K51 - Male Contraception.ppt [Read-Only]ocw.usu.ac.id/course/download/1110000106... · References: zGuidelines on Male Infertility, European Association of Urology March 2007of Urology,

MALE CONTRACEPTION

dr. Syah Mirsya Warli, SpUdr. Bungaran Sihombing, SpU

Urology Division, Surgery DepartmentMedical Faculty, University of Sumatera UtaraUniversity of Sumatera Utara

1

References:

Guidelines on Male Infertility, European Association of Urology March 2007of Urology, March 2007Clinical Manual of Urology, (Philip M. Hanno et al eds), McGraw-Hill Int ed, 3rd ed, 2001), , ,Smith’s General Urology (Tanagho & McAninch eds), Lange Medical Books, 15th ed, 2000Infertility in The Male, (Lipshultz & Howards eds), Mosby, 1997

2

Male contraseption

male contraceptive method :d- condoms

- periodic abstinencewithdrawl- withdrawl

Typical 1st-year failure rates :- condoms 3 – 14%condoms 3 14%- periodic abstinence 20%- withdrawl 19%

3

Male contraception

Use of existing malecontraceptives in developed regioncontraceptives in developed region

Use of existing malecontraceptives in developing

regiong

4

Condoms

5

Condoms

Thin sheaths of rubber, vinyl or natural products which may be treated with a spermicide for added protectionmay be treated with a spermicide for added protection. They are placed on the penis once it is erectCondoms differ in such qualities as shape, color, q p , ,lubrication, thickness, texture and addition of spermicide (usually nonoxynol-9)

6

Types of Condom

Latex (rubber)Plastic (vinyl)Natural (animal products)

7

8

Mechanism of action condom

Prevent sperm from gaining access to female reproductive tractreproductive tractPrevent micro organism (Sexual Transmitted Disease) from passing from one partner to another ) p g p(latex & vinyl condom only)

9

Contraceptive benefits

Effective immediatelyD t ff t b tf diDo not affect breastfeedingCan be used as back up to other methodsNo method related health riskNo method-related health riskNo systemic side-effectsWidely availableWidely availableInexpensive

10

Research Contraceptive :

- prevent sperm production (use of androgen, progesteron, GnRH)

- interfere with the ability of sperm to mature and carry out fertilization by using an epididymalapproach to create a hostile environment for spermsprod ce better barrier methods- produce better barrier methods

- produce of antisperm contraceptive vaccine- inhibit sperm-egg interactionsinhibit sperm egg interactions

11

Hormonal male contraception

Based on suppression of gonadotrophin & the use of testosterone substitution to maintain male sexual function & bone mineralization & to prevent muscle wastinggResearch :- testosterone monotherapy- androgen/progestin combination- testosterone with GnRH analogues

l ti d d ti t- selective androgen and progestin receptormodulation12

Vasectomy

Is an effective method of permanent male surgical p gsterilizationBefore the procedure, the couple should be given

t i f ti b t th b fit & i kaccurate information about the benefit & risks

13

Surgical techniques

various techniquesl l t th l t i ino-scalpel vasectomy the least invasive

approach to the vascauterization of the lumen of the vas & fascialcauterization of the lumen of the vas & fascial interposition most effectiveocclusion technique

14

Vasectomy

15

Complications

Acute local complications :- haematoma, wound infection, epididymitis

5% casesL t li tiLong term complications :

- chronic testicular pain, epididymal tubal damage

16

Complications

Vasectomy does not significantly alter t i & L di ll f tispermatogenesis & Leydig cell function

Volume of ejaculate unchangedRate of prostate cancer could not increasedRate of prostate cancer could not increased

17

18

19

20

Vasectomy failure

Effective occlusion technique risk of recanalization < 1%< 1%No motile spermatozoa 3 mo laterPersistent motility sign of vasectomy failurePersistent motility sign of vasectomy failure need to repeat the procedureLong term recanalization may occur (rare)

21

Counseling

It should be considered irreversibleIt has a low complication rate. However, because vasectomy is an elective operation even smallvasectomy is an elective operation even small risks should be explained as men may wish to consider these before giving their consentIt has a low but existing failure rateIt has a low, but existing, failure rateCouples should be advised to continue with other effective contraception until clearance is

hi dachieved

22

Vasectomy

All available data indicate that vasectomy is safe & not associated with any serious, long term side effectFascial interposition & cauterization seem to give a higher efficacyhigher efficacy

23

Vasectomy reversal

Success rate > 90%, depend on :th ti l d ft t- the time elapsed after vasectomy

- type of vasectomy (open ended or sealed)type of reversal (vasovasostomy or- type of reversal (vasovasostomy or vasoepididymostomy)

- unilateral or bilateralunilateral or bilateral

24

Conclusions

The most cost-effective approach to treatment of post-vasectomy infertility is microsurgical reversal. This also has the highest chance of deliveryCouples can have a family after successful vasectomyCouples can have a family after successful vasectomy reversal. There is no need for hormonal treatment of the female partner, with its associated risks of ovarian hyperstimulation and multiple pregnancies

25

Th k YThank You

wr’0726