recommend and use the method. High satisfaction among DMAU and placebo groups affirms acceptability of a daily male contraceptive pill, warranting further study of oral DMAU.
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25
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Abstract
Even after decades of research men still lack reliable and reversible contraceptive methods comparable to female methods of contraception. Traditional methods of male contraception present a high failure rate and also involve high risk both when used for contraception and for protection against sexually transmitted diseases. Various chemical, hormonal, immunological, vas based and herbal methods of contraception have been examined by scientists world over during the past four decades. Among the possible lead approaches, exogenous hormonal contraception, either alone or in combination with progesterone or antiandrogen, is being viewed at low profile because of their insufficiency in inducing uniform suppression of spermatogenesis and steroid related long term complications. As an alternative to vasectomy, among various intravasal devices being examined, RISUG® (Reversible Inhibition of Sperm Under Guidance), a co-polymer of styrene and maleic anhydride offers long term contraception with safety, efficacy and it can be delivered by no-scalpel injection. Thus it is the only male contraceptive procedure currently under Phase- III Clinical Trial. The non-invasive reversal technique, successfully demonstrated in langur monkeys and functional reversal achieved with dimethyl sulphoxide (DMSO) and sodium bicarbonate (NaHCO3) in rats and rabbits with safety at F1 generation (first filial generation) have projected RISUG® as a better alternative to vasectomy. In this narrative review we revisit the long journey of RISUG® beginning with formulation on a bench towards reaching the market as a safe and effective contraceptive method, discussing various milestones and roadblocks of this expedition awaiting the mandatory regulatory clearance from the Government of India. Successful completion of ongoing phase III clinical trials with demonstration of reversal in human volunteers will give an indigenously developed male contraceptive to the world.
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Affiliation(s)
- Barkha Khilwani
- Centre for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, 302004 India
| | - Ayesha Badar
- Centre for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, 302004 India
| | - Abdul S. Ansari
- Centre for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, 302004 India
| | - Nirmal K. Lohiya
- Centre for Advanced Studies, Department of Zoology, University of Rajasthan, Jaipur, 302004 India
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Abstract
Infertility affects nearly 15 per cent of all couples within the reproductive age worldwide, with about 50 per cent being exhibited in the male, called male factor infertility. Successful reproduction is dependent on sperm chromatin integrity. Spermatozoa are highly specialized cells that aim to transmit the paternal genomic blueprint to the oocyte. The spermatozoon is regulated by redox mechanisms during its epididymal transit to acquire fertilizing ability. While, at physiological levels, the production of reactive oxygen species (ROS) supports the spermatozoon to acquire its fertilizing ability, at high concentrations, it affects sperm function leading to infertility. Emerging proteomic technologies provide an opportunity to address these key issues that may solve many fertility-associated problems resulting from oxidative stress (OS). This review highlights the need for an efficient therapeutic approach to male infertility with the application of high-throughput OS-mediated proteomic technology, and also addresses the question as to whether targeting these altered sperm-specific proteins may help in designing an efficient and reversible male contraceptive.
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Affiliation(s)
- Gayatri Mohanty
- Department of Zoology, Redox Biology Laboratory, Ravenshaw University, Cuttack, India
| | - Luna Samanta
- Department of Zoology, Redox Biology Laboratory, Ravenshaw University, Cuttack, India
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Chen H, Mruk D, Wong CKC, Silvestrini B, Cheng CY. F5-peptide enhances the efficacy of the non-hormonal male contraceptive adjudin. Contraception 2019; 99:350-6. [PMID: 30763581 DOI: 10.1016/j.contraception.2019.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 01/07/2019] [Accepted: 01/19/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The bioavailability of the non-hormonal male contraceptive adjudin is low in rats due to the blood-testis barrier (BTB). This study was designed to examine if F5-peptide, an endogenously produced reversible BTB modifier, could enhance the bioavailability of adjudin to affect spermatogenesis and provide a contraceptive effect in rats while reducing systemic toxicity. STUDY DESIGN We overexpressed F5-peptide in adult male rats (n=10 rats; with 3 or 4 rats for each of the three different experiments noted in the three regimens) by intratesticular injection of a mammalian expression vector pCI-neo (pCI-neo/F5-peptide) vs. empty vector alone (pCI-neo/Ctrl) to be followed by treatment with adjudin by oral gavage at a dose of 10 or 20 mg/kg. The status of spermatogenesis was assessed by histological analysis and dual-labeled immunofluorescence analysis on Day 16. To assess fertility, we allowed treated males (n=3-4 rats) to mate with mature female rats (n=3-4) individually, and assessed the number of pups on Days 23, 36 and 82 to assess fertility and reversibility. RESULTS All 4 treated rats overexpressed with F5-peptide and low-dose adjudin were infertile by Day 36, and half of these rats were fertile by Day 82, illustrating reversibility. However, overexpression of F5-peptide alone (or low-dose adjudin alone) had no effects on fertility in n=3 rats. These findings were consistent with the histology data that illustrated the BTB modifier F5-peptide promoted the action of adjudin to induce germ cell exfoliation, mediated by changes in cytoskeletal organization of F-actin and microtubules across the epithelium, thereby reducing the systemic toxicity of adjudin. CONCLUSION In this proof-of-concept study, it was shown that overexpression of the F5-peptide prior to administration of adjudin to rats at a low (and ineffective dose by itself) was found to induce reversible male infertility. IMPLICATIONS Overexpression of F5-peptide, an endogenously produced biomolecule in the testis known to induce BTB remodeling, enhanced the contraceptive effect of adjudin in rats, supporting proof of concept studies of BTB disrupters in men.
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Hamm M, Evans M, Miller E, Browne M, Bell D, Borrero S. "It's her body": low-income men's perceptions of limited reproductive agency. Contraception 2018; 99:111-117. [PMID: 30336131 DOI: 10.1016/j.contraception.2018.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/17/2018] [Accepted: 10/08/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES While some attention has been paid to men's contraceptive use and attitudes in international contexts, relatively little is known about the attitudes towards contraception and pregnancy of low-income, urban men in the U.S. STUDY DESIGN We conducted semi-structured interviews with 58 low-income men in Pittsburgh, PA, to explore their perspectives on contraception, pregnancy, fatherhood, and relationships. We analyzed the interviews using a combination of content analysis, the constant comparison method, and thematic analysis. RESULTS Men who we interviewed frequently described feeling that they lacked agency regarding when pregnancies occurred and whether or not they became fathers. Several factors contributed to their sense of low agency, including the belief that women should control contraception and reproduction, a reluctance to have conversations about contraception in some contexts, a lack of acceptable male-controlled contraceptive methods, experiences with pregnancy-promoting behaviors by women, and fatalistic attitudes towards pregnancy occurrence. CONCLUSIONS Many men in our study described perceptions of limited reproductive agency. In describing their lack of agency, men reinforced contemporary gender norms in which the "work" of pregnancy prevention is a woman's responsibility. Responses to men's perceived limited reproductive agency should work towards deconstructing gendered norms in the work of pregnancy prevention and promote shared and mutual gender responsibility over reproduction while also supporting women's reproductive autonomy. IMPLICATIONS This study identifies several factors that contribute to low-income men's sense of low reproductive agency and highlights the complexity of acknowledging men's feelings and perceptions about reproductive control in the broader context of gender and power.
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Affiliation(s)
- Megan Hamm
- Center for Research on Healthcare, University of Pittsburgh, 200 McKee Place, Suite 600, Pittsburgh, PA 15213, USA.
| | - Mark Evans
- University of California San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA 15224, USA; Division of Adolescent and Young Adult Medicine, Pediatrics, University of Pittsburgh School of Medicine, 4401 Penn Ave, Pittsburgh, PA15224, USA; Center for Women's Health Research and Innovation, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA
| | - Mario Browne
- University of Pittsburgh Schools of the Health Sciences, 3550 Terrace St, Pittsburgh, PA 15213, USA
| | - David Bell
- Columbia University Medical Center, 1790 Broadway, New York, NY 10019, USA
| | - Sonya Borrero
- Center for Research on Healthcare, University of Pittsburgh, 200 McKee Place, Suite 600, Pittsburgh, PA 15213, USA; Center for Women's Health Research and Innovation, University of Pittsburgh, 4200 Fifth Ave, Pittsburgh, PA 15260, USA; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA 15240, USA
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Nguyen BT, Schickler R. Of mosquitoes and men: mitigating Zika risk via Men's family planning and male contraception. Contracept Reprod Med 2018; 3:17. [PMID: 30338122 PMCID: PMC6174554 DOI: 10.1186/s40834-018-0069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/27/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Outbreaks of mosquito-borne viral illnesses commonly occur after storms. As storms are predicted to worsen in intensity and frequency, mosquito-borne viruses, including the Zika virus are expected to spread, and with devastating consequences. While the disease is self-limited, pregnant women who contract Zika can transmit the virus to their fetuses, causing neurodevelopmental abnormalities, including microcephaly. An overlooked vector of the Zika virus, however, is men whose semen can transmit the virus at the time of sexual intercourse. Current recommendations for preventing the sexual transmission of Zika are inadequate and need to emphasize male reproductive responsibility, via expanding services for men's family planning and developing novel male contraceptives. MAIN BODY To prevent the sexual transmission of Zika, the World Health Organization recommends that couples use condoms or abstain from sexual activity for at least 6 months when traveling in Zika-infected areas. Strict adherence to these recommendations is neither practical nor adequate to address Zika's sexual transmission. As up to 13% of couples who use condoms experience unintended pregnancy, semen and consequent viral exposure is imminent. The use of contraception beyond just barrier methods is essential. However, the burden of contraception largely falls upon women and efforts to prevent vertical transmission are often aimed at educating women, when the outcome is equally undesirable among their male partners. These short-comings highlight the lack of attention to men's options for family planning. Educating men about the full range of contraceptive options, correcting misconceptions about the efficacy of withdrawal and barrier contraceptive methods, increasing access to vasectomy, and developing novel male contraceptive options would allow shared responsibility for the prevention of unintended pregnancy and Zika-related morbidity. CONCLUSION Gaps in recommendations to prevent the sexual transmission of Zika provide an opportunity to develop men's family planning initiatives and the range of accessible contraceptives to men.
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Affiliation(s)
- Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Robyn Schickler
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
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Dorman E, Perry B, Polis CB, Campo-Engelstein L, Shattuck D, Hamlin A, Aiken A, Trussell J, Sokal D. Modeling the impact of novel male contraceptive methods on reductions in unintended pregnancies in Nigeria, South Africa, and the United States. Contraception 2017; 97:62-69. [PMID: 28887053 DOI: 10.1016/j.contraception.2017.08.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We modeled the potential impact of novel male contraceptive methods on averting unintended pregnancies in the United States, South Africa, and Nigeria. STUDY DESIGN We used an established methodology for calculating the number of couple-years of protection provided by a given contraceptive method mix. We compared a "current scenario" (reflecting current use of existing methods in each country) against "future scenarios," (reflecting whether a male oral pill or a reversible vas occlusion was introduced) in order to estimate the impact on unintended pregnancies averted. Where possible, we based our assumptions on acceptability data from studies on uptake of novel male contraceptive methods. RESULTS Assuming that only 10% of interested men would take up a novel male method and that users would comprise both switchers (from existing methods) and brand-new users of contraception, the model estimated that introducing the male pill or reversible vas occlusion would decrease unintended pregnancies by 3.5% to 5.2% in the United States, by 3.2% to 5% in South Africa, and by 30.4% to 38% in Nigeria. Alternative model scenarios are presented assuming uptake as high as 15% and as low as 5% in each location. Model results were sensitive to assumptions regarding novel method uptake and proportion of switchers vs. new users. CONCLUSION Even under conservative assumptions, the introduction of a male pill or temporary vas occlusion could meaningfully contribute to averting unintended pregnancies in a variety of contexts, especially in settings where current use of contraception is low. IMPLICATIONS Novel male contraceptives could play a meaningful role in averting unintended pregnancies in a variety of contexts. The potential impact is especially great in settings where current use of contraception is low and if novel methods can attract new contraceptive users.
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Affiliation(s)
- Emily Dorman
- Modeling and Simulation, Evidera Inc., Bethesda, MD, USA; Male Contraception Initiative, Durham, NC, USA
| | - Brian Perry
- Department of Population Health Science, Duke University, Durham, NC, USA.
| | - Chelsea B Polis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Guttmacher Institute, New York, NY, USA
| | - Lisa Campo-Engelstein
- Alden March Bioethics Institute and Department of Obstetrics and Gynecology, Albany Medical College, Albany, NY, USA
| | - Dominick Shattuck
- Institute for Reproductive Health, Georgetown University, Washington, DC, USA
| | | | - Abigail Aiken
- LBJ School of Public Affairs, University of Texas at Austin, Austin, TX, USA
| | - James Trussell
- Office of Population Research, Princeton University, Princeton, NJ, USA; University of Edinburgh, Edinburgh, Scotland
| | - David Sokal
- Male Contraception Initiative, Durham, NC, USA; Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Schlager D, Maas M, Hein S, Adams F, Schoenthaler M, Spittau B, Wetterauer U, Miernik A. Is Endoscopic Vasectomy Just a Dream: An ex vivo Study on Feasibility and Reliability of Endoluminal Occlusion of Porcine Vas Deferens. Urol Int 2017; 99:467-475. [PMID: 28813710 DOI: 10.1159/000478790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/19/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND AIM Surgical vasectomy remains the gold standard for fertility control in men. Endoluminal occlusion of the seminal ducts, thus avoiding an external incision, may become an appealing alternative to this approach. As our group has shown, nontraumatic endoscopic inspection of the seminal ducts is feasible in the human cadaver. We investigated the feasibility and reliability of occlusion using several commercially available medical sealing agents in the porcine vas deferens (VD). METHODS AND MAIN OUTCOME MEASURES Tests were conducted using 25 porcine spermatic ducts (10 cm length) ex vivo. The explanted specimens were fixed and cannulated using the Seldinger technique. We administered 5 different agents (n-butyle-2-cyanoacrylate, n-butyle-2-cyanoacrylate in combination with a platinum vascular coil, Tissucol Duo S®, Gelita Spon® and AFP Plug®) endoluminally. Tightness was evaluated after 5, 15, 60, 360, 720, and 1,440 min for each of the five grades, respectively, using a solution of methylene blue and saline injected under controlled pressure of 300 mm Hg followed by histological examination. RESULTS All agents were administered into the porcine seminal ducts (4 out of 5 via a ureteric catheter). Gelita Spon® and Tissucol Duo S® did not occlude the lumen sufficiently, whereas n-butyle-2-cyanoacrylate, n-butyle-2-cyanoacrylate in combination with coil, Tissucol Duo and AFP Plug® performed satisfactorily. In particular, cyanoacrylate combined with a coil was able to close the seminal duct tightly and for a long time. Histological findings confirmed this sealant's gapless adhesion. AFP Plug® application revealed similarly good results. However, its form needs to be optimized to ensure its suitability for endoscopic use. CONCLUSION Various developments regarding minimally invasive fertility control methods have been underway for decades. Further miniaturization of endoscopy and novel materials may pave the way for endoscopic fertility control in males in the future. We demonstrated the potential of commercially available medical sealing agents to reliably occlude the porcine VD.
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Affiliation(s)
- Daniel Schlager
- Department of Urology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Waller D, Bolick D, Lissner E, Premanandan C, Gamerman G. Reversibility of Vasalgel™ male contraceptive in a rabbit model. Basic Clin Androl 2017; 27:8. [PMID: 28417005 PMCID: PMC5381074 DOI: 10.1186/s12610-017-0051-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 03/01/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Development of a non-hormonal long-acting reversible contraceptive for men could have a significant impact on reducing unintended pregnancies. Vasalgel™ is a high molecular weight polymer consisting of styrene-alt-maleic acid (SMA) dissolved in dimethyl sulfoxide being developed as a reversible male contraceptive device. It forms a hydrogel when implanted into the vasa deferentia, which prevents the passage of sperm. Previous studies in the rabbit have proven its efficacy, durability and rapid onset. This study evaluates the capacity to restore sperm concentrations in ejaculates after a reversal procedure. METHODS Sodium bicarbonate was injected into the vasa deferentia after fourteen months of azoospermia following the injection of two device variations (Vasalgel 100 and Vasalgel 80). Semen samples were then collected for six months and sperm characteristics were compared to baseline levels. Samples of vasa deferentia were obtained for histological examination. RESULTS Spermatozoa were present in all subject ejaculates after the reversal procedure. Sperm concentration and sperm motility were similar to baseline levels after reversal, while sperm forward progression was significantly lower and normal acrosomes were not observed. Forward progression percentages increased linearly during six months of semen collection, however, normal acrosomes were not observed at the conclusion of the study. Histologically, several vasa deferentia were clear of the device and contained an intact epithelial lining. A smaller proportion of tissues contained residual test material. A secondary intraluminal inflammatory response was seen occasionally in the tissues containing residual material. There was no difference between the two device variations for studied parameters. CONCLUSIONS Vasalgel's prevention of sperm transport for 14 months was reversed through an intravasal injection of sodium bicarbonate. Post-reversal sperm concentrations and motility returned to baseline levels during the six-month follow up. Residual material in the vas lumen or compromised epididymal and vas deferens function may be resulting in reduced forward progression and loss of acrosomes during transit through the vas. Reduced forward progression and the lack of normal acrosomes strongly suggest impaired sperm function.
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Affiliation(s)
- Donald Waller
- Prelabs, LLC, 33 W Chicago Ave., Oak Park, IL 60302 USA
| | - David Bolick
- Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
| | - Elaine Lissner
- Parsemus Foundation, PO Box 2246, Berkeley, CA 94702 USA
| | - Christopher Premanandan
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1925 Coffey Road, Columbus, OH 43215 USA
| | - Gary Gamerman
- Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
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Soufir JC. Hormonal, chemical and thermal inhibition of spermatogenesis: contribution of French teams to international data with the aim of developing male contraception in France. Basic Clin Androl 2017; 27:3. [PMID: 28101363 PMCID: PMC5237323 DOI: 10.1186/s12610-016-0047-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/20/2016] [Indexed: 11/13/2022] Open
Abstract
Since the 1970s, international research on male contraception has been actively pursued. Hormonal and non-hormonal methods (thermal, chemical) have been tested, leading to clinical trials of interest to thousands of men and couples. The results showed that it was possible to develop methods of male contraception that inhibited spermatogenesis with good contraceptive efficacy. However, their side effects (mainly loss of libido), poorly accepted modes of administration, and the high frequency of poor responders prevented their widespread use. Based on earlier initiatives, new avenues were explored and significant progress was achieved, allowing the reasoned use of male contraception. For 40 years, several French teams have played an important role in this research. The aim of this paper is to outline the history and the progress of the experimental and clinical works of these teams who addressed hormonal, chemical and thermal approaches to male contraception. These approaches have led to a better comprehension of spermatogenesis that could be useful in fields other than male contraception: effects of toxic compounds, fertility preservation.
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Affiliation(s)
- Jean-Claude Soufir
- Biologie de la Reproduction, Centre Hospitalier Universitaire Cochin, 123 Bd de Port Royal, 75014 Paris, France
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Banholzer ML, Wandel C, Barrow P, Mannino M, Schmitt G, Guérard M, Müller L, Greig G, Amemiya K, Peck R, Singer T, Doessegger L. Clinical trial considerations on male contraception and collection of pregnancy information from female partner: update. Clin Transl Med 2016; 5:23. [PMID: 27455840 PMCID: PMC4960246 DOI: 10.1186/s40169-016-0103-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 06/24/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This is an update to our 2012 publication on clinical trial considerations on male contraception and collection of pregnancy information from female partner, after critical review of recent (draft) guidances released by the International Council for Harmonisation [ICH] the Clinical Trial Facilitation Group [CTFG] and the US Food & Drug Administration [FDA]. METHODS Relevant aspects of the new guidance documents are discussed in the context of male contraception and pregnancy reporting from female partner in clinical trials and the approach is updated accordingly. RESULTS Genotoxicity The concept of a threshold is introduced using acceptable daily intake/permissible daily exposure to define genotoxicity requirements, hence highly effective contraception in order to avoid conception. The duration for highly effective contraception has been extended from 74 to 90 days from the end of relevant systemic exposure. Teratogenicity Pharmacokinetic considerations to estimate safety margins have been contextualized with regard to over- and underestimation of the risk of teratogenicity transmitted by a vaginal dose. The duration of male contraception after the last dose takes into account the end of relevant systemic exposure if measured, or a default period of five half-lives after last dose for small molecules and two half-lives for immunoglobulins (mAbs). Measures to prevent exposure of the conceptus via a vaginal dose apply to reproductively competent or vasectomized men, unless measurements fail to detect the compound in seminal fluid. CONCLUSION Critical review of new guidance documents provides a comparison across approaches and resulted in an update of our previous publication. Separate algorithms for small molecules and monoclonal antibodies are proposed to guide the recommendations for contraception for male trial participants and pregnancy reporting from female partners. No male contraception is required if the dose is below a defined threshold for genotoxic concern applicable to small molecules. For men treated with teratogenic mAbs, condom use to prevent exposure of a potentially pregnant partner is unlikely to be recommended because of the minimal female exposure anticipated following a vaginal dose. The proposed safety margins for teratogenicity may evolve with further knowledge.
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Affiliation(s)
- Maria Longauer Banholzer
- Safety Risk Management, Licensing & Early Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Christoph Wandel
- Safety Risk Management, Licensing & Early Development, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Paul Barrow
- Pharma Research & Early Development, Roche Innovation Center Basel, Pharmaceutical Sciences, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Marie Mannino
- Safety Risk Management, Licensing & Early Development, F. Hoffmann-La Roche Ltd, New York, NY USA
| | - Georg Schmitt
- Pharma Research & Early Development, Roche Innovation Center Basel, Pharmaceutical Sciences, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Melanie Guérard
- Pharma Research & Early Development, Roche Innovation Center Basel, Pharmaceutical Sciences, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Lutz Müller
- Pharma Research & Early Development, Roche Innovation Center Basel, Pharmaceutical Sciences, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Gerard Greig
- Pharma Research & Early Development, Roche Innovation Center Basel, Clinical Pharmacology, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Kenjie Amemiya
- Non-Clinical Safety Department, Genentech Inc, South San Francisco, CA USA
| | - Richard Peck
- Pharma Research & Early Development, Roche Innovation Center Basel, Clinical Pharmacology, F. Hoffmann-La Roche AG, Basel, Switzerland
| | - Thomas Singer
- Pharma Research & Early Development, Roche Innovation Center Basel, Pharmaceutical Sciences, F. Hoffmann-La Roche AG, Basel, Switzerland
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Affiliation(s)
- D Serfaty
- 9, rue de Villersexel, 75007 Paris, France.
| | - R Sitruk-Ware
- Population Council and Adjunct Faculty at Rockefeller University, 1230,York Avenue, 10065 New York, NY, USA.
| | - C Wang
- UCLA Clinical and Translational Science Institute, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, David Geffen School of Medicine, UCLA, 1000, W. Carson Street, 90509 Torrance, CA, USA.
| | - E Nieschlag
- Centre of Reproductive Medicine and Andrology of the University, Domagkstrasse 11, D-48149 Münster, Germany.
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Waller D, Bolick D, Lissner E, Premanandan C, Gamerman G. Azoospermia in rabbits following an intravas injection of Vasalgel ™. Basic Clin Androl 2016; 26:6. [PMID: 27030808 PMCID: PMC4812607 DOI: 10.1186/s12610-016-0033-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vasectomy is currently the only long-acting contraceptive option available for men, despite increasing demand and potentially significant positive impacts on human health of additional male contraceptive options. Vasalgel ™ is a high molecular weight hydrogel polymer being developed as a non-hormonal long-acting reversible male contraceptive. Vasalgel consists of styrene-alt-maleic acid dissolved in dimethyl sulfoxide, which is distinct from styrene-alt-maleic anhydride materials previously studied. METHODS The goal of the study was to determine the contraceptive efficacy of two test articles with different levels of styrene maleic acid (100 %, and 80 % acid/20 % anhydride). The test articles were injected bilaterally in the vasa deferentia of mature male rabbits. Post-implantation analyses of semen parameters were completed over a 12 month period and compared to baseline measures of sperm concentration, motility and forward progression. RESULTS Both test articles were effective in blocking the passage of spermatozoa through the vasa deferentia in the 12 subjects completing the study. A significant decrease in sperm concentration occurred following implantation of the test material, with no measurable sperm concentration except for a few samples in one animal that were markedly oligospermic. Vasalgel produced a rapid onset of azoospermia, with no sperm in semen samples collected as early as 29-36 days post-implantation, and was durable over a 12 month period. CONCLUSION This study indicated that Vasalgel is an effective non-hormonal long-acting male contraceptive in a rabbit model.
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Affiliation(s)
- Donald Waller
- />Prelabs, LLC Inc., 33 W Chicago Ave., Oak Park, IL 60302 USA
| | - David Bolick
- />Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
| | - Elaine Lissner
- />Parsemus Foundation, PO Box 2246, Berkeley, CA 94702 USA
| | - Christopher Premanandan
- />Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, 1925 Coffey Road, Columbus, OH 43215 USA
| | - Gary Gamerman
- />Seraphim Life Sciences Consulting, LLC, 2158 Bonaventure Drive, Suite 101, Vienna, VA 22181 USA
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Abstract
World population continues to grow at an unprecedented rate, doubling in a mere 50years to surpass the 7-billion milestone in 2011. This steep population growth exerts enormous pressure on the global environment. Despite the availability of numerous contraceptive choices for women, approximately half of all pregnancies are unintended and at least half of those are unwanted. Such statistics suggest that there is still a gap in contraceptive options for couples, particularly effective reversible contraceptives for men, who have few contraceptive choices. Male hormonal contraception has been an active area of research for almost 50years. The fundamental concept involves the use of exogenous hormones to suppress endogenous production of gonadotropins, testosterone, and downstream spermatogenesis. Testosterone-alone regimens are effective in many men but high dosing requirements and sub-optimal gonadotropin suppression in 10-30% of men limit their use. A number of novel combinations of testosterone and progestins have been shown to be more efficacious but still require further refinement in delivery systems and a clearer understanding of the potential short- and long-term side effects. Recently, synthetic androgens with both androgenic and progestogenic activity have been developed. These agents have the potential to be single-agent male hormonal contraceptives. Early studies of these compounds are encouraging and there is reason for optimism that these may provide safe, reversible, and reliable contraception for men in the near future.
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Affiliation(s)
- Jing H Chao
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Stephanie T Page
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
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Abstract
Hormonal male contraception clinical trials began in the 1970s. The method is based on the use of exogenous testosterone alone or in combination with a progestin to suppress the endogenous production of testosterone and spermatogenesis. Studies using testosterone alone showed that the method was very effective with few adverse effects. Addition of a progestin increases the rate and extent of suppression of spermatogenesis. Common adverse effects include acne, injection site pain, mood change including depression, and changes in libido that are usually mild and rarely lead to discontinuation. Current development includes long-acting injectables and transdermal gels and novel androgens that may have both androgenic and progestational activities. Surveys showed that over 50 % of men will accept a new male method and female partners will trust their partner to take oral “male pills.” Partnership between government, nongovernment agencies, academia, and industry may generate adequate interest and collaboration to develop and market the first male hormonal contraception.
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Abstract
Developing a non-hormonal male contraceptive requires identifying and characterizing an appropriate target and demonstrating its essential role in reproduction. Here we review the development of male contraceptive targets and the current therapeutic agents under consideration. In addition, the development of EPPIN as a target for contraception is reviewed. EPPIN is a well characterized surface protein on human spermatozoa that has an essential function in primate reproduction. EPPIN is discussed as an example of target development, testing in non-human primates, and the search for small organic compounds that mimic contraceptive antibodies; binding EPPIN and blocking sperm motility. Although many hurdles remain before the success of a non-hormonal male contraceptive, continued persistence should yield a marketable product.
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Affiliation(s)
- Michael G O'Rand
- Department of Cell Biology & Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, United States; Eppin Pharma Inc., Chapel Hill, NC, 27514, United States.
| | - Erick J R Silva
- Department of Pharmacology, Instituto de Biociências de Botucatu, Universidade Estadual Paulista, Botucatu, SP 18618-970, Brazil
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Bernard V, Bouvattier C, Christin-Maitre S. [Therapeutic issues concerning male fertility]. Ann Endocrinol (Paris) 2015; 75 Suppl 1:S13-20. [PMID: 25617918 DOI: 10.1016/s0003-4266(14)70023-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Men reproductive health has long been ignored although it is responsible for 50% of couple's infertility. However, in recent years, the understanding of endocrine physiology underlying testis development and spermatogenesis has enabled the development of new therapeutic strategies. Some concern the management of male infertility. Others are dealing with finding an effective male contraceptive. In this review, we first present the management of infertility, in patients with congenital hypogonadotropic hypogonadism. We then describe the major improvements for Klinefelter patient's infertility. Finally, we review the different hormonal and non-hormonal methods for male contraception, currently in development. Efficacy and safety of the some non-hormonal methods remain to be demonstrated so far in humans.
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Affiliation(s)
- V Bernard
- Unité INSERM 693, 63 rue Gabriel-Péri, 94276 Le Kremlin-Bicêtre cedex, France.
| | - C Bouvattier
- Service d'endocrinologie et diabétologie pédiatrique, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - S Christin-Maitre
- Service d'endocrinologie et maladies de la reproduction, Hôpital Saint-Antoine, Paris, France
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Abstract
Although the twentieth century has seen great strides in the development of female contraception, not a single new agent has been introduced as an approved method for common use for male contraception. Condoms (considered uncomfortable by some) and vasectomy (a permanent invasive procedure) are the only options provided to men, leaving an undue burden on women to bear contraceptive responsibility. Significant developments have, however, been made with regard to hormonal and nonhormonal contraception, and minor, reversible, procedural contraception. This article reviews the currently available, soon to be available, and theoretically possible methods of male contraception.
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Affiliation(s)
- Paul Kogan
- Department of Urology, University of Iowa, 200 Hawkins Drive, 3 RCP, Iowa City, IA 52242-1089, USA
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Nath S, Dutta Choudhury M, Roychoudhury S, Talukdar AD, Misro MM. Male contraceptive efficacy of Ricinus communis L. extract. J Ethnopharmacol 2013; 149:328-334. [PMID: 23850709 DOI: 10.1016/j.jep.2013.06.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Revised: 06/10/2013] [Accepted: 06/24/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ricinus communis L. (Rc), of Euphorbiaceae family is a widespread plant in tropical regions and it is used in traditional medicines as an antifertility agent in India and different parts of the world. AIM OF THE STUDY The aim of the present study is to revalidate the ethnobotanical knowledge by evaluating the activity of only crude stem bark extracts of Rc. In this study, effects of extracts on male contraceptive efficacy were experimented in vitro with human sperm sample. The work is based on primordial and contemporary therapeutic uses of this plant. MATERIALS AND METHODS In this study, dose of petroleum ether extract, ethyl acetate extract, acetone extract and lyophilised aqueous extract of Rc were added to fresh human semen in 1:1 volumetric ratio. As the aqueous extract showed a promising result in 1:1 ratio, therefore, the Hypo-osmotic swelling test (HOS), Nuclear chromatin decondensation test (NCD) and Acrosomal status and function test (AFT) were also carried out with the aqueous extract of Rc. RESULTS The sperm immobilisation effects of the extract appeared immediately in a dose-dependent manner when the samples were treated with four different extracts of this plant. At a concentration of 100mg/mL, 100% (p<0.001 and p<0.05) sperms lost their progressive motility. At a concentration of 300 mg/mL, 100% (p<0.001 and p<0.05) became immotile when treated with aqueous extract. There was 88% (p<0.001 and p<0.05) morphological deformities in sperm sample due the effect of aqueous extract when they were tested for HOS and 91% (p<0.05) sperms behaved against NCD as compared to control group. Also there was a distinct decline (p<0.05) in AFT with increase in dosage concentration. CONCLUSION The findings of the study revealed that aqueous stem bark extract of the plant showed dose dependent loss of sperm motility by influencing the morphological deformation, blockage in nuclear envelope and distinct declination in acrosomal status of spermatozoa. This research, thus, opens up scope for future exploration of bark of the plant as commercial source of new male contraceptive.
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Affiliation(s)
- Sushmita Nath
- Department of Life Science and Bioinformatics, Assam University, Silchar, Assam 788011, India
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Halvaei I, Roodsari HRS, Harat ZN. Acute Effects of Ruta graveolens L. on Sperm Parameters and DNA Integrity in Rats. J Reprod Infertil 2012; 13:33-8. [PMID: 23926522 PMCID: PMC3719372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 01/16/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Increase in world population is one of the serious and threatening issues in this century. Therefore, it is vitally important to find safe and effective contraceptive methods, especially for men which already have few choices in this regard. Medicinal plants that were used for contraception in ancient times could be good sources of investigation in this filed. Ruta graveolens L. is one the plants introduced in the Iranian traditional medicine as an oral male contraception to be used before intercourse. In this study we tried to investigate the probable effects of the plant on the spermatozoa of male rats. METHODS Ruta graveolens L. aqueous extract (5 g/kg) was administered orally to five groups of male rats and sperm motility was checked after half, one, two, four and six hours later. Moreover, one group of rats served as the control group. Subsequently, viability of cells (Eosin-Nigrosin staining), morphological changes (Diff-Quick staining), DNA status (acridine orange dye) and serum testosterone levels were assessed in the treated groups which had significant immotile spermatozoa. For statistical analysis, Student's t-test and one-way ANOVA with Tukey's post-hoc test were employed for comparison between groups. RESULTS A significant reduction in sperm motility was seen one hour after administration of the extract in the case groups compared to the controls (36% vs. 68.15%, respectively, p <0.01). The motility gradually increased afterwards, and by 6 hours, it was the same as the control group (65.43% and 68.15%, respectively). No significant changes were seen in viability, morphology or DNA structure of spermatozoa in each group. Testosterone levels did not show any significant changes in the treated groups when compared with the controls. CONCLUSION Since a significant temporary immobility of spermatozoa without any adverse effects on other sperm characteristics occurred upon the administration of Ruta graveolens L. aqueous extract, it seems that this plant might have the potential to be used for the suggested male contraception.
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Affiliation(s)
- Iman Halvaei
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,Yazd Institute for Reproductive Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hamid Reza Sadeghipour Roodsari
- Department of Physiology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Hamid Reza Sadeghipour Roodsari, Department of Physiology, Faculty of Medicine, Tehran University of Medical Sciences, Poursina ave., Tehran, Iran, PO Box: 1417613151. E-mail:
| | - Zhila Naghibi Harat
- IVF laboratory of Arash Women's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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