Male contraception: mechanical, hormonal and non-hormonal methods

Nanomaterials Solutions for Contraception: Concerns, Advances, and Prospects

Preventing unintentional pregnancy is one of the goals of a global public health policy to minimize effects on individuals, families, and society. Various contraceptive formulations with high effectiveness and acceptance, including intrauterine devices, hormonal patches for females, and condoms and vasectomy for males, have been developed and adopted over the last decades. However, distinct breakthroughs of contraceptive techniques have not yet been achieved, while the associated long-term adverse effects are insurmountable, such as endocrine system disorder along with hormone administration, invasive ligation, and slowly restored fertility after removal of intrauterine devices. Spurred by developments of nanomaterials and bionanotechnologies, advanced contraceptives could be fulfilled via nanomaterial solutions with much safer and more controllable and effective approaches to meet various and specific needs for women and men at different reproductive stages. Nanomedicine techniques have been extended to develop contraceptive methods, such as the targeted drug delivery and controlled release of hormone using nanocarriers for females and physical stimulation assisted vasectomy using functional nanomaterials via photothermal treatment or magnetic hyperthermia for males. Nanomaterial solutions for advanced contraceptives offer significantly improved biosafety, noninvasive administration, and controllable reversibility. This review summarizes the nanomaterial solutions to female and male contraceptives including the working mechanisms, clinical concerns, and their merits and demerits. This work also reviewed the nanomaterials that have been adopted in contraceptive applications. In addition, we further discuss safety considerations and future perspectives of nanomaterials in nanostrategy development for next-generation contraceptives. We expect that nanomaterials would potentially replace conventional materials for contraception in the near future.

Interest in a pericoital pill among women in family planning and abortion clinics

BACKGROUND

The purpose of this study was to determine whether women might be interested in repeated use of a pericoital pill, a pill taken around the time of each act of intercourse.

STUDY DESIGN

We surveyed women from abortion (n=635) and family planning (n=981) clinics regarding their interest in using a pericoital pill.

RESULTS

Over two thirds (69%) of abortion and 50% of family planning clients said they would definitely or probably be interested in a pericoital pill. Significant predictors of interest in a pericoital pill included race/ethnicity, ease of getting a birth control prescription, frequent unprotected intercourse and seeking abortion services.

CONCLUSION

More work is needed to establish the effectiveness of a pericoital pill and determine how frequently a pericoital pill might be used by women who currently have unprotected intercourse.

Effects of combined administration of low-dose gossypol with steroid hormones on the mitotic phase of spermatogenesis of rat

Our previous studies suggested that combined low-dose gossypol with steroid hormones possesses a reversible antifertility role on adult male rat. Spermatocyte apoptosis during the meiosis of spermatogenesis is the main reason for the antifertility. This study evaluates the effects of the regimen on the mitosis of spermatogenesis. Thirty-two adult male rats were divided into four groups randomly, Group GH: rats were fed orally with gossypol acetic acid (GA, 12.5 mg/kg d) and desogestrel (DSG, 0.125 mg/kg d)/ethinylestradiol (EE, 0.025 mg/kg d)/testosterone undecanoate (TU, 100 mg/kg d); Group G: a single dose of GA (12.5 mg/kg d); Group H: the same dosage of DSG/EE/TU as in Group GH; Group C: rats were treated with vehicle (1% methyl cellulose) as control. Testes were removed at the 8th week after treatment to assess the weight, volumes, diameter, and degenerated rate of seminiferous tubule, spermatogonia is quantitated by stereological assay. TUNEL assay and proliferating cell nuclear antigen immunohistochemistry were used to determine the germ cell apoptosis and proliferation. The changes of gene expression of glial cell line-derived neurotrophic factor (GDNF) and Ets variant gene 5 (Etv5) were analyzed. The results manifested that the spermatogenesis was suppressed, the type A and intermediate spermatogonia reduced, and spermatocyte and spermatid apoptosis increased both in Group GH and Group H. The expressions of GDNF protein in these two groups were downregulated, but no change was observed in Etv5 expression. However, the numbers of spermatogonia, germ cell apoptosis and proliferation, and the expressions of GDNF and Etv5 were unchanged in Group G compared with Group C. Above all, we concluded that the mitotic phase of spermatogenesis is suppressed by the combination regimen, it might be the steroid hormones in the regimen that caused the reduction of spermatogonia through the downregulation of GDNF.

Fertility control in wildlife: humans as a model

In a time of accelerated extinction rates and biodiversity loss, it may seem illogical to be concerned with methods limiting the reproduction of wild populations; however, there is an urgent need to inhibit the proliferation of a wide variety of species. The range of animals for which fertility control is desired makes the development of a single method impossible. The various reproductive strategies used by individual species, the desired outcome of contraceptive programs (reversible or irreversible; male or female directed) and our ignorance of the reproductive biology of many endangered species necessitate thorough species-specific investigations. As fertility control in humans is a reality and research into methods of fertility control is more advanced, humans serve as a model for developing contraceptive approaches for wild species. Population control by traditional methods (indirect or direct intervention by culling, poisoning, translocation, etc.) is increasingly unacceptable to the public, making human studies even more valuable for finding solutions to overabundant wild populations. This review compares and contrasts the range of contraceptive methods used in both wildlife and humans.

Nonhormonal drugs for contraception in men: a systematic review

Nonhormonal drugs for contraception in men may have advantages over hormonal methods. The nonhormonal methods can have more rapid onset and less interference with androgen-dependent functions. This systematic review summarizes the clinical studies evaluating nonhormonal drugs administered to men for contraception. Relevant clinical results were found for gossypol, which is derived from the cotton plant, and for extracts of Tripterygium, a plant used in Chinese traditional medicine. Randomized, controlled trials were available on the efficacy of gossypol and on the effect of gossypol on potassium levels. Gossypol had problems with low efficacy and toxicity. For Tripterygium, 2 observational studies described men who were treated for rheumatoid arthritis. Although sperm density was lower among those taking Tripterygium, later reports indicated some toxicity. Nonclinical research continues on isolates of Tripterygium. No clinical studies for contraception in men were found for nonhormonal vaccines or neem, which is also a plant used for medicinal purposes. Clinical trials studied injecting styrene maleic anhydride into the vas deferens, but no comparative data were provided. At this time, no safe and effective nonhormonal drug is available for contraception in men.

TARGET AUDIENCE

Obstetricians & Gynecologists, Family Physicians.

LEARNING OBJECTIVES

After completion of this article, the reader should be able to state that the number of studies concerning the use of nonhormonal drugs for male contraception are very limited, point out that the two nonhormonal drugs used to a small degree have varying results and serious side effects, and recall that there are limited clinical studies on use of vas deferens injections and vaccines in humans.

Expression of human hormone-sensitive lipase (HSL) in postmeiotic germ cells confers normal fertility to HSL-deficient mice

Hormone-sensitive lipase (HSL, Lipe, E.C.3.1.1.3) is a multifunctional fatty acyl esterase that is essential for male fertility and spermatogenesis and that also plays important roles in the function of adipocytes, pancreatic beta-cells, and adrenal cortical cells. Gene-targeted HSL-deficient (HSL-/-) male mice are infertile, have a 2-fold reduction in testicular mass, a 2-fold elevation of the ratio of esterified to free cholesterol in testis, and unique morphological abnormalities in round and elongating spermatids. Postmeiotic germ cells in the testis express a specific HSL isoform. We created transgenic mice expressing a normal human testicular HSL cDNA from the mouse protamine-1 promoter, which mediates expression specifically in postmeiotic germ cells. Testicular cholesteryl esterase activity was undetectable in HSL-/- mice, but in HSL-/- males expressing the testicular transgene, activity was 2-fold greater than normal. HSL transgene mRNA became detectable in testes between 19 and 25 days of age, coinciding with the first wave of postmeiotic transcription in round spermatids. In contrast to nontransgenic HSL-/- mice, HSL-/- males expressing the testicular transgene were normal with respect to fertility, testicular mass, testicular esterified/free cholesterol ratio, and testicular histology. Their cauda epididymides contained abundant, normal-appearing spermatozoa. We conclude that human testicular HSL is functional in mouse testis and that the mechanism of infertility in HSL-deficient males is cell autonomous and resides in postmeiotic germ cells, because HSL expression in these cells is in itself sufficient to restore normal fertility.