MALE CONTRACEPTION - HORMONAL, MECHANICAL AND OTHER

Methods of male contraception that have been developed so far have mai nly focused on the inhibition of spermatogenesis through suppression o f the hypothalamo - pituitary secretion of gonodotrophins, and simulta neous supplementation with androgens. These methods include the use of combinations of progestogens or luteinizing hormone-releasing hormone antagonists and testosterone derivatives, or high dose testosterone. Though effective contraception can be obtained, side-effects and/or th e high cost of treatment limit the widespread use of these approaches. Inhibition of sperm maturation in the epididymis, or direct interfere nce with spermatogenic cells or the cells of Sertoli by e.g. gossypol have been abandoned because of toxic side-effects. Voluntary steriliza tion by vasectomy is the most commonly used method of male contracepti on, but its surgical nature, problematic reversibility and suspected l ink with subsequent prostate cancer render the method far from ideal. Non-surgical vas occlusion may overcome some of these problems, but da ta on long-term side-effects and reversibility are lacking. New contra ceptive developments should focus on interfering with highly specific aspects of spermatogenesis such as unique enzymatic processes and inte rcellular communication through cytokines, or application of antibodie s against antigens of the epididymis or the spermatozoa. Only through better understanding of normal and pathological spermatogenesis will i t be possible to develop an acceptable male contraceptive.