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 gonadotrophins, and simultane ous supplementation with androgens. These methods include the use of c ombinations of progestogens or luteinizing hormone-releasing hormone a ntagonists and testosterone derivatives, or high dose testosterone. Th ough effective contraception can be obtained, side-effects and/or the high cost of treatment limit the widespread use of these approaches. I nhibition of sperm maturation in the epididymis, or direct interferenc e with spermatogenic cells or the cells of Sertoli by e.g. gossypol ha ve been abandoned because of toxic side-effects. Voluntary sterilizati on by vasectomy is the most commonly used method of male contraception , but its surgical nature, problematic reversibility and suspected lin k with subsequent prostate cancer render the method far from ideal. No n-surgical vas occlusion may overcome some of these problems, but data on long-term side-effects and reversibility are lacking. New contrace ptive developments should focus on interfering with highly specific as pects of spermatogenesis such as unique enzymatic processes and interc ellular communication through cytokines, or application of antibodies against antigens of the epididymis or the spermatozoa. Only through be tter understanding of normal and pathological spermatogenesis will it be possible to develop an acceptable male contraceptive.