Development of a noninvasive vasectomy technique may eliminate male fear of complications (incision, bleeding, infection, and scrotal pain) and result in a more popular procedure. These studies build off previous studies that report the ability to thermally target tissue substructures with near infrared laser radiation while maintaining a healthy superficial layer of tissue through active surface cooling. Initial studies showed the ability to increase the working depth compared to that of common dermatological procedures and the translation into an ex vivo canine model targeting the vas deferens in a noninvasive laser vasectomy. Laser and cooling parameter optimization was required to determine the best possible wavelength for a safe transition to an in vivo canine model. Optical clearing agents were investigated as a mechanism to decrease tissue scattering during in vivo procedures to increase optical penetration depth and reduce the overall power required. Optical and thermal computer models were developed to determine the efficacy for a successful transition into a human model. Common clinical imaging modalities (ultrasound, high frequency ultrasound, and optical coherence tomography) were tested as possible candidates for real-time imaging feedback to determine surgical success. Finally, a noninvasive laser vasectomy prototype clamp incorporating laser, cooling, and control in a single package was designed and tested in vivo. Occlusion of the canine vas deferens able to withstand physiological burst pressures measured postoperative was shown during acute and chronic studies. This procedure is ready for azoospermia and recanalization studies in a clinical setting.
Cilip, Christopher Michael
CD4+ CD25+ regulatory T cells (Tregs) strongly influence the early and late autoimmune responses to meiotic germ cell antigens (MGCA) and the gonadal immunopathology in vasectomized mice. This is supported by the published and recently acquired information presented here. Within 24h of unilateral vasectomy (uni-vx) the ipsilateral epididymis undergoes epithelial cell apoptosis followed by necrosis, severe inflammation, and granuloma formation. Unexpectedly, vasectomy alone induced MGCA-specific tolerance. In contrast, uni-vx plus simultaneous Treg depletion resulted in MGCA-specific autoimmune response and bilateral autoimmune orchitis. Both tolerance and autoimmunity were strictly linked to the early epididymal injury. We now discovered that testicular autoimmunity in uni-vx mice did not occur when Treg depletion was delayed by one week. Remarkably, this delayed Treg depletion also prevented tolerance induction. Therefore, tolerance depends on a rapid de novo Treg response to MGCA exposed after vasectomy. Moreover, tolerance was blunted in mice genetically deficient in PD-1 ligand, suggesting the involvement of induced Treg. We conclude that pre-existing natural Treg prevents post-vasectomy autoimmunity, whereas vasectomy-induced Treg maintains post-vasectomy tolerance. We further discovered that vasectomized mice were still resistant to autoimmune orchitis induction for at least 12-16 months; thus, tolerance is long-lasting. Although significant sperm autoantibodies of low titers became detectable in uni-vx mice at 7 months, the antibody titers fluctuated over time, suggesting a dynamic "balance" between the autoimmune and tolerance states. Finally, we observed severe epididymal fibrosis and hypo-spermatogenesis at 12 months after uni-vx: findings of highly critical clinical significance. PMID:24080233
Rival, Claudia; Wheeler, Karen; Jeffrey, Sarah; Qiao, Hui; Luu, Brian; Tewalt, Eric F; Engelhard, Victor H; Tardif, Stephen; Hardy, Daniel; Del Rio, Roxana; Teuscher, Cory; Tung, Kenneth
Although an estimated 100 million couples who practice contraception have chosen sterilization as their accepted method, the overwhelming majority of the sterilizations were obtained by women even though vasectomy is known to be simpler, safer and cheaper than tubal ligation. In an effort to stimulate new interest in male sterilization an international meeting was held in Sri Lanka in 1982. 66 participants from 25 countries discussed problems related to the acceptance of vasectomy and the delivery of sterilization services. Yearly vasectomy figures have fluctuated widely and are attributed to new simplified female procedures, fluctuating government policies, erratic funding and male chauvinism. Machismo in Central and South America were of particular concern. The use of paramedics to perform vasectomies in areas where there are few overworked doctors was debated. It was concluded that quality services were essential and both physicians and paramedics may have to be used. In Africa neither the population nor the government is interested in male sterilization and contraception is considered woman's business. Several gynecologists are just beginning to introduce the male role in contraception. In Thailand, vasectomy is widely promoted and rewarded, and additional mass market techniques were suggested. Some countries have given cash payments for the procedure, but the conference participants were in favor of more indirect motivational methods. The conference concluded that promoting vasectomy will require more information, education and effort than female sterilization. In particular erroneous fears of castration and impotence must be overcome. Word of mouth communication was judged to be the best way of promoting the success of the procedure. PMID:6680702
Johnson, J H
Since the late 1960s, vasectomy has been a popular and widely used form of contraceptive in Britain for couples who do not want to have any more children. However, throughout the past decade there has been considerable concern about the safety of this procedure. This paper reviews the current opinion on the possible health considerations associated with this operation and shows that the latest news is mostly reassuring. PMID:9231476
McDonald, S W
This paper examines some of the reasons for the paucity of vasectomy programs in Latin America and some considerations which should be taken into account before such programs are implemented. Social constraints, the structure of the Latin American family, and the “machismo” cult are discussed. The authors conclude that if the processes of self?selection, screening and counseling are employed, vasectomy
Alfredo Goldsmith; Rona J. Goldberg
Background: Irregular growth of population is considered as a serious threat to the international community. It is a major obstacle for socioeconomic development. One of the methods to control the population is by providing effective methods of contraception. Vasectomy, as a simple and effective contraceptive method, has been approved by the World Health Organization (WHO). It is very important to involve men in the control of population and the promotion of reproductive health. Aims: This study was conducted with the aim of describing the experiences of the men who underwent vasectomy. Materials and Methods: This qualitative study was performed by using a phenomenological research design. The sample consisted of 14 vasectomized men selected through purposive sampling method. In-depth and open interviews with participants were conducted to collect the data. Results: The results were transcribed and recorded in comprehensive field notes. Colaizzi's method was used to analyze the data. Four themes emerged from the obtained results of the present study, which described the structure of the experiences of men as follows: Opinions about vasectomy, own perceptions about vasectomy, experiences with the procedure, and recommendation of vasectomy to others. Conclusion: Vasectomy can influence achievement of family planning goals and participation of men in this regard. The results of this study can help the planners and health-care providers for appropriate interventions, and training and counseling programmers to increase the acceptability and uptake of vasectomy in the society.
Hosseini, Habibollah; Abdi, Fatemeh
Sperm-agglutinating antibodies were present in three (2-6%) of 117 fertile men and in 19 (33-9%) of 56 men who had been vasectomized. Twenty-four of the 56 vasectomized men had been studied before vasectomy; sperm-agglutinating antibodies were present in one (4-3%) compared with eight (33-3%) after vasectomy. No sperm-immobilizing antibodies were detected before vasectomy but were present in 10 (17-9%) of the 56 men after vasectomy.
Hunter, J; Logan, H; Greer, G
A qualitative study was performed to: investigate the process that leads couples to de- cide for vasectomy; characterize the gender relations involved in this process; and identify sources of information on vasectomy. Semi-structured interviews were conducted with 20 cou- ples who had requested vasectomy at the outpatient clinic of the Center for Integrated Women's Health Care, State University in Campinas,
Nádia Maria Marchi; Augusta Thereza de Alvarenga; Maria José Duarte Osis; Luis Bahamondes
Prostate cancer Basics In-Depth Multimedia Expert Answers Expert Blog Resources What's New Reprints A single copy ... only. Vasectomy: Does it increase my risk of prostate cancer? By Mayo Clinic staff Original Article: http:// ...
Chinese scientists have reported on new chemical and reversible vasectomy methods. Although data is difficult to confirm because of the secrecy surrounding these projects, China has been credited with advancing the no-scalpel vasectomy. According to Chinese officials, 30 million vasectomies have been performed nationwide in the last 2 decades. In some areas, the vasectomy prevalence equals 31%, and the ratio of vasectomy to female sterilization is 5 to 1. In the rest of China, the ratio is 1 to 3. Based on a 1990 survey, 12% of Chinese couples use vasectomy. Because of China's burgeoning population, new research on male sterilization is being emphasized. This includes vas ligation (via the no-scalpel method) and vas occlusion (via chemicals, electricity, or a reversible device). In these methods, a tiny puncture or injection is substituted for an incision. Electrocoagulation has been used clinically in China since the 1980s. This method requires insertion of a needle electrode into the vas lumen. A current is run for 2 seconds, and then the electrode is removed. 1 cm of the vas becomes rigid and yellowish brown. Based on the results of 2 studies, the efficacy rate of this method was 99.2%-100% in 7439 cases over 10 years. The rate of azoospermia was 0%, while the rate of complications was 0.53% in 1088 vasectomies. A blunt wire cautery unit has also been used, but it causes more tissue damage and is more difficult to use. In chemical vasectomies, the agent is injected through the skin into the lumen. The vas is not pulled out of the scrotum. An adhesive blocking agent (CABCM) containing carbolic acid is injected into both sides of the vas lumen, solidifies in 20 seconds, and blocks 2 cm of the vas. The effectiveness rate is 95.6% in 456 cases over 10 years. A plastic tube has replaced the puncture needle recently and seems less difficult and dangerous to use. Vas blocking forceps have been developed to shorten the amount of vas to be occluded. Reversible vasectomies require implantation of removable devices. Although plugs, beads, wires, threads, or filterable devices have been used, clips have met with the greatest success, according to the Chinese. However, silver, or silicon with silver and rubber, clips that are under study are difficult to remove because of tissue adhesions. They also slip, which may cause irreversible damage to the vas. A tantulum ring clip causes less damage and has greater reversibility. These had a 99% effectiveness rate in 28,537 cases. PMID:12318853
Family Health International (FHI) and EngenderHealth conducted a multicenter, randomized controlled trial to evaluate a fascial interposition (FI) component of a vas occlusion procedure for male sterilization. A data monitoring committee (DMC) was established to provide independent review of the interim report. The DMC met to review the interim report after enrollment of 552 men. As planned, an estimate of the hazard ratio (HR) for successful vasectomy for the FI group versus the no-FI group controlling for age of the participant and level of experience of the surgeon was obtained for the interim report using Cox's proportional hazards regression. The main analysis comparing time to vasectomy success, defined as two consecutive azoospermic semen samples, was highly significant and met the prespecified level for stopping enrollment (HR=1.54, p<0.01). However, a troublesome age by vasectomy technique interaction became apparent in the analysis. FI was clearly beneficial for younger males. However, the trend for older men was not as clear. The DMC recommended continuing the trial to better study this interaction and obtain more data to clarify the effect of FI for older men. After consulting further with the DMC, the study statisticians presented the interim report to senior management at FHI. A meeting between FHI senior management and the DMC followed. After much deliberation, trial enrollment was terminated. Follow-up of participants already enrolled in the study continued as planned. This paper presents the issues involved in the decision to terminate the study. PMID:12559645
Chen-Mok, Mario; Bangdiwala, Shrikant I; Dominik, Rosalie; Hays, Melissa; Irsula, Belinda; Sokal, David C
Voluntary sterilization exclusively for contraceptive purposes is now legal in many countries of Asia, North America, and Europe. Since 1972 most European countries have taken action through statutes, codes of medical ethics, decrees, or court decisions to establish the legality of contraceptive sterilization. France and Italy, neighboring countries with Catholic majorities and a tradition of Roman law, have had great difficulties in recognizing the legality of vasectomy. Italy was 1 of the few countries of the world with a law specifically prohibiting voluntary sterilization. The 1930 law was abrogated by Parliament in 1978, but in 1982 a physician was prosecuted for performing 50 vasectomies on men who had sought the procedure and consented to it. Prosecution argued that sterilization was not decriminalized despite abrogation of the 1930 law, and that voluntary sterilization was prohibited by the article of the penal code dealing with voluntary assault and battery. The interpretation surprised experts in population law, since the physician had received permission from the regional government of Tuscany to perform the vasectomies. The physician won the case, lost it in the Court of Appeals in Florence, and was finally acquitted in the Court of Cassation after a 5-year legal struggle. The court declared explicitly that voluntary sterilization did not constitute a penal infraction, but it recommended legislation to establish a minimum age, assure informed consent, and protect the interests of the spouse. In France, the legality of sterilization for purely contraceptive purposes has not always been explicitly recognized by the courts. Some recent verdicts have held that sterilization without therapeutic motivations is illicit, and some local committees of medical ethics continue to argue that vasectomy is an illicit practice that should only be considered in the presence of precise medical indications. The position is contrary to a resolution of the Committee of Ministers of the Council of Europe which France voted for in 1975, and a resolution of the National Council of the Order of Physicians in 1983. The resolution of the Order relaxed its earlier opposition to sterilization on the grounds that operative techniques had improved and that the chances for successful reversal had improved. It argued that sterilization should only be performed for very serious nonmedical reasons and required informed consent, spousal notification, and a waiting period of 2 months. The resolution has however been largely ignored. Although vasectomies are performed in numerous hospitals in France, their legal status remains ambiguous. PMID:12282190
Dourlen-rollier, A M
Vasectomy has advantages with respect to safety and cost when compared with female sterilization. The reasons underlying the overall low use of vasectomy, particularly among Black and Latinos, have not been adequately explored. The goals of this study were to (a) explore the social context of vasectomy decisions and (b) generate hypotheses about the social factors contributing to differences in vasectomy use by race/ethnicity. Fourteen group and nine couples interviews were conducted. Participants were 37 heterosexual couples aged 25 to 55 years who had reached their desired family size and self-identified as Black, Latino, or White. Participants discussed reasons that men and women would or would not select male sterilization. Reasons to select vasectomy included a desire to care for their current family, sharing contraceptive responsibility, and infidelity. Reasons not to select vasectomy included negative associations with the term sterilization, loss of manhood, and permanence. Misconceptions about vasectomy included misunderstandings about the vasectomy procedure and adverse postvasectomy sexual function. In addition, Black and Latino participants cited perceived ease of reversibility of female sterilization and lack of support around vasectomy as reasons not to choose it. Improving communication and social support for vasectomy, particularly among Black and Latino communities, may improve vasectomy utilization. Misconceptions regarding female and male sterilization should be targeted in counseling sessions to ensure men, women, and couples are making informed contraceptive decisions. PMID:23144022
Shih, Grace; Dubé, Kate; Sheinbein, Miriam; Borrero, Sonya; Dehlendorf, Christine
In this study of 1,600 men aged 25-50 from semi-rural Guatemala, three-fourths had heard of vasectomy. Among these, 54 per cent approved of it. However, the survey reveals a widespread lack of knowledge regarding the procedure, as well as negative perceptions or doubts about its effect on sexual performance, ability to do hard work, health, and manhood. One-fourth of the respondents who knew of vasectomy and who desired no more children expressed interest in having the operation, a finding which raises questions as to the potential (unrecognized) demand for vasectomy in other developing countries.
Santiso, R; Bertrand, J T; Pineda, M A; Guerra, S
The results of 355 questionnaires are reported, returned one or more years after vasectomy from 1,000 consecutive patients undergoing vasectomies performed by the author from 1959 to 1972. A majority claimed either unchanged or improved health, satisfaction with sexual relations, and frequency of sexual intercourse; 99.5 per cent were satisfied with the operation and in retrospect 96.7 per cent would have the operation again. PMID:1162809
Moss, W M
OBJECTIVE:To compare the 5-year cumulative probability of regret and risk factors for regret among women whose husbands underwent vasectomy with women after tubal sterilization.METHODS:A total of 525 women whose husbands underwent vasectomy were compared with 3672 women who underwent tubal sterilization in a prospective, multicenter, cohort study.RESULTS:The cumulative probability of a woman expressing regret within 5 years after her husband’s
Denise J Jamieson; Steven C Kaufman; Caroline Costello; Susan D Hillis; Polly A Marchbanks; Herbert B Peterson
In counselling the increasing number of men applying for vasectomy the practitioner should be aware that anxiety demonstrated in office interviews has no correlation with postoperative satisfaction. Young, childless men need special consideration, and a waiting period of at least one month is recommended for all. The operative procedure should be kept as simple as possible without reducing effectiveness. The use of the Weck clips is a step in this direction. Special attention to hemostasis is necessary to avoid postoperative swelling. Operative techniques, management of complications and the status of reversal operations are discussed. Small amounts of sperm in the semen after three months are not uncommon, but the testing routine recommended allows surety of permanent sterility.
Dodds, Donald J.
Three semen samples were collected at 48 h intervals from 20 mature research dogs previously conditioned to manual semen collection. Vasectomy was performed in all dogs, and 15 days after surgery, another three ejaculates were similarly collected. The semen was evaluated, and centrifuged to obtain seminal plasma for measurement of pH, and concentrations of total proteins (TP), total chlorides (Cl), calcium (Ca), potassium (K), and sodium (Na). The seminal plasma protein profile was evaluated by SDS-PAGE; molecular weights and the integrated optical density (IOD) of each band were estimated. There was a negative correlation between K concentration and progressive motility (r = -0.49, P = 0.027), sperm vigor (r = -0.60, P = 0.0053), and plasma integrity, evaluated by both the hypo-osmotic swelling test (r = -0.50, P = 0.026) and a fluorescent stain (r = -0.45, P = 0.046). Positive correlations between Na and K pre- and post-vasectomy (r = 0.88, P < 0.001; r = 0.56, P < 0.01, respectively) were verified. There were a total of 37 bands pre-vasectomy and 35 post-vasectomy (range, 100.6-3.6 kDa). Bands B9 and B13 (42.6 and 29.2 kDa) were not present post-vasectomy. The IOD of band B3 (73.5 kDa) was higher (P = 0.03) pre-vasectomy, compared to post-vasectomy; conversely, the IODs of bands B29 and B37 (7.8 and 3.6 kDa) increased (P = 0.026 and 0.047). Pre-vasectomy, there was a positive correlation (r = 0.49, P = 0.029) between band B37 band (3.6 kDa) and the Na:K ratio. In conclusion, K appeared to be involved in sperm motility in dogs and could be a tool to evaluate sperm function. The prostate contributed several elements to canine seminal plasma. Vasectomy changed Ca concentrations and the protein profile of the seminal plasma. Further studies must be performed to clarify the function of these elements on the in vivo fertility of dogs. PMID:16644001
de Souza, Fabiana Ferreira; Martins, Maria Isabel Mello; Lopes, Maria Denise
Microsurgical vasectomy reversal is a technically demanding procedure. Previous studies have shown the possible benefit of robotic assistance during such procedures. Our goal was to compare robotic assisted vasovasostomy and vasoepididymostomy to standard microsurgical vasovasostomy (MVV) and vasoepididymostomy (MVE). The use of robotic assistance for vasectomy reversal may provide the microsurgeon with improved visualization, elimination of tremor, and decreased fatigue and obviate the need for a skilled microsurgical assistant. This study provides the first clinical prospective control trial of robotic assisted versus pure microsurgical vasectomy reversal. The use of robotic assistance in microsurgical vasovasostomy and vasoepididymostomy may have benefit over MVV and MVE with regards to decreasing operative duration and improving the rate of recovery of postoperative total motile sperm counts based on our study. PMID:22744901
Parekattil, Sijo J; Gudeloglu, Ahmet; Brahmbhatt, Jamin; Wharton, Jessica; Priola, Karen B
This article interrogates the modes by which cultural constructions of male contraceptive use emerge in Costa Rica by analyzing men's narratives of vasectomy. Drawing on ethnographic research data, I examine men's contraceptive decision making and perspectives on vasectomy and specify the ways they work through their vasectomy to rearticulate the relationship between masculinity and contraceptive responsibility and tensions in an emerging Costa Rican social modernity. Following Oudshoorn's (2003) analysis on male contraceptive research, this article highlights contraceptive technologies and men's narratives of these technologies as key sites for examining gender politics in contemporary societies and the materialization of new social orders. In the discussion, I argue that the men's narratives examined here potentiate creation of an "alternative technosociality" (Oudshoorn 2003) in Costa Rica, in which men taking contraceptive responsibility does not constitute performing a subordinate masculinity, but simply another way of acting as men. PMID:23674321
Pomales, Tony O
Endocarditis caused by Staphylococcus warneri and necessitating valve replacement occurred in a previously healthy 32-year-old patient following vasectomy. No sign of an underlying valvular defect was noted during the operation. S. warneri is a recently identified species of coagulase-negative staphylococci. Endocarditis caused by coagulase-negative staphylococci is uncommon in young, healthy patients with normal heart valves and has not previously been described as a complication of vasectomy. Similarly, infections caused by S. warneri have not previously been described in humans.
Dan, M; Marien, G J; Goldsand, G
Purpose Compliance with post-vasectomy semen analysis could be improved with the availability of a simple, rapid and accurate home test. SpermCheck Vasectomy®, a highly sensitive lateral flow immunochromatographic diagnostic device, was designed to detect extreme oligospermia or azoospermia in men after vasectomy. We report the results of clinical and consumer testing of SpermCheck. Materials and Methods A prospective, noncomparative observational study assessed the ability of SpermCheck Vasectomy to predict post-vasectomy sperm counts obtained using a hemacytometer procedure based on standard World Health Organization methodology. Consumer studies evaluated ease of use. Results A cohort of 144 post-vasectomy semen samples was tested in the clinical trial. SpermCheck was 96% accurate in predicting whether sperm counts were greater or less than a threshold of 250,000 sperm per ml, a level associated with little or no risk of pregnancy. Sensitivity was 93% (95% CI 79% to 98%) and specificity was 97% (91% to 99%). The positive predictive value of the test was 93% (79% to 98%), and most importantly the negative predictive value was 97% (91% to 99%). The test gave a positive result 100% of the time at sperm concentrations of 385,000/ml or greater. Consumer studies with 109 lay volunteers showed that SpermCheck was easy to use. Volunteers obtained the correct or expected test result in every case and the correct response rate on a 20 question survey about the test was 97%. Conclusions SpermCheck Vasectomy, a simple and reliable immunodiagnostic test that can provide evidence of vasectomy success or failure, offers a useful alternative to improve compliance with post-vasectomy sperm monitoring. It is currently the only Food and Drug Administration approved test for this purpose.
Klotz, Kenneth L.; Coppola, Michael A.; Labrecque, Michel; Brugh, Victor M.; Ramsey, Kim; Kim, Kyung-ah; Conaway, Mark R.; Howards, Stuart S.; Flickinger, Charles J.; Herr, John C.
Three semen samples were collected at 48h intervals from 20 mature research dogs previously conditioned to manual semen collection. Vasectomy was performed in all dogs, and 15 days after surgery, another three ejaculates were similarly collected. The semen was evaluated, and centrifuged to obtain seminal plasma for measurement of pH, and concentrations of total proteins (TP), total chlorides (Cl), calcium
Fabiana Ferreira de Souza; Maria Isabel Mello Martins; Maria Denise Lopes
Summary Transgenic mice are vital tools in both basic and applied research. Unfortunately, the transgenesis process as well as many other assisted reproductive techniques involving embryo transfer rely on vasectomized males to induce pseudopregnancy in surrogate mothers. Vasectomy is a surgical procedure associated with moderate pain and must be carried out under full anaesthesia by qualified personnel. Eliminating the need for vasectomy would be beneficial from the economic and animal welfare point of view. Our aim was to develop a transgene-based alternative to the surgical vasectomy procedure. We generated several transgenic mouse lines expressing a Protamine-1 (Prm1) EGFP fusion protein under the transcriptional and translational regulatory control of Prm1. Male mice from lines showing moderate transgene expression were fully fertile whereas strong overexpression of the Prm1-EGFP fusion protein resulted in complete and dominant male sterility without affecting the ability to mate and to produce copulatory plugs. Sterility was due to impaired spermatid maturation affecting sperm viability and motility. Furthermore, sperm having high Prm1-EGFP levels failed to support preimplantation embryonic development following Intracytoplasmic Sperm Injection (ICSI). The “genetic vasectomy system” was further improved by genetically linking the dominant male sterility to ubiquitous EGFP expression in the soma as an easy phenotypic marker enabling rapid genotyping of transgenic males and females. This double transgenic approach represents a reliable and cost-effective “genetic vasectomy” procedure making the conventional surgical vasectomy methodology obsolete.
Haueter, Sabine; Kawasumi, Miyuri; Asner, Igor; Brykczynska, Urszula; Cinelli, Paolo; Moisyadi, Stefan; Burki, Kurt; Peters, Antoine H.F.M.; Pelczar, Pawel
Background In this study we aimed to find factors affecting vasectomy acceptability in Shahroud (north eastern Iran). Methods This study was carried out in three stages. The first stage was a survey of couples that had the vasectomy procedure during 2004-2007 in the Shahroud area. In the second stage of the study we compared characteristics of the cases (the couples who had the vasectomy procedure during the study period) and controls (including couples with at least one child that choose other contraceptive methods excluding a vasectomy) using ?² and T student tests. In the third stage of the study we aimed to assess the knowledge and attitudes of those who did not choose to have a vasectomy as there contraception method by filling out questionnaires in personal interviews. Results An increasing trend toward the vasectomy procedure was observed during 2005 to 2007. We found positive associations between male and female educational levels and choosing to have a vasectomy (p < 0.05). Majority of women (88.44%) thought that their husbands would prefer to have a tubectomy to a vasectomy. Conclusion The study results show a necessity for both couples to participate in educational programs about the vasectomy procedure.
This paper discusses research on men's reproductive health and sexuality in Oaxaca, Mexico, and specifically why some men there choose to be sterilized. Men who opt for vasectomies do so after considering numerous cultural, historical, physiological, commercial, and other concerns. Men and women in Oaxaca negotiate certain cultural folk beliefs about supposed male sexual desires and practices before arriving at the decision to get the operation. Vasectomy as a method of birth control is chosen despite folk beliefs that take the form of a totemic illusion which treats male sexuality as naturalized, something fixed, and as entirely distinct from female sexuality. Among its many consequences, this totemic illusion serves to conceal inequalities in the sphere of reproductive health and sexuality in relation to contraception. PMID:16108204
Gutmann, Matthew C
From April 1970 to December 1980, 14 047 men underwent vasectomy for sterilisation under local anaesthetic at this clinic. In each man sterility was confirmed by two analyses of semen showing azoospermia. Allowing for a minimum follow up of three years, the wives of six of these men subsequently became pregnant between 16 months and three years after vasectomy. Analyses of semen confirmed recanalisation of the vasa deferentia in all six men. Only five similar cases initially fulfilling the same criteria for sterility have previously been reported. Full account of the rare possibility of recanalisation should be taken both when couples are counselled preoperatively and when pregnancy occurs after the male partner has been confirmed to be sterile.
Philp, T; Guillebaud, J; Budd, D
The cause of the variable immune response in the regional testicular lymph node of inbred Albino Swiss rats after vasectomy was investigated in two experiments. In the first, the ductus deferens was transected at its junction with the epididymis so that, in every case, sperm granulomas developed in the epididymis, from which lymph is known to drain invariably to the testicular node. In spite of this, not all testicular nodes showed histological signs of an immune response at 12 weeks after vasectomy. In the second experiment the contents of epididymal lymphatics were compared in vasectomised rats and sham-operated controls at intervals of up to 18 months after operation. Lymphatics in animals with an 'active' epididymal granuloma invariably contained numbers of macrophages and lymphocytes, thought to be involved in antigen transport, while those of controls contained none. It is concluded that variations in the lymphatic drainage of vasal granulomas were not primarily responsible for the variable lymph node response to vasectomy previously reported. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9 Fig. 10
McDonald, S W; al Saffar, R; Scothorne, R J
The lymphatic drainage of the testis, epididymis and ductus deferens was determined in unoperated and in unilaterally vasectomised Albino Swiss rats. In the vasectomised animals, the lymphatic drainage of epididymal and vasal sperm granulomas was also investigated. The normal epididymis, and sperm granulomas which develop in it after vasectomy, drain to the regional testicular lymph node via the inferior epididymal trunk; vasectomy does not interfere with this route. There is a lymphatic watershed within the middle one third of the scrotal ductus deferens; lymph may drain caudally, to enter the inferior epididymal trunk and/or rostrally to the iliac node. Lymphatics draining granulomas at the vasectomy site, may, therefore, be interrupted by vasectomy. This would contribute to, but does not fully explain, the variable immune response of the regional testicular node following vasectomy.
McDonald, S W; Scothorne, R J
Fifty patients undergoing vasectomy at community-based day surgery clinics in Grampian were invited to participate in follow-up by text message. Forty-six (92%) of the patients responded, 14 reporting problems, generally of a minor nature, but severe enough to result in unscheduled time off work (n = 4) and oral antibiotic therapy (n = 5). Text messaging appears to be a useful form of communication for audit in this setting. The study findings have influenced the information provided by the authors at preoperative counselling.
Cooper, Graham; Walker, Jean; Harris, Douglas; Stewart, Rorie; Nicol, Douglas; Ogg, Mike
A vasectomy patient with sleep apnea syndrome, who requested general anesthesia and day surgery, was given sole propofol infusion with airway maintenance by noninvasive positive-pressure ventilation. Surgery was performed with additional local anesthesia. Because this patient was treated successfully, this anesthetic technique may also be applicable to other normal patients.
Hiroshi Iwama; Mari Suzuki
Abstract. A noninvasive approach to vasectomy may eliminate male fear of complications related to surgery and increase its acceptance. Noninvasive laser thermal occlusion of the canine vas deferens has recently been reported. Optical coherence tomography (OCT) and high-frequency ultrasound (HFUS) are compared for monitoring laser thermal coagulation of the vas in an acute canine model. Bilateral noninvasive laser coagulation of the vas was performed in six dogs (n=12 vasa) using a Ytterbium fiber laser wavelength of 1075 nm, incident power of 9.0 W, pulse duration of 500 ms, pulse rate of 1 Hz, and 3-mm-diameter spot. Cryogen spray cooling was used to prevent skin burns during the procedure. An OCT system with endoscopic probe and a HFUS system with 20-MHz transducer were used to image the vas immediately before and after the procedure. Vasa were then excised and processed for gross and histologic analysis for comparison with OCT and HFUS images. OCT provided high-resolution, superficial imaging of the compressed vas within the vas ring clamp, while HFUS provided deeper imaging of the vas held manually in the scrotal fold. Both OCT and high HFUS are promising imaging modalities for real-time confirmation of vas occlusion during noninvasive laser vasectomy.
Cilip, Christopher M.; Allaf, Mohamad E.; Fried, Nathaniel M.
A noninvasive approach to vasectomy may eliminate male fear of complications related to surgery and increase its acceptance. Noninvasive laser thermal occlusion of the canine vas deferens has recently been reported. Optical coherence tomography (OCT) and high-frequency ultrasound (HFUS) are compared for monitoring laser thermal coagulation of the vas in an acute canine model. Bilateral noninvasive laser coagulation of the vas was performed in six dogs (n=12 vasa) using a Ytterbium fiber laser wavelength of 1075 nm, incident power of 9.0 W, pulse duration of 500 ms, pulse rate of 1 Hz, and 3-mm-diameter spot. Cryogen spray cooling was used to prevent skin burns during the procedure. An OCT system with endoscopic probe and a HFUS system with 20-MHz transducer were used to image the vas immediately before and after the procedure. Vasa were then excised and processed for gross and histologic analysis for comparison with OCT and HFUS images. OCT provided high-resolution, superficial imaging of the compressed vas within the vas ring clamp, while HFUS provided deeper imaging of the vas held manually in the scrotal fold. Both OCT and high HFUS are promising imaging modalities for real-time confirmation of vas occlusion during noninvasive laser vasectomy. PMID:22559684
Cilip, Christopher M; Allaf, Mohamad E; Fried, Nathaniel M
The histological response of the regional testicular lymph node has been studied at intervals from 1-12 weeks after unilateral vasectomy in rats. The criteria of a humoral immune response were increase in volume of the node, of number and size of germinal centres and of thickness and cellularity of medullary cords. Histological evidence of an immune response was delayed and variable, in conformity with serological data. Variability in the lymphatic drainage of the testis and epididymis has not been finally excluded as a cause of this variation in response. Variability of response did not seem to correlate with variation in site and size of the sperm granuloma, which is thought to be the principal site of leakage of sperm antigens. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 8 Fig. 9
McDonald, S W; Scothorne, R J
The objective of this research was to use a model of unilateral and bilateral occlusion of the ductus deferens in the dog to study the use of alkaline phosphatase (AP) as an indicator of tubular patency. Seven healthy cross bred dogs weighing 10-15 kg BW with normal spermiogram and AP concentrations in semen were used. From each dog, three semen samples were obtained before (intact) and after right (unilateral) and left (bilateral) vasectomy. The AP concentrations were measured in duplicates by a colorimetric method in each of the three fractions (first, second (sperm-rich), third) of each ejaculate. In addition, a macroscopic and microscopic evaluation of each ejaculate was carried out to assure its quality. Data were analysed by least squares analysis of variance using SAS(R). In intact and unilateral vasectomized dogs, 96.6% of AP measured in semen corresponded to the second sperm-rich fraction whereas 1.53 and 1.83% corresponded to the first and third fractions respectively. Total AP concentrations (first and second and third fraction) in vasectomized dogs were lower than in intact animals (19.857 vs 2284.431 +/- 4.347 UAL; p < 0.001). AP concentrations were much lower in bilateral than in unilateral vasectomized dogs (142 vs 39.572 +/- 4.347 UL, p < 0.001). In summary, AP concentrations in semen can be used as an early indicator of unilateral or bilateral lack of patency of the epididymal and deferent ducts in the dog. PMID:12535322
Stornelli, A; Arauz, M; Baschard, H; de la Sota, R-L
Background Male circumcision (MC) has been shown to reduce the risk of HIV acquisition among heterosexual men, with WHO recommending MC as an essential component of comprehensive HIV prevention programs in high prevalence settings since 2007. While Papua New Guinea (PNG) has a current prevalence of only 1%, the high rates of sexually transmissible diseases and the extensive, but unregulated, practice of penile cutting in PNG have led the National Department of Health (NDoH) to consider introducing a MC program. Given public interest in circumcision even without active promotion by the NDoH, examining the potential health systems implications for MC without raising unrealistic expectations presents a number of methodological issues. In this study we examined health systems lessons learned from a national no-scalpel vasectomy (NSV) program, and their implications for a future MC program in PNG. Methods Fourteen in-depth interviews were conducted with frontline health workers and key government officials involved in NSV programs in PNG over a 3-week period in February and March 2011. Documentary, organizational and policy analysis of HIV and vasectomy services was conducted and triangulated with the interviews. All interviews were digitally recorded and later transcribed. Application of the WHO six building blocks of a health system was applied and further thematic analysis was conducted on the data with assistance from the analysis software MAXQDA. Results Obstacles in funding pathways, inconsistent support by government departments, difficulties with staff retention and erratic delivery of training programs have resulted in mixed success of the national NSV program. Conclusions In an already vulnerable health system significant investment in training, resources and negotiation of clinical space will be required for an effective MC program. Focused leadership and open communication between provincial and national government, NGOs and community is necessary to assist in service sustainability. Ensuring clear policy and guidance across the entire sexual and reproductive health sector will provide opportunities to strengthen key areas of the health system.
An alternate approach to vasectomy for long-term male contraception following a single intra-vas application of a traditional plant (Azadirachta indica) product having immunomodulatory properties is described. Male Wistar rats of proven fertility were given a single dose (50 microliters) of neem oil in the lumen of the vas deferens on each side; control animals received the same volume of peanut oil. Animals were put on continuous mating 4 weeks after the treatment, with females of proven fertility. While the control animals impregnated the female partners, all males treated with neem oil remained infertile throughout the 8 months of observation period. Epididymal and vas histology were normal without any inflammatory changes or obstruction. The intra-vas administration of neem oil resulted in a block of spermatogenesis without affecting testosterone production; the seminiferous tubules, although reduced in diameter, appeared normal and contained mostly early spermatogenic cells. No anti-sperm antibody could be detected in the serum. Unilateral administration of neem oil in the vas resulted in a significant reduction of testicular size and spermatogenic block only on the side of application; the draining lymph node cells of the treated side also showed enhanced proliferative response to in vitro mitogen challenge. These results indicate that the testicular effects following intra-vas application of neem oil may possibly be mediated by a local immune mechanism. PMID:8226307
Upadhyay, S N; Dhawan, S; Talwar, G P
Establishing effective cage-side pain assessment methods is essential if post-surgical pain is to be controlled effectively in laboratory animals. Changes to overall activity levels are the most common methods of assessment, but may not be the most appropriate for establishing the analgesic properties of drugs, especially in mice, due their high activity levels. Use of drugs that can affect activity (e.g. opioids) is also a problem. The relative merits of both manual and automated behaviour data collection methods was determined in two inbred mouse strains undergoing vasectomy following treatment with one of 2 buprenorphine dose rates. Body weights and the effects of surgery and buprenorphine on faecal corticosterone were also measured. Surgery caused abnormal behaviour and reduced activity levels, but high dose buprenorphine caused such large-scale increases in activity in controls that we could not establish analgesic effects in surgery groups. Only pain-specific behaviour scoring using the manual approach was effective in showing 0.05 mg/kg buprenorphine alleviated post-vasectomy pain. The C57 mice also responded better to buprenorphine than C3H mice, indicating they were either less painful, or more responsive to its analgesic effects. C3H mice were more susceptible to the confounding effects of buprenorphine irrespective of whether data were collected manually or via the automated approach. Faecal corticosterone levels, although variable, were higher in untreated surgery mice than in control groups, also indicating the presence of pain or distress. Pain-specific scoring was superior to activity monitoring for assessing the analgesic properties of buprenorphine in vasectomised mice. Buprenorphine (0.01 mg/kg), in these strains of male mice, for this procedure, provided inadequate analgesia and although 0.05 mg/kg was more effective, not completely so. The findings support the recommendation that analgesic dose rates should be adjusted in relation to the potential severity of the surgical procedure, the mouse strain, and the individual animals' response.
Wright-Williams, Sian; Flecknell, Paul A.; Roughan, Johnny V.
Responses to questionnaire interviews of 73 men who had undergone vasecto- mies are discussed, and summary tables presented. The questions cover personal characteristics, the operation itself, motivational factors, and outcome of the operation. Analysis of the outcome includes pre- and postoperative physical health; sexual behavior; psychosocial adjustment factors—including marital, job, and community relationships and concern over children; satisfaction with the
ANDREW S. FERBER; CHRISTOPHER TIETZE; SARAH LEWIT
Objectives. The correlation between infertility and morphofunctional alterations following vasal occlusion is not clearly understood. Although a correlation has been found between the expression of a high titer of antisperm antibodies and the status of infertility, the relationship between the immunoglobulin (Ig) depositions in the testis and ultrastructural alterations of the peritubular structures has not been clearly established. The objective
Kaan Aydos; Tarkan Soygür; Bora Küpeli; Ali Ünsal; Özden Tolunay; Esra Erdem; Cengiz Güven; Sadettin Küpeli
Coagulation factor (F) IX is a zymogen of the plasma serine proteases, one that plays an essential role in the regulation of normal blood coagulation. Congenital defects of FIX synthesis or function cause hemophilia B (originally called hemophilia C). Factor IX is activated by Tissue Factor (TF):FVII\\/FVIIa complex and FXIa. Subsequent to its activation, FIXa combines with FVIIIa on the
BASHIR A. LWALEED; ROBERT S. GREENFIELD; JAMES HICKS; BRIAN R. BIRCH; ALAN J. COOPER
|"Kerala's Pioneering Experiment in Massive Vasectomy Camps," the principal article in this monthly publication of the Population Council, is a detailed research report on the success of a massive vasectomy camp conducted at Cochin, the capital city of the Ernakulam District of Kerala State, India. The second article, "The Gujarat State Massive…
Population Council, New York, NY.
Vasectomy is one of the extensively used methods of contraception in family planning programs. Antisperm antibodies (ASA) develop after vasectomy which can result in auto-immune male infertility. The precise sperm antigens involved in the autoimmune response are still poorly defined, therefore we determined the circulating ASA and identified relevant sperm antigens based on localization of binding sites of ASA to
M. R. Nowroozi; A. H. Keyhani; M. Ayati
Background: Vasectomy is a common method of family planning in India and worldwide. The objective of the present study was to assess the association of vasectomy with prostate cancer in a low risk population of a developing country. A population based case control study was conducted in Mumbai, India, for this purpose. Methods: Included in this study were microscopically proved
...Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS STANDARDS OF CARE FOR CHIMPANZEES...transferred to the sanctuary sites must be permanently incapable of reproduction, for example, by vasectomy, tubal ligation, or...
...Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL PROVISIONS STANDARDS OF CARE FOR CHIMPANZEES...transferred to the sanctuary sites must be permanently incapable of reproduction, for example, by vasectomy, tubal ligation, or...
Background Vasectomy techniques have been the subject of relatively few rigorous studies. The objective of this analysis was to compare the effectiveness of two techniques for vas occlusion: intraluminal cautery versus ligation and excision with fascial interposition. More specifically, we aimed to compare early failure rates, sperm concentrations, and time to success between the two techniques. Methods We compared semen analysis data from men following vasectomy using two occlusion techniques. Data on intraluminal cautery came from a prospective observational study conducted at four sites. Data on ligation and excision with fascial interposition came from a multicenter randomized controlled trial that evaluated the efficacy of ligation and excision with versus without fascial interposition. The surgical techniques used in the fascial interposition study were standardized. The surgeons in the cautery study used their customary techniques, which varied among sites in terms of type of cautery, use of fascial interposition, excision of a short segment of the vas, and use of an open-ended technique. Men in both studies had semen analyses two weeks after vasectomy and then approximately every four weeks. The two outcome measures for the analyses presented here are (a) time to success, defined as severe oligozoospermia, or <100,000 sperm/mL in two consecutive semen analyses; and (b) early vasectomy failure, defined as >10 million sperm/mL at week 12 or later. Results Vasectomy with cautery was associated with a significantly more rapid progression to severe oligozoospermia and with significantly fewer early failures (1% versus 5%). Conclusion The use of cautery improves vasectomy outcomes. Limitations of this comparison include (a) the variety of surgical techniques in the cautery study and differences in methods of fascial interposition between the two studies, (b) the uncertain correlation between sperm concentrations after vasectomy and the risk of pregnancy, and (c) the use of historical controls and different study sites.
Sokal, David; Irsula, Belinda; Chen-Mok, Mario; Labrecque, Michel; Barone, Mark A
AVSC supports vasectomy services in Ghana. The author tells the story of a 57-year-old man who underwent vasectomy 4 years ago, and now travels around his region to speak publicly about the matter. He believes that more people should be informed about vasectomy, a family planning option which is largely unknown in his community. In his community, women are typically responsible for dealing with family planning. This man was one of the first men to undergo vasectomy at the local hospital in Kumasi, to which he has since referred 5 men. Many people in his village believe that vasectomy and castration are the same thing. AVSC trains both male and female clients to become experts in public speaking, basic contraceptive technology, and teamwork. Once trained, they talk to people both informally and during outreach visits with local doctors and nurses. They also sometimes escort friends or family members to hospitals and clinics to get more information about family planning, and also tell their stories on the radio. It is important that such family planning experiences be shared with satisfied clients' peers, for trust is important in decision making on reproductive health. PMID:12321871
Mahony, E; Kanlisi, N
To establish the prevalence of vasitis nodosa in patients who had undergone vasectomy segments of vas deferens resected from 40 patients at the time of vasectomy reversal were examined histologically and immunohistochemically. The findings were correlated with clinical history and postoperative outcome. Controls comprised segments of normal vas deferens excised at vasectomy. Twenty of the 40 vasovasostomy specimens showed vasitis nodosa; in 13 this was associated with sperm granulomas and in two with spermatocoeles. The vasitis nodosa was characterised by multiple small ductules extending from the central lumen of the vas into the muscle layers and adventitia. In 14 cases there was mucinous metaplasia of the epithelium lining the ductules. The number of nerve fibres in the submucosa and muscle layers was reduced after vasectomy. In patients with vasitis, however, hyperplasia of nerve fibres in the adventitia (16 of 20 cases) and formation of neuromas were seen. Nerve fibre hyperplasia was seen in only one, and sperm granulomas and spermatocoeles in none of the 20 specimens without vasitis nodosa. The development of vasitis nodosa was independent of the patients' age or the interval between vasectomy and reversal. The restoration of fertility did not seem to be affected by previous vasitis nodosa. Images Fig 1 Figs 2a and b Fig 3 Fig 4 Fig 5
Hirschowitz, L; Rode, J; Guillebaud, J; Bounds, W; Moss, E
Purpose: Vasovasostomy (VVS) represents the standard therapy of choice for the treatment of obstructive azoospermia following vasectomy. However, recently, intracytoplasmic sperm injection (ICSI) has been suggested by some to represent the solution for all cases of malefactor infertility regardless of its etiology based on its success rates. Therefore, we compared VVS to microsurgical epididymal sperm aspiration (MESA)/testicular extraction of sperm
Axel Heidenreich; Petra Altmann; Udo H. Engelmann
Up to 6% of men who have undergone vasectomy will ultimately elect for reversal in the form of vasovasostomy or vasoepididymostomy for various reasons. Vasovasostomy performed to regain fertility is a technique that has undergone numerous advances during the last century, including the use of microsurgical equipment and principles to construct a meticulous anastomosis. It is important during vasovasostomy to ensure good blood supply to the anastomosis as well as to build as a tension-free anastomosis. Visual inspection to ensure healthy mucosa and inner muscularis as well as atraumatic handling of tissues is helpful. With vasovasostomy, it is essential to create a watertight anastomosis to prevent secondary scar formation. The microdot technique of vasovasostomy allows for markedly discrepant lumens to be brought together more precisely. Thereby, the planning is separated from suture placement, which prevents dog-ears and avoids subsequent leaks. In the age of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI), it becomes even more important to clarify outcomes after vasectomy reversals, as patients now have a choice between surgical sperm retrieval coupled with IVF/ICSI versus vasectomy reversal. Little data on long-term outcomes for vasectomy reversals exist. Therefore, further research in this field needs to evaluate the rate of late failures and the predictors of late failures.
Herrel, Lindsey; Hsiao, Wayland
The authors study the acceptance of family planning methods according to the level of couple's literacy in 14 states in India during 1986-87, using the Lorenz curve. The Gini Concentration Ratio and Index of Dissimilarity were calculated by level of couple's literacy for vasectomy, tubectomy, IUD, and all method combined. Firstly, analysis found literates to have accepted vasectomy and IUD more than tubectomy. Secondly, among the 3 methods, a high Gini Concentration Ratio was found for vasectomy when the wife was literate. Moreover, when the wife was literate, the Gini Concentration Ratio of IUD acceptance was higher than the acceptance of IUD by the wife whose husband was literate. Thirdly, the same trend was observed when the husband was illiterate. It is therefore clear that the level of a woman's literacy is a key factor in securing the acceptance of male or female methods of family planning. Planners should therefore concentrate on literacy programs for females independently of their age. Increasing the level of female literacy may ultimately help improve the understanding of family planning methods, while these women may also motivate their husbands to undergo vasectomy which will ultimately foster the success of the family planning program. PMID:12287029
Prakasam, C P; Murthy, P K
The role of interviewing in diffusing possible harmful side effects of sterilization operations was evaluated in an acute general hospital. Two simultaneous field experiments were conducted with 50 vasectomy couples and 50 tubal-ligation couples. There were no significant differences between the interview and control groups. (Author)
Carey, Raymond G.
Higher Hysterectomy Risk for Sterilized than Nonsterilized Women: Findings from the U.S. Collaborative Review of Sterilization fn1 fn1 Supported by an interagency agreement (3YO2HD41075-10) with the National Institute of Child Health and Human Development
Objective: To compare the risk of hysterectomy among previously sterilized women and women whose husbands had undergone vasectomy, and to evaluate whether this risk differed by age at surgical procedure or by method of tubal occlusion.Methods: Our study population comprised 7718 women enrolled in a prospective, multicenter cohort study between 1978 and 1986. After stratifying by the woman’s age at
Susan D. Hillis; Polly A. Marchbanks; Lisa Ratliff Tylor; Herbert B. Peterson
Summary The activity of angiotensin converting enzyme (ACE) was assessed in human body fluids (serum, seminal plasma, prostatic secretions), in tissue extracts of the testis, epididymis, prostate and skeletal muscle, in split ejaculates and in seminal plasma obtained from patients before and after vasectomy. To ensure the specificity of the results the dependence of ACE activity on specific inhibitors was
F. KRASSNIGG; H. NIEDERHAUSER; E. FINK; J. FRICK; W.-B. SCHILL
Objective: To evaluate two different assays of human sperm DNA integrity, DNA denaturation (DD) and DNA fragmentation (DF), and to correlate these with standard semen parameters.Design: Prospective, observational study.Setting: University infertility clinic.Patient(s): Forty consecutive semen samples from 33 nonazoospermic men presenting for infertility evaluation and 7 fertile men presenting for vasectomy.Intervention(s): Assessment of sperm concentration, motility, morphology, DD and DF.Main
Armand Zini; Ryszard Bielecki; Donna Phang; Maria Teresa Zenzes
Seminal plasma is a promising biological fluid to use for noninvasive clinical diagnostics of male reproductive system disorders. To verify a list of prospective male infertility biomarkers, we developed a multiplex selected reaction monitoring assay and measured the relative abundance of 31 proteins in 30 seminal plasma samples from normal, nonobstructive azoospermia and post-vasectomy individuals. Median levels of some proteins were decreased by more than 100-fold in nonobstructive azoospermia or post-vasectomy samples, in comparison with normal samples. To follow up the most promising candidates and measure their concentrations in seminal plasma, heavy isotope-labeled internal standards were synthesized and used to reanalyze 20 proteins in the same set of samples. Concentrations of candidate proteins in normal seminal plasma were found in the range 0.1–1000 ?g/ml but were significantly decreased in nonobstructive azoospermia and post-vasectomy. These data allowed us to select, for the first time, biomarkers to discriminate between normal, nonobstructive azoospermia, and post-vasectomy (simulated obstructive azoospermia) seminal plasma samples. Some testis-specific proteins (LDHC, TEX101, and SPAG11B) performed with absolute or nearly absolute specificities and sensitivities. Cell-specific classification of protein expression indicated that Sertoli or germ cell dysfunction, but not Leydig cell dysfunction, was observed in nonobstructive azoospermia seminal plasma. The proposed panel of biomarkers, pending further validation, could lead to a clinical assay that can eliminate the need for testicular biopsy to diagnose the category of male infertility, thus providing significant benefits to patients as well as decreased costs associated with the differential diagnosis of azoospermia.
Drabovich, Andrei P.; Jarvi, Keith; Diamandis, Eleftherios P.
Development of a noninvasive vasectomy technique may eliminate male fear of complications and result in a more popular procedure. This study explores application of an optical clearing agent (OCA) to scrotal skin to reduce laser power necessary for successful noninvasive laser vasectomy and eliminate scrotal skin burns. A mixture of dimethyl sulfoxide and glycerol was noninvasively delivered into scrotal skin using a pneumatic jet device. Near-infrared laser radiation was delivered in conjunction with cryogen spray cooling to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify strength of vas closure. A 30-min application of OCA improved skin transparency by 26±3%, reducing average power necessary for successful noninvasive laser vasectomy from 9.2 W without OCA (BP=291±31 mmHg) to 7.0 W with OCA (BP=292±19 mmHg). Control studies without OCA at 7.0 W failed to coagulate the vas with burst pressures (82±28 mmHg) significantly below typical ejaculation pressures (136±29 mmHg). Application of an OCA reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by ?25%. This technique may result in use of a less expensive laser and eliminate the formation of scrotal skin burns during the procedure.
Cilip, Christopher M.; Ross, Ashley E.; Jarow, Jonathan P.; Fried, Nathaniel M.
Development of a noninvasive vasectomy technique may eliminate male fear of complications and result in a more popular procedure. This study explores application of an optical clearing agent (OCA) to scrotal skin to reduce laser power necessary for successful noninvasive laser vasectomy and eliminate scrotal skin burns. A mixture of dimethyl sulfoxide and glycerol was noninvasively delivered into scrotal skin using a pneumatic jet device. Near-infrared laser radiation was delivered in conjunction with cryogen spray cooling to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify strength of vas closure. A 30-min application of OCA improved skin transparency by 26+/-3%, reducing average power necessary for successful noninvasive laser vasectomy from 9.2 W without OCA (BP=291+/-31 mmHg) to 7.0 W with OCA (BP=292+/-19 mmHg). Control studies without OCA at 7.0 W failed to coagulate the vas with burst pressures (82+/-28 mmHg) significantly below typical ejaculation pressures (136+/-29 mmHg). Application of an OCA reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by approximately 25%. This technique may result in use of a less expensive laser and eliminate the formation of scrotal skin burns during the procedure. PMID:20799844
Cilip, Christopher M; Ross, Ashley E; Jarow, Jonathan P; Fried, Nathaniel M
OBJECTIVE: To compare the efficacy of, and complications associated with, vasectomies performed in two medical clinics. DESIGN: Retrospective cohort study. SETTING: A private medical clinic and a family planning clinic at a teaching hospital in the Quebec City region, where one doctor performs all surgery. PARTICIPANTS: The 1223 men who underwent a first vasectomy between January 1994 and February 1996. INTERVENTIONS: Isolations of the vas deferens through the scrotum was performed using the no-scalpel technique in both clinics. At the private clinic (n = 775), vasectomy was performed by ligature with tantalum clips. At the family planning clinic (n = 448), a combination of cauterisation of the abdominal end of the vas deferens, leaving the testicular end open, and fascial interposition with a clip was used. MAIN OUTCOME MEASURES: Rate of postoperative complications (painful granuloma; noninfectious inflammation of the vas deferens, epididymis, and testes; hematoma; infection; undiagnosed pain) and rate of recanalization (early and late). RESULTS: At the private clinic, 39 patients (5.0%) consulted for postoperative complications, compared with 55 patients (12.3%) at the family planning clinic (chi (2)1 = 21.0; P < 0.001). Of the patients who underwent semen analysis, 15 (2.8%) at the private clinic and 4 (1.2%) at the family planning clinic experienced early or late recanalization (chi (2)1 = 2.2; P < .14). CONCLUSION: The rate of consultation for postoperative complications was lower at the private clinic than at the family planning clinic, but the efficacy of the procedure appeared to be higher at the family planning clinic. The surgical techniques used at the two clinics might partially explain these differences.
Labrecque, M.; Bedard, L.; Laperriere, L.
This study represents the results of a coupon analysis of government contraceptive programs and menstrual regulation acceptors in Cheju province. Analysis of coupons for this study was limited to those collected during the period January-March 1978; the total number collected and analyzed for this study was 1075. Of these, 646 were for 1st IUD insertion, 128 for IUD reinsertion, 134 for vasectomy, 588 for tubal ligation, and 579 for (MR) menstrual regulation. The coupons reveal that the educational level of wives is comparatively lower than that of all eligible Cheju women. Modal age of wives is 25-34 for the IUD, 30-4 for vasectomy, and 30-9 for tubal ligation acceptors. The mean number of living children is 3.85 for tubal ligation acceptors, 3.07 for IUD acceptors, and 2.96 for vasectomy acceptors. A similar trend is revealed in the number of living sons; 2.2 for tubal ligation acceptors, 1.5 for new IUD acceptors (1st insertion), and 1.7 for both IUD acceptors (for reinsertion) and vasectomy acceptors. In Cheju-do, MR is 2nd in popularity only to tubal ligation in terms of number of coupons collected. The total yearly target of 600 cases in 1978 was 97% (570 cases) achieved during the 1st quarter. Of special concern to the study was the amount of immediate postabortal contraceptive acceptance occurring in the province. The coupons indicate that 70% of all aborters accept immediate postabortal contraception. Tubal ligation proved the most popular (254 acceptors), followed by IUD 1st insertion (119 acceptors), and IUD reinsertion (33 acceptors). Postabortal contraceptive acceptance rates vary by area. 74% of MR acceptors in Nam-gun accepted contraception, 66% of Cheju City did so, and 55% in Buk-gun became immediate contraceptive acceptors. Most post-MR contraceptive acceptors had only a primary school background. IUD acceptors had less education than did the average post-MR contraceptive acceptor while tubal ligation acceptors had more. The age of post-MR also varied by method selected. Younger women selected the IUD and older women selected sterilization. Most post-MR contraceptive acceptors had at least 1 living son. However, 12-4% of IUD acceptors had no son. All tubal ligation acceptors had at least 1 son. The study results indicate that MR procedures performed by designated doctors or clinics will result in high levels of contraceptive acceptance, especially for tubal ligation. Therefore, it is recommended that the government increase its support of MR to meet their goal of expanding contraceptive use. (Author's modified) PMID:12178459
Hong, M S; Park, S K; Hong, S Y
Percutaneous epididymal sperm aspiration (PESA) and intracytoplasmic sperm injection (ICSI) were carried out in patients with congenital bilateral absence of the vas deferens (CBAVD) and men with failed reversal of vasectomy (FRV). PESA was successful in 55 out of 62 patients with CBAVD (89%) and in 57 out of 60 men with FRV (95%). The fertilization rates after ICSI (53 and 55%), cleavage rates (70 and 76%) and pregnancy rates (36 and 32%) did not differ significantly between the two respective groups (CBAVD and FRV). PESA and ICSI are effective both in patients with CBAVD and in those with FRV. PMID:9436681
Meniru, G I; Gorgy, A; Podsiadly, B T; Craft, I L
Two men, aged 37 and 47 years old, visited the urologist because of secondary infertility. These underwent an examination whilst under general anaesthesia; the examination was converted to a vasovasostomy, as in both cases it was found that a vasectomy had previously been performed. A third man, 56 years old, wished to undergo vasovasostomy; a few months later he appeared to have pre-existent retrograde ejaculation after an earlier bladder neck incision. For various reasons, no adequate information about the psychosocial and medical history was available. These case histories stress the importance of all of the patient records being available prior to an intervention. PMID:14587137
Breeuwsma, A J; van Driel, M F; Mensink, H J
This article examines the Steinach rejuvenation operation (a vasectomy) which Norman Haire performed on W. B. Yeats in 1934: while this method is now discredited, many others are still used in similar attempts to "cure" old age and restore youthful vitality. The article deals substantially with ideas which were popular among well-read people and intellectuals in the 1920s and 1930s and discusses whether the poet's late-in-life burst of creativity was caused by a medical breakthrough, Haire's more general medical advice, the placebo effect, or by a combination of factors: questions which still have relevance to theories about age, sexuality, and mind-body relationships. PMID:12541290
The IPPF member, the Asociacion Pro-Bienestar de la Familia Colombiana (Profamilia), is discussed and its clinic, the Pilot Center in Bogota, reputed to be the largest family clinic in the world, is described. From January 1966 until the end of 1970, the Pilot Center served 59,469 new acceptors. Of the 31 Profamilia clinics in Colombia, the Pilot Center was visited by 22% of all new acceptors during 1970. Profamilia established the first vasectomy clinic in Latin America in February 1970. By the end of 1970, 92 vasectomies had been performed. Profamilia has expanded its family planning program, and part of this expansion is a result of Profamilia's extensive use of mass media in its education campaign. In 1970, there was a 24% increase in new acceptors over 1969 and a 66% increase in follow-up visits. 62,292 radio spots and 7 television programs were broadcast and announcements about family planning were shown in public cinemas in the latter half of 1970. Nearly 300,000 women attended talks, meetings, and film shows on family planning, and approximately 2 million leaflets and information sheets were distributed. To increase community involvement, Profamilia held 26 short courses for various groups including religious and community leaders. Profamilia also conducted a training course for doctors and sociologists from Colombia and other Latin American countries. PMID:12306057
Objective Several epidemiologic studies have investigated sexually transmitted infections (STIs) and later risk of genitourinary conditions with suggestive positive results. While these results may reflect causal associations, other possible explanations include confounding by factors possibly related to both STI acquisition and genitourinary condition risk, such as recognized STI risk factors/correlates, and other factors not typically considered in relation to STIs (e.g., general health-related behaviors or markers of such behaviors). Very few of these factors have been investigated in older populations in which STIs and genitourinary conditions are typically studied. Therefore, we investigated STI history correlates in one such population, the Health Professionals Follow-up Study. Methods We ascertained histories of potential correlates, and gonorrhea and syphilis by questionnaire (n=36,032), and performed serologic testing for Chlamydia trachomatis, Trichomonas vaginalis, human papillomavirus, and human herpesvirus type 8 infection in a subset (n=651). Results Positive correlations were observed for African-American race, foreign birth, southern residence, smoking, alcohol consumption, ejaculation frequency, vasectomy, and high cholesterol. Inverse correlations were observed for social integration and routine health-related examinations. Conclusions These findings provide useful information on potential confounders for epidemiologic investigations of STIs and chronic diseases, and interesting new hypotheses for STI prevention (e.g., STI counseling before vasectomy).
Sutcliffe, Siobhan; Kawachi, Ichiro; Alderete, John F.; Gaydos, Charlotte A.; Jacobson, Lisa P.; Jenkins, Frank J.; Viscidi, Raphael P.; Zenilman, Jonathan M.; Platz, Elizabeth A.
The development by a large percentage of vasectomized men of sperm autoantibodies is discussed in this monograph chapter. The production of anti-sperm antibodies is attributed to: 1) granuloma formation; 2) increased permeability of epithelial barriers in the rete testis and epididymis; and 3) transport of phagocytic cells to regional lymph nodes. Individual variation in type of antibodies and response to antibody production is documented and is thought to depend on such factors as rate of sperm production, the structure of the blood-testis barrier, surgical technique, and expression of immune response genes. Morphological changes in spermatozoa and testes occurring after vasectomy may be induced by immunological mechanisms. Tests of cell-mediated immunity to sperm antigens are described, and more accurate tests are needed. Animal studies provide evidence that chronic immune stimulation can result in formation of circulating immune complexes, resulting in deleterious systemic effects, including damage to kidneys, blood vessels, and cells of the immune system. Further studies of the autoimmune orchitis phenomenon may aid in avoidance of immunologically mediated side effects of vasectomy. PMID:92384
Anderson, D J; Alexander, N J
Success with the optical loupe magnification system encouraged this report of 21 patients undergoing vasovasostomy from 2-21 years since vasectomy using this procedure. 20 of the 21 patients were available for follow-up. All had undergone single-layer vasovasostomy using optical magnification and fine absorbable suture at the Ochsner Medical Institutions (1975-1979). Ejaculates contained sperm in 18 of the 20 patients. This yielded a patency rate of 90%. Semen analysis revealed a sperm count of greater than 20 million/ml, and average motility rate of 50% with normal movement graded on a scale of 1-4 (normal=2+) in 83% of successful anastomosis. There were 13 pregnancies reported in the postvasovasostomy period, resulting in a pregnancy rate of 68%. 1 patient is single (13 of 19=68%). 2 cases of multiple pregancies were reported. In the group with a 2-5 year vasectomy reversal interval, 8 of 8 patients had patent tubes. In the group 6-10 postvasectomy, 6 of 7 were patent. In the 10 year + group, 4 of 5 had patent tubes. PMID:7240906
Fuselier, H A; Lesser, D A
Azoospermia is a descriptive term referring to ejaculates that lack spermatozoa without implying a specific underlying cause. The traditional definition of azoospermia is ambiguous, which has ramifications on the diagnostic criteria. This issue is further compounded by the apparent overlap between the definitions of oligospermia and azoospermia. The reliable diagnosis of the absence of spermatozoa in a semen sample is an important criterion not only for diagnosing male infertility but also for ascertaining the success of a vasectomy and for determining the efficacy of hormonal contraception. There appears to be different levels of rigor in diagnosing azoospermia in different clinical situations, which highlights the conflict between scientific research and clinical practice in defining azoospermia.
We evaluated the vasectomy of 72 male Canada geese as a method to control growing populations of nuisance geese in Westchester County, New York. Thirty-three of the vasectomized males paired with a female and were located during ?1 breeding seasons; 7 treated males were not seen following surgery. The remaining 32 males were never observed paired with a female during the breeding season. Of 56 nesting attempts by the 33 pairs in ?1 breeding seasons, 84% of the nests were unsuccessful. Fidelity to nest sites during the second and third breeding seasons occurred for 17 of the 18 vasectomized males and their females that were observed for ?2 seasons. The results suggest that male sterilization may reduce productivity of nuisance Canada geese providing one carefully selects areas and flocks suitable for this type of control.
Converse, Kathryn A.; Kennelly, James J.
This article describes the history and activities of the mobile clinic field by the Lorma Medical Center in Carlatan, San Fernando, in the province of La Union. The clinic is free and offers integrated medical services to 4-5 baranguays (villages) per day, averaging 861 cases including an average of 86 family planning cases. The clinic is part of Lorma's Outreach Program which includes a daily radio program answering questions on "Better Health for You and Your Family," a seminar program for local, voluntary health assistants and an "Adopt a Family" program in which nursing students visit and care for an indigent family throughout their training. In September 1977, a mobile vasectomy clinic will begin daily rounds. The mobile clinic program has little access to remote areas because the van cannot navigate the narrow, bumpy roads. However, funding is the program's only real limitation and its possibilities for improved health and family planning services are very great. PMID:12278133
Soriano, M B
We report the case of a 42-year-old patient with contralateral inguinal seminoma metastasis. He had a history of prior bilateral open inguinal hernia repair and scrotal vasectomy. Staging CT revealed no further lymphoma or organ metastases. After discussion of adjuvant treatment options and contacting a referral centre for testicular cancer, adjuvant treatment was performed with 3 cycles of cisplatin, etoposide and ifosfamide. The development of the contralateral inguinal metastasis is most likely caused by the prior inguinal and scrotal surgery, whereas a primary atypical retrograde metastatic route can't be ruled out. Physical examination of the inguinal lymph nodes should be performed in all patients with testicular cancer and prior inguinal and scrotal surgery. PMID:22911382
Rausch, S; Yiakoumos, T; Schieber, M; Özdemir, K; Kälble, T
This article presents a review of the history and evolution of robotic instrumentation and its applications in urology. A timeline for the evolution of robotic instrumentation is presented to better facilitate an understanding of our current-day applications. Some new directions including robotic microsurgical applications (robotic assisted denervation of the spermatic cord for chronic orchialgia and robotic assisted vasectomy reversal) are presented. There is a paucity of prospective comparative effectiveness studies for a number of robotic applications. However, right or wrong, human nature has always led to our infatuation with the concept of using tools to meet our needs. This chapter is a brief tribute to where we have come from and where we may be potentially heading in the field of robotic assisted urologic surgery.
Parekattil, Sijo J.; Moran, Michael E.
Family planning (FP) and social marketing messages must utilize the rules concerning artfulness developed in the private sector for effective communication in the mass media around the world. They have to compete for the attention of television program viewers accustomed to receiving hundreds of 30-second messages. There are some rules essential to any effective communication program: 1) Command attention. In the US over 1350 different mass media messages vie for attention every single day. FP messages are sensitive, but dullness and passivity is not a requisite. 2) Clarify the message, and keep it simple and direct. Mixed messages equal less effective communication. 3) Communicate a benefit. Consumers do not only buy products, they buy expectations of benefits. 4) Consistency counts. The central message should remain consistent to allow the evaluation of its effectiveness, but execution should vary from time to time and medium to medium. 5) Cater to the heart and the head. Effective communication offers real emotional values. 6) Create trust. Words, graphics, sounds, and casting in the campaign should support 1 central key promise to a single prime prospect. 7) Call for action. Both commercial and social marketing campaigns can calculate results by quantifiable measurement of sales (of condoms) transactions (the number of IUD insertions), floor traffic (clinic visits), attitude shifts, and behavior change. The PRO-PATER Vasectomy Campaign of 1988 in Sao Paulo, Brazil successfully used the above rules for effective communication. During the 1st 2 months of the campaign, phone calls increased by over 300%, new clients by 97%, and actual vasectomies performed by 79%. PMID:12343901
Williams, J R
The relation between medicine and overpopulation is seen in the following: 1) achievements in medicine have decreased mortality leading to population explosion, 2) lack of food supply leads to deficiency diseases, and 3) starvation and overpopulation leads to the social diseases of unemployment and poverty. Population control can be achieved by medical methods of contraception. Japan's overpopulation is contrasted with that of India. In Japan the standard of living is high and food supply adequate because Japan's technological products are exported and food imported. The mostly rural areas of India promote families with many children. The available farmland is not sufficient for all family members. Growing children seek occupations in the cities leading to slum conditions and great poverty and misery as exemplified by Calcutta. In Europe there is a mostly balanced population because industrialization counteracts population growth. Too many children are a financial burden to the parents and the getting of children is prevented by contraception and/or abortion. In developing countries this balance is not yet achieved; industrialization lags behind the application of medical technology which promotes population explosion. To counteract this, medical methods of contraception must be used. In India with an annual population growth of 2.1% (this would lead to a population of 1.17 billion by the year 2008) this control would be best achieved through tubal ligation and/or vasectomy. There is little motivation for other methods in family planning because of the attitude toward poverty and hardship. To achieve a shrinking of their population, vasectomy (easier and less hazardous than tubal ligation) should be performed after the 2nd child. This, obviously, would need a national well-organized, program and a change in attitude of India's inhabitants. If not, the future might lead to rebellion by the poor and starving masses; civil war might break out and thus decimate the population. PMID:7281040
Knaus, J P
The Institute for Population and Social Research of Thailand's Mahidol University and the Thai Association for Voluntary Sterilization (TAVS) conducted a survey among "recent" Medical graduates to determine the achievement of training programs on sterilization operations among reent medical graduates, who graduated from the 7 medical schools in Thailand during 1978-81; to assess whether the skills attained from the training sessions during the undergraduate years are sufficient or whether additional training programs are required; to determine the willingness of the recent medical graduates to have more training in various techniques of sterilization operations; and to estimate the rate of vasectomy and tubal ligation performed by recent medical graduates. The questionnaire was mailed to all medical graduates listed as the population under study. The response was 1358 or 64.6%. Analysis was based on 972 completed questionnaires. The following were among the major survey findings: experiences gained during the medical undergraduate training did not seem to be sufficient for only 41% of respondents had performed tubal ligation; 52% of the respondents indicated that they did not have enough training during their undergraduate training, and 72% stated that they needed additional training; 89% of the respondents who stated that they did not have sufficient skill in performing sterilization operations expressed willingness to participate ina training session if it would be organized; and regarding the rate of vasectomy and tubal sterilization performed by intership trainees, these were on the average 3 and 25 cases per year. On the basis of the findings that recent medical graudates still have insufficient skills in performing the sterilization procedure, it is recommended that an attempt be made to improve the medical undergraduate training. Training should be improved either through training method or increase in number of cases to be performed before graduation. PMID:12266146
Relevant research efforts in male contraception involve: 1) hormonal approaches to block sperm production by inhibiting the hypothalamic-pituitary-gonadal axis, 2) disruption of sperm production by drugs that act directly on the testes, 3) interruption of sperm transport, and 4) alteration of secretions of the accessory sex glands and their subsequent effect on the spermatozoa. Both agonistic and antagonistic synthetic analogs of the hypothalamic gonadotropin releasing hormone (GnRH) factor cost too much and lack an effective mode of administration. Recent studies indicate that over 90% of Chinese and Indonesian men can develop complete azoospermia following either a testosterone or a progestin and an androgen combination treatment. Vaccines that utilize GnRH and follicle stimulating hormone as the active antigens have been introduced in clinical studies in the US and India. Drugs such as sulfasalazine, pyrimethamine, nitrofurane, and bis(di-chloracytal) diamines reduce male fertility but side effects make them unacceptable. Dinitropyrroles, halopropanedils, chlorosugars, and indazole carboxylic acids have been tried in laboratory animals. Gossypol rendered men infertile in large-scale clinical studies conducted in China but synthesis of safer analogs has not succeeded. Extracts of another plant, tripterigium wilfordii, are used in China as a popular herbal medicine. Vasectomy has improved with no-scalpel vasectomy and by the novel technique of blocking the vas with cured in situ polymeric plugs. Preliminary data suggest that men prefer condoms made from polyurethane as opposed to latex rubber increasingly used to protect against AIDs and sexually transmitted diseases. The antifungal agents, imidazoles, have spermicidal activity and synthetic variants may reduce undesirable side effects. Research on male-oriented methods has intensified during the last 10-15 years, but a new product is not likely to appear in the next 5-10 years. PMID:12286189
Bialy, G; Alexander, N J
Since the early 1980s, Johns Hopkins University's Population communication Services has conducted evaluations of mass media campaigns in developing countries which communications personnel have designed to change health and sex behavior. The mass media campaigns involved relaying health and family planning information via radio, television, and pamphlets. The evaluations showed that these campaigns were an effective technique to promote behavior change, e.g. they have boosted demand for contraceptives, condom sales, clinic visits, and inquiries to hotlines. A 6-part television drama incorporating health and family planning into its storyline stimulated behavior change in Pakistan in 1991. 36% of people surveyed after the drama series said they would limit the number of children they would have. 44% planned to improve communication with their spouse. An amusing television promotion in Brazil which ran for 6 months in the late 1980s prompted 58% of new clinic patients in 1 town to seek a vasectomy. 1 clinic experienced an 81% increase in vasectomies. A 6-month campaign to promote condom use in Colombia in 1988-89 resulted in a 75% rise in condom sales. In the mid 1980, a 6-9 month mass media popular music campaign (2 songs and videos disseminated via television, radio, and print materials) in Mexico and Latin America strove to encourage youth to be responsible for their sexual behavior. During the campaign, an adult counseling center received an 800% increase in letters (50-450 letters/month). 4 radio and 5 television spots promoting health and family planning in Kwara State, Nigeria in 1984-87 increased family planning acceptors 500% from 258 to 1526 in the 7 existing clinics. Other successful campaigns took place in the Philippines, Zimbabwe, Indonesia, Turkey, Bolivia and Honduras. PMID:12285445
After the revolution, the Islamic Republic of Iran instituted pronatalist policies which included lowering the minimum marriage age for girls to 9 years, abolishing some laws securing women's rights, and limiting availability of family planning (FP) services. By 1983, Iran's population growth rate was 3.9% which was among the highest worldwide. Before the revolution, Iran had 37 million people. About 2 million more people were added each year, resulting in a population size of 60 million by 1992. By the mid-1980s, economic development stood idle, there were not enough houses, children attended schools on 3 shifts, and malnutrition was spreading. In 1989, the government formed a population council and reestablished FP services. It also increased the minimum age of marriage for girls to 13 years, slightly improved women status, and eliminated fertility incentives for couples with at least 4 children. It also significantly increased funding for FP (from 560 million to 13 billion rials between 1990 and 1992). Government spending for FP will likely increase 2% annually until 2011. The government initiated a promotion of FP mass media campaign, emphasizing a 2-child family. Some posters showed a family with 2 girls. The mass media campaign promoted specific contraceptive methods (even tubal occlusion and vasectomy), a practice other Middle Eastern countries not do. 80% of sterilization acceptors claimed to learn about sterilization from the radio or newspapers. The Ministry of Health has invited the Association for Voluntary Surgical Contraception (AVSC) to help with its campaign to update sterilization techniques, including the non scalpel vasectomy technique. AVSC hopes to become even more involved in helping Iran update its national FP program. PMID:12318289
Data on the provision of seven types of reproductive health care were collected from private physicians in four specialties: general/family practitioners (GP/FPs), general surgeons, obstetrician-gynecologists and urologists. All ob-gyns, and eight in 10 GP/FPs, provide the pill, IUD or diaphragm. Over nine in 10 ob-gyns provide infertility and obstetric care and prenatal genetic screening; but only one-third or fewer of GP/FPs do so. Ob-gyns and urologists are far more likely to perform sterilizations than are GP/FPs and surgeons (nine in 10, compared with one-fifth to one-half). Although ob-gyns are the most likely to perform abortions, only four in 10 do so. Among ob-gyns who do not perform tubal sterilizations or abortions, and among urologists who do not perform vasectomies, the primary reason is moral or religious objections (reported by 59-71 percent). For GP/FPs and surgeons who do not perform the three procedures, the leading reason is that they do not perform surgery or that type of surgery; however, 34 percent of nonproviders in these specialties report moral or religious opposition to abortion. Eight in 10 ob-gyns will provide contraceptives to minors without parental consent, but only six in 10 GP/FPs will do so. One-half of doctors who perform female sterilizations, and eight in 10 of those who do vasectomies, require spousal consent. Among those who perform abortions, half require parental consent for minors. Access to private reproductive health care is quite limited for the poor, because many physicians will not accept Medicaid reimbursements or reduce their fees for low-income patients.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3842655
Orr, M T; Forrest, J D
The stated aim of this discussion is to examine the extent of male use of family planning and the nature of men's role in family planning in developing countries. Case studies are presented which are successful examples of strategies for involving men in family planning. Policies that aim to increase male involvement must be sensitive to cultural values, apply to a decentralized government approach toward information and supplies, include adequate political will, and consider the costs and benefits of changing values. A male family planning policy would not always be compatible with all fertility values in developing countries or traditional values of the older population. A policy should stress the value of male individuals contributing as much as possible for their own and others' welfare. Community participation is considered important in order to create a feeling of mutual support. A sizeable investment will be required for mass distribution of contraceptive information. Schools are viewed as an ideal place for educating youth about the problems of high fertility and about use of family planning methods, such as the condom. Religious organizations should be used to educate people about responsible parenthood and to minimize barriers to use of modern contraception. Comic books on how to use condoms are suggested as a good source. Local authorities who are trusted are useful in influencing acceptance among local populations. Local personnel may be trained as information disseminators. Adequate contraceptive information needs to be supplied to a wide audience. Lack of supply and inadequate information are given as two key reasons for insufficient use of male contraception. Condoms should be priced to be affordable to the average person and free to those with no income. Program strategies that proved successful are cited for Thailand's Mechai Viravaidya program and Bali's grass-roots program. The vasectomy program in Bangladesh is also noted for its success. Low levels of condom use are attributed to factors such as price, education, availability, accessibility, culture, religion, and economic conditions. Male sterilization levels can be enhanced with wider availability of clinics and provision of correct information for challenging beliefs that vasectomy is a form of castration. PMID:12290097
Pillai, V K; Kelley, A C
Objective Determine whether testicular sperm extractions and pregnancy outcomes are influenced by male and female infertility diagnoses, location of surgical center and time to cryopreservation. Patients One hundred and thirty men undergoing testicular sperm extraction and 76 couples undergoing 123 in vitro fertilization cycles with testicular sperm. Outcome Measures Successful sperm recovery defined as 1–2 sperm/0.5 mL by diagnosis including obstructive azoospermia (n?=?60), non-obstructive azoospermia (n?=?39), cancer (n?=?14), paralysis (n?=?7) and other (n?=?10). Obstructive azoospermia was analyzed as congenital absence of the vas deferens (n?=?22), vasectomy or failed vasectomy reversal (n?=?37) and “other”(n?=?1). Sperm recovery was also evaluated by surgical site including infertility clinic (n?=?54), hospital operating room (n?=?67) and physician’s office (n?=?11). Treatment cycles were evaluated for number of oocytes, fertilization, embryo quality, implantation rate and clinical/ongoing pregnancies as related to male diagnosis, female diagnosis, and use of fresh or cryopreserved testicular sperm. Results Testicular sperm recovery from azoospermic males with all diagnoses was high (70 to 100%) except non-obstructive azoospermia (31%) and was not influenced by distance from surgical center to laboratory. Following in vitro fertilization, rate of fertilization was significantly lower with non-obstructive azoospermia (43%, p?=?<0.0001) compared to other male diagnoses (66%, p?=?<0.0001, 59% p?=?0.015). No differences were noted in clinical pregnancy rate by male diagnosis; however, the delivery rate per cycle was significantly higher with obstructive azoospermia (38% p?=?0.0371) compared to diagnoses of cancer, paralysis or other (16.7%). Women diagnosed with diminished ovarian reserve had a reduced clinical pregnancy rate (7.4% p?=?0.007) compared to those with other diagnoses (44%). Conclusion Testicular sperm extraction is a safe and effective option regardless of the etiology of the azoospermia. The type of surgical center and/or its distance from the laboratory was not related to success. Men with non-obstructive azoospermia have a lower chance of successful sperm retrieval and fertilization.
Omurtag, Kenan; Cooper, Amber; Bullock, Arnold; Naughton, Cathy; Ratts, Valerie; Odem, Randall
The proteins in human seminal plasma were mapped by high-resolution two-dimensional electrophoresis (ISO-DALT and BASO-DALT systems). When analyzed under dissociating conditions, samples from normal fertile males revealed a pattern of over 200 proteins, ranging in mass from 10,000 to 100,000 daltons. Comparison of the mapped proteins from these males and those who had undergone vasectomy allowed us to identify one series of glycoproteins as missing from the semen from vasectomized individuals. Glycoproteins isolated by affinity chromatography with use of concanavalin A were also mapped. Some of the protein spots were identified either by coelectrophoresis with purified proteins or by the electrophoretic transfer of proteins to nitrocellulose sheets and subsequent detection by immunological procedures. The proteins identified include a number of serum proteins as well as prostatic acid phosphatase and creatine kinase. Proteolytic events shown to occur during the liquefaction of semen that occurs early after collection indicate the importance of carefully controlled collection and preparation methods for clinical evaluation of seminal plasma. Ethylenediaminetetraacetic acid and phenylmethylsulfonyl fluoride inhibit this proteolysis.
Edwards, J.J.; Tollaksen, S.L.; Anderson, N.G.
Objective To assess racial differences in attitudes and knowledge about sterilization. Design Cross-sectional survey Setting Questionnaires were mailed to participants’ home addresses Patients 193 women aged 18–45 who had undergone tubal sterilization. Intervention(s) None Main Outcome Measure Attitudes and knowledge about tubal sterilization and awareness of contraceptive alternatives Results We received 193 completed surveys (64% response rate). AA woman were more likely to have a family member who had undergone tubal sterilization, to report that their mothers influenced their sterilization decisions, and to report that prior unintended pregnancy and desire to avoid insertion of a foreign object were very important factors in their decision to choose sterilization over other methods. Compared to white women, AA women more often thought that sterilization reversal could easily restore fertility (62 % vs 36%); that a woman’s sterilization would reverse itself after 5 years (60% vs 23%); and that a man cannot ejaculate after vasectomy (38% vs 13%). Fewer AA women had ever heard of intrauterine contraception (90% vs 98%). Racial differences in knowledge remained statistically significant after adjusting for socioeconomic confounders. Conclusions Misinformation about sterilization and limited awareness of contraceptive alternatives among AA women may contribute to racial disparities in tubal sterilization rates.
Borrero, Sonya; Abebe, Kaleab; Dehlendorf, Christine; Schwarz, Eleanor Bimla; Creinin, Mitchell D.; Nikolajski, Cara; Ibrahim, Said
The two most important demographic characteristics of prostate cancer in Los Angeles are the high rates among blacks, which are two times those among whites and four times those among Asians, and the rapid increase in rates with age after age 40. Despite the high rates among blacks, a birth cohort analysis indicates that mortality rates among black men born after 1900 have decreased. In this report, epidemiologic and experimental evidence supporting each of three etiologic hypotheses--industrial exposure to cadmium, sexual transmission by an infectious agent, and endocrine factors--are reviewed. Evidence from descriptive data in Los Angeles suggests that only a small portion of cases might be attributable to industrial exposures. In a cohort study of Catholic priests, we found no deficit of prostate cancer mortality, strong evidence against sexual transmission of the disease. Experimental evidence and a limited amount of human data support an endocrine hypothesis. Preliminary results of a case-control study of prostate cancer are presented, but these results are unable to distinguish among these hypotheses further. This study finds a substantial protective effect of vasectomy, an event that is accompanied by reduced prostatic function and size, but this result is thus far statistically insignificant.
Ross, R.K.; Paganini-Hill, A.; Henderson, B.E.
OBJECTIVES. The purpose of the study was to determine the clinical and economic impact of alternative contraceptive methods. METHODS. Direct medical costs (method use, side effects, and unintended pregnancies) associated with 15 contraceptive methods were modeled from the perspectives of a private payer and a publicly funded program. Cost data were drawn from a national claims database and MediCal. The main outcome measures included 1-year and 5-year costs and number of pregnancies avoided compared with use of no contraceptive method. RESULTS. All 15 contraceptives were more effective and less costly than no method. Over 5 years, the copper-T IUD, vasectomy, the contraceptive implant, and the injectable contraceptive were the most cost-effective, saving $14,122, $13,899, $13,813, and $13,373, respectively, and preventing approximately the same number of pregnancies (4.2) per person. Because of their high failure rates, barrier methods, spermicides, withdrawal, and periodic abstinence were costly but still saved from $8933 to $12,239 over 5 years. Oral contraceptives fell between these groups, costing $1784 over 5 years, saving $12,879, and preventing 4.1 pregnancies. CONCLUSIONS. Contraceptives save health care resources by preventing unintended pregnancies. Up-front acquisition costs are inaccurate predictors of the total economic costs of competing contraceptive methods. Images FIGURE 1 FIGURE 2
Trussell, J; Leveque, J A; Koenig, J D; London, R; Borden, S; Henneberry, J; LaGuardia, K D; Stewart, F; Wilson, T G; Wysocki, S
Control of fertility constitutes a global health issue, as overpopulation and unintended pregnancy have both major personal and societal impact. Although the contraceptive revolution in the 1960s following the development of hormonal-based oral contraceptives for women has had a major impact on societal dynamics in several cultures, little product innovation has occurred since then. One solution to this global health issue lies in the development of new and innovative contraceptives for both women and men, the goal of which is to provide a range of options for people at all stages and walks of life. Currently, three options for male-based contraception exist (i.e. withdrawal, condoms and vasectomy), and these are acknowledged as woefully inadequate. Introduction of new forms of male contraception based on both hormonal and non-hormonal paradigms are wanted and needed; this need is now becoming recognized by both the public and private sectors. New and innovative products will come from our knowledge of the unique physiology and genetics of reproduction, as well as by exploiting existing and future genomics, proteomics and protein network platforms. PMID:14644021
Lyttle, C Richard; Kopf, Gregory S
Human-population increase and land development portend increasing conflict with large predators. Concurrently, changes and diversification of human attitudes are bringing increased disagreement about wildlife management. Animal-rights advocacy resulting from urbanization of human populations conflicts with traditional wildlife management. These forces focus more on wolves than on other wildlife because of strong public and media interest in wolves. Thus wolf management in the future will come under even greater public scrutiny, involve more public input, and may have greater restrictions imposed on it. This will lead to increased complexity in wolf management including more zoning, more experimentation with lethal and non-lethal capture techniques and alternate methods of alleviating damage to pets, livestock, and large ungulate herds, and greater public and private subsidy of wolf damage. One form of non-lethal control of wolf populations that may hold some promise is direct sterilization of males to reduce the biotic potential of the wolf population. Experimental vasectomy of five wild male wolves from four packs in Minnesota indicates that sterile males will continue to hold mates and territories, which would be necessary if sterilization is to be a viable technique for assisting with population control. If sterile males held territories but failed to produce pups, such territories might contain only about a third the number of wolves as fertile pack territories. Because wolves are long-lived in unexploited populations and their territories are large, direct sterilization of relatively few animals each year might significantly reduce populations.
Mech. L.D.; Fritts, S.H.; Nelson, M.E.
Patients with complex medical problems should be counselled about the need for highly effective contraception. As failure resulting in pregnancy, could cause significant morbidity and mortality. The LNG-IUS has gained great popularity and generally has a low side effect profile; however, perforation of the uterus and migration of the device is a potentially serious complication known to be associated with its use. The current accepted management is removal of the device from the abdominal cavity in order to prevent further morbidity. However this is not always a simple matter in patients who have complex medical problems and who are deemed unfit for surgery. Each time the patient comes for renewal of the contraceptive method, clinicians need to reassess the risks and benefits. This is particularly relevant in patients who have complex medical problems where special attention needs to be given, not only to immediate risks but also to long-term ones. Careful individualised counselling and consideration are paramount and perhaps it would have been prudent to discuss vasectomy with this patient and her husband (as the first line of contraception), as this may have avoided the ensuing complications arising from the chosen method. PMID:18568357
Soleymani Majd, Hooman; El Hamamy, Essam; Chandrasekar, Ramya; Ismail, Lamiese
The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation (for chronic orchialgia) and robotic assisted microsurgical testicular sperm extraction (microTESE).
Parekattil, Sijo J; Gudeloglu, Ahmet
BACKGROUND: Family planning is a method of thinking and a life style which is chosen voluntarily and according to the attitudes and responsible determination of the couples in order to promote the hygiene and convenience of the family. This study aimed to identify and compare the attitudes of the users of common contraceptive methods with regard to each method separately. METHODS: The descriptive study was conducted in 2010. The study samples included 378 women using common contraceptive methods as LD pills, IUD (intrauterine devices), condom, withdrawal, tubectomy (females sterilization) and vasectomy as well as withdrawal method. The samples were selected through systemic random sampling from 9 health care centers. The data collection tool was a researcher-made. In order to determine the validity and reliability of the questionnaires, the content validity and Cronbach's alpha correlation coefficient methods were used. In order to analyze the data, the descriptive and inferential statistical methods (ANOVA) were used. RESULTS: Mean score of attitude regarding different contraceptive methods in the group who were users of the same method was above the users of all the methods; however, total attitude score toward the contraceptive methods was approximately similar to each other in all the groups and there was no significant difference among the different groups. CONCLUSIONS: The findings of this study showed that attitude is an important factor in choosing the contraceptive methods; therefore, this issue should to be taken into account by the family planning planners and consultants.
Ehsanpour, Soheila; Mohammadifard, Maedeh; Shahidi, Shahla; Nekouyi, Nafise Sadat
The new development programs in India's poorest state, Uttah Pradesh, are summarized. Family planning is among the most important components of this effort. The Chief Minister Shri Narayan Datt Tiwari, has set a target of 150,000 acceptors, 10 times the total achievement during the previous year. During March 1976 there were 50,000 sterilizations, almost 40% of the total achievement of the entire previous year. The state government is giving a 15% land rebate to small farmers who get themselves sterilized and group incentives are being offered. 1200 centers, including Primary Health Centers, are being set up where vasectomy operations will be made available. More facilities for medical termination of pregnancy are also being set up. The target is to reduce the birthrate to 30/1000 by 1980. The present rate in Uttar Pradesh is 41.8, compared with 35 for India as a whold. Reports from various sections of the state confirm increased tempo of the family planning effort. PMID:12334859
Mehta, P S
This study was conducted to examine factors which influence contraception in order to ameliorate services. For 12 consecutive months, 706 consenting women on fertility control presenting at the Dschang District Hospital, Cameroon were interviewed and cervical/blood samples collected for analysis. Study respondents were aged 15-50 years (mean 33.61 +/- 6.29 years). Levonorgestrel implants (46.7%) and medroxyprogesterone injections (27.6%) were cost effective over the intrauterine copper device (9.5%), Norgestrel (7.8%), Norethisterone enanthate (6.7%), male condoms (6.4%), Progestin only pills (1.4%) and spermicides (1.1%). Lack of expertise precluded tubal ligation or implants and vasectomy. Stigmatization, male rejection, giving or taking methods without adequate laboratory services or regular health checks and failure to recognize or report adverse reproductive health changes impacted on contraception. Genital infections were identified in 33.7% respondents, vaginal candidiasis 20%, bacterial vaginosis 19%, HIV/AIDS 90%, chlamydia 6% and < 2% other traditional venereal diseases. Sensitization, education, improved diagnostics and attitude change were adopted. PMID:24069743
Fusi-Ngwa, Catherine K; Payne, Vincent K; Asakizi, Augustine N; Katte, Bridget F
Background Ethiopia is the second most populous country in Sub-Saharan Africa. Total Fertility Rate of Ethiopia is 5.4 children per women, population growth rate is estimated to be 2.7% per year and contraceptive prevalence rate is only 15% while the unmet need for family planning is 34%. Overall awareness of Family Planning methods is high, at 87%. The prevalence of long acting and permanent contraceptive methods (LAPMs) in Tigray region was very low which accounts for 0.1% for implants and no users for intra-uterine contraceptive device (IUCD) and female sterilization. Moreover almost all modern contraceptive use in Ethiopia is dependent on short acting contraceptive methods. The objective of this study was to assess factors associated with utilization of long acting and permanent contraceptive methods (LAPM) among married women of reproductive age group in Mekelle town. Methods A cross sectional community based survey was conducted from March 9-20, 2011. Multistage sample technique was used to select the participants for the quantitative methods whereas purposive sampling was used for the qualitative part of the study. Binary descriptive statistics and multiple variable regressions were done. Results The study consisted of quantitative and qualitative data. From the quantitative part of the study the response rate of the study was 95.6%. Of the qualitative part two FGDs were conducted for each married women and married men. 64% of the married women heard about LAPMs. More than half (53.6%) of the married women had negative attitude towards practicing of LAPMs. The overall prevalence of LAPMs use was 12.3% however; there were no users for female or male sterilization. The main reason cited by the majority of the married women for not using LAPMs was using another method of contraception 360 (93.3%). Mothers who had high knowledge were 8 times more likely to use LAPMs as compared with those who had low knowledge (AOR = 7.9, 95% CI of (3.1, 18.3). Mothers who had two or more pregnancies were 3 times more likely to use LAPM as compared with those who had one pregnancy (AOR = 2.7, 95% CI of (1.4, 5.1). Conclusion A significant amount of the participants had low knowledge on permanent contraceptive particularly vasectomy. More than half (53.6%) of married women had negative attitude towards practicing of LAMPs. Few of married women use female sterilization and none use of female sterilization and or vasectomy. Positive knowledge of LAMPs, women who had two and above pregnancies and women who do not want to have additional child were significantly associated. Information education communication should focus on alleviating factors hinder from practicing of LAPMs.
Rumors and misinformation about the use of contraceptives can arise from general fears about contraception, fears about specific methods, and fears based on a poor understanding of human physiology. In Uganda, general fears about contraception include the notion that usage encourages promiscuity in women, that contraception causes sickness, and that the use of contraception is not socially acceptable. Specific fears about oral contraceptives include the notions that they burn all the women's eggs, that they cause changes in weight, that they cause high blood pressure, and that they are not effective. Specific fears about the IUD are that it can move within the body and that a woman can conceive with it in place (which is true). The condom is thought to be able to disappear in the uterus or to slip off inside a woman's body and require surgical removal. Vasectomy is believed to make men impotent or mentally disturbed. Tubal ligation is thought to stop menstruation or to "overturn" the tubes. Medical personnel can be the source of some of these rumors when they lack appropriate training. Uninformed users can also start rumors. In order to combat these misconceptions and increase the practice of family planning (FP) in Uganda, the FP delivery system must be standardized, FP personnel must be adequately trained, FP providers must counsel clients, satisfied users should disseminate FP information and motivation in their communities, and IEC (information, education, and communication) programs should be increased. In addition to misconceptions, nutritional and sexual taboos affect maternal and child health in Uganda. Some prohibit women from eating high protein foods; others prohibit pregnant women from eating salt. Other practices include 1) deciding whether an infant is really a member of the clan by the behavior of its dried umbilical cord when thrown in water and 2) allowing men instead of women to decide how many children a woman should have. PMID:12318958
I applaud Marge Berer's initial proposal on feminist population police, demonstrating that feminists are capable of construction as well as criticism. Such creative efforts, while partial, are what keep the conversation going and us in it. Several points deserve to be highlighted as they point toward much needed changes in public policy. One is the need to shift the overwhelming burden of reproduction from women alone to society in general and men in particular. This is not to give an inch on women;s moral agency and primary decision making. To the contrary, it is to insist that male birth control be an integral part of all population policies in action as well as in regulations. Rates of tubal ligations and vasectomies in most countries show that women assume more than a fair share, men doing comparative little. Another important element is the role of religion as a shaper of social policy, the Catholic church worldwide being the prime example of how sex education, birth control, and abortion are regulated as much be theology as by law. Feminist s ignore this reality in our peril, though dealing head on with it, as some religious professions have found out, is also dangerous. The fact that the majority of women of childbearing age in the US ignore the church's pronouncements and use contraception shows that the ideological strangle hold is slipping. We can loosen it further. A related, though perhaps less politically correct, concern in such a feminist proposal is the place of sexual pleasure for its own sake. While public policy is not typically concerned with such matters, education is needed for women to feel entitled to separate sex from procreation, to enjoy the full range of sexual activities for which reproduction is but 1 possible outcome. This, after all, is a major feminist achievement that deserves to made available without delay] PMID:12178839
Hunt, M E
The International Planned Parenthood Federation's Vision 2000 Strategic Plan has emphasized advocacy and the training of family planning associations (FPAs) in the Western Hemisphere region. During the summer of 1995 training programs in advocacy leadership management were sponsored for six FPAs in the Bahamas, Suriname, Belize, Colombia, Honduras, and Brazil. At the Western Hemisphere Regional Council Meeting in September 1995 awards were presented to FPAs for media outstanding projects. These FPAs used outreach to the community to promote the goals of Vision 2000. The Bahamas FPA won the Rosa Cisneros Award for articles published in a magazine that is distributed in primary and secondary schools and deals with the activities, achievements, and opinions of students. Issues include: love, relationships, responsibility, and teen pregnancy. A weekly television talk show also addresses the issues facing youth including education, music, community work, sexuality, pregnancy, and the relationship between teenagers and adults. The Family Planning Association of Honduras was also nominated for the award for a radio show on the health of mothers and children, the problems of adolescents, and FP. The newspaper Tiempo received the award for feature articles on social issues and FP. In 1994 the Association distributed thousands of booklets on contraceptives as well as fliers on vasectomy, female sterilization, oral contraceptives, IUDs, condoms, responsible parenthood, high-risk pregnancy, vaginal cytology, and cervical cancer. Similar posters were placed in hospitals and health centers, in 1997 FP posts, and 400 commercial outlets. The Family Planning Association of Suriname also carried out an impressive advocacy program during the period of 1968-93 with the goals of establishing a balance between population growth and the available resources to achieve well-being with regard to education, health care, nutrition, and housing. PMID:12291093
Andrews, D J
This brief article focuses on the history of family planning in Zimbabwe, available services, community-based distribution, contraceptive use, and program problems. Family planning services were first available in Zimbabwe in 1953. The Rhodesian Family Planning Association (RFPA) was established formally in 1965. RFPA distributed contraceptives in 1966 and trained for the first time "field educators" in 1967. The first community-based distributors were trained in 1972. The Ministry of Health integrated the RFPA into its department in 1981. In 1985, the family planning association became a parastatal and was renamed the Zimbabwe National Family Planning Council (ZNFPC). Services today are provided through 37 family planning clinics. The distribution of contraceptives includes IUDs, condoms, pills, and injectables. Harare and Bulawayo centers receive referrals and perform tubal ligation, vasectomy, and infertility counseling. 700 community-based distributors (CBDs) received a 6-week training course in order to educate about oral contraceptives, encourage their use, and screen clients for high blood pressure and side effects for oral contraceptives. CBDs use bicycles to make home visits and also have access to motorcycles. Each CBD averages 135 clients/month. Most visits are revisits. CBDs provided 25.3% of family planning in 1988. Local clinics provided 19.1% of family planning. Ministry of Health facilities provided 14.8% of services. ZNFPC clinics provided 13.7% of services. Private doctors or pharmacies provided 2.3% of services. 38% of women currently in a union used family planning in 1984, and 43% used it in 1988. 36% in 1988 used modern methods. The pill was the most common method, followed by withdrawal. Logistics of supplies and equipment remain problematic. PMID:12290319
Throughout the 3rd World, family planners have turned to television in order to spread their message. Combining education and entertainment in the form of advertisements and soap operas, television offers a way to provide clear and memorable information about an otherwise sensitive issue. In 1977, Mexico's Miguel Sabido developed the idea of using television as a means of social instruction. His initial soap opera dealt with adult literacy, and the success of that program led him to develop a show focusing on family planning called "Come Along with Me." Following the airing of this soap opera, attendance to family planning clinics increased by 32%. Since then, Mexico has produced a series of soap operas dealing with sex education, women's status, and the treatment of children. Soon, Mexican viewers will see a soap opera addressing the issue of AIDS. Family planners in other countries have also begun employing television. Conventional communication methods require trained counselors travelling villages, and most often, those most in need of family planning are the most difficult to reach. But over the last 10 years, the number of televisions in the Third World has doubled, and there is now approximately 1 television for every 12 people in the developing nations. In Turkey, advertisements have been used to promote modern methods of contraception. In Brazil, vasectomy has been one of the topics of ad campaigns. Mexico, the Philippines, and Nigeria have also experimented with the use of music videos. Nigeria has already had great success in integrating family planning themes to an already existing variety show. Family planning visits have increased by 47%. International agencies have recognized the value of television and have provided financial support. PMID:12343296
This article describes how the Population Communication Services (PCS) has seized on the "enter-educate" approach, the blending of popular entertainment with social messages, to change reproductive health behavior. The enter-educate approach spreads its message through songs, soap operas, variety shows, and other types of popular entertainment mediums. Because they entertain, enter-educate projects can capture the attention of an audience -- such as young people -- who would otherwise scorn social messages. And the use of population mediums makes it possible to reach a variety of audiences. Funded by USAID, PCS began its first enter-educate project in response to the increasing number of teenage pregnancies in Latin America. PCS developed 2 songs and videos, which featured popular teenage singers to serve as role models, to urge abstinence. The songs became instant hits. Since then, PCS has mounted more then 80 major projects in some 40 countries. Highlights of programs range from a successful multi-media family planning campaign in Turkey to humorous television ads in Brazil promoting vasectomy. Recently, PCS initiated projects to teach AIDS awareness. At the core of the enter-educate approach is the social learning theory which holds that much behavior is learned through the observation of role-models. Health professionals work alongside entertainers to produce works that have audience appeal and factual social messages. The enter-educate approach works because it is popular, pervasive, personal, persuasive, and profitable. PCS has found that enter-educate programs pay for themselves through cost sharing and cost recovery. PMID:12284960
Piotrow, P T; Coleman, P L
Male contraceptive drugs meeting the criteria of efficacy, easy applicability and reversibility -- and also having limited side effects -- are discussed. These drugs affect the hypothalamus, the hypophysis, the ductus deferens, and the testes. Gestagens inhibit the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Gonadotropic hormones inhibit spermatogenesis by producing intratesticular concentration of testosterone. Recently, a combination of gestagen and androgen has been used to avoid decreased libido. Oral medroxyprogesterone acetate and percutaneous testosterone produce azoospermia, but with serious side effects, i.e., hirsutism and acne; however, they can be reduced by iv administration. Cyproterone acetate inhibits androgen secretion, and a daily dosage of 5-10 mg slightly reduces the sperm count; however, higher doses can lead to thromboembolitic effects. Combining cyproterone with an androgen prevents negative effects on the libido. Buserelin administered iv or as a nasal spray stimulates the secretion of LH and FSH from the hypophysis 20-40 times more effectively than does natural LH release of the hormone (LH-RH). Gossypol exerts its inhibitory effect on the epithelium of testes, but can cause hypokalemia. It has been used successfully in a Chinese experiment involving 9000 men who received daily oral doses of 20 mg for 60-70 days. Cytostatic agents also produce azoospermia, but are not recommended. Implantation of a copper wire into the ductus deferens has been tried in animal experiments with mixed results. Vasectomy has been performed on 50 million men since the 1960's (48,000 in 1981 in Denmark). It has to be regarded as a partially irreversible operation. The oral administration of the adrenergic blocking agent, phenoxybenzamine, at the rate of 20 mg per day has produced azoospermia; however, more research is needed to understand its side effects. Finally, chlorohydrin is not usable because of its neurotoxic and nephrotoxic effects. PMID:3775919
This article is a proflie of Khun Mechai, a leader in the Thai family planning field who was instrumental in creating the community-based contraceptive distribution program which began in 1973 with the 1st in a series of grants from the International Planned Parenthood Federation (IPPF). The community-based distribution program is active in some 16,000 villages and neighborhoods throughout Thailand. The Community-Based Family Planning Service (CBFPS) was established in 1974 with Khun Mechai as secretary general to coordinate the efforts of the nationwide network. The CBFPS has been linked with a massive, humorous, and creative campaign of "desensitization": Khun Mechai passes out condoms at official dinners, and honors the king's birthday with an annual free vasectomy marathon. As a result of his efforts, family planning is no longer a taboo topic and no longer the exclusive province of government bureaucrats and medical professionals. Khun Mechai's basic concern is in improving access to family planning services by overcoming physical and sociocultural distance and by providing an acceptable method of service delivery. All family planning activities of the Population and Community Development Association, the CBFPS parent organization, are voluntary. Links have been created between family planning and personal and community betterment to help motivate acceptance. Khun Mechai became acquainted with the country' development needs as a young economist with the National Economic and Social Development Board. His family planning activities grew out of his conviction that rapid, unplanned population growth is Thailand's and the world's single most serious problem. An incremental approcah with insistence on individual and local responsibility for development is essential to his philosphy and personality. PMID:12266279
The history of sterilization dates back to the time of Hippocrates, when female sterilization was recommended for preventing hereditary mental diseases. James Blundell introduced surgical sterilization in 1823 for the prevention of high risk pregnancies. Vasectomy was first performed in the US at the end of the 19th century, mainly to prevent hereditary disorders. Male sterilization was a means of genocide during Nazi rule in Germany. Religious beliefs have the most powerful impact on the practice or nonpractice of family planning. In the teachings of Islam, Christianity, and Judaism, only sporadic references explicitly prohibit contraception, yet various religious edicts have interpreted these references too broadly by advocating prohibition of most contraceptive methods. Recently, the world community endorsed the basic right of couples to decide the number of children they want and the right to family planning with free informed choice. An integral part of a successful family planning program is voluntarism. In Europe and North America sterilization is legal, except in Italy, France, and Turkey. In Latin America sterilization is illegal in a number of countries; in Burma and Vietnam restrictions are in place; and in Africa fertility regulation is illegal in one-third of the countries. Informed consent before sterilization during counseling by a skilled, unbiased counselor is indispensable. All family planning services should be part of the national health care system including the voluntary contraception services. Incentives may compromise voluntarism. Most programs require a minimum age and a minimum number of children, marital status, and spousal consent. For sterilization, a waiting period of 1-30 days has been recommended. The exclusion of childless and single individuals has been challenged as a violation of human rights. For mentally retarded people parents or guardians provide consent. Major ethical issues in the future could emerge concerning novel fertility techniques: cryopreservation of sperm and intracytoplasmic sperm injection. PMID:8535748
Rizvi, S A; Naqvi, S A; Hussain, Z
Helping to pave the way for family planning in Muslim societies is a change in attitude about family size. Once regarded as an economic asset, the large family is recognized by more and more people as a handicap. Family Health International (FHI) and collaborating scientists in Africa are embarking on several studies to provide family planning information to the governments of Niger, Sudan, and Mali. 1 research priority for 1985 in Nepal is a study of vanguard acceptors to determine the characteristics of the 1st acceptors of family planning services and the contraceptive needs of potential users. Also a pregnancy surveillance study will be conducted in Niamey to collect obstetric information that will allow for the design of programs to improve the quality of deliveries and reduce unwanted pregnancies. FHI plans to support a contraceptive technology seminar to be held in 1986 and, later, a training program hosted by the Universite de Niger to enhance research methodology skills. FHI supported a survey in Sudan conducted by Dr. Mutassin Mustafa and Dr. Mona Khalifa of the Sudan Fertility Control Association (SFCA) to assess male attitudes toward family planning. A previous survey using a quota sample indicated there was strong support for family planning, particularly vasectomy, among Sudanese men. The current study, using a random sample, will determine if those findings can be repeated. Clinical trial of progestogen-only pills is ongoing in Sudan. Future plans include a clinical trial of the Copper T 380 A IUD and a comparative study of standard versus low-dose pills. FHI will provide technical assistance to evaluate a training program on family planning skills and knowledge for midwives. A workshop is planned for August 1985 on research methodology. Since 1979, FHI has collaborated with the Malian government and L'Association Malienne pour la Protection et la Promotion de la Famille (AMPPF). The importance of breastfeeding on birth spacing was found in a study that monitored prenatal care, pregnancy, and childbirth in a maternity care facility. Women who breastfed had birth intervals more than twice as long as women who did not breastfeed. A multicenter surveillance study of Malian women hospitalized for treatment of incomplete abortion revealed that abortion was being used mostly by young, unmarried women to postpone a 1st birth. A recent study of the Copper T 200 showed a larger number of expulsions than expected, and FHI will help AMPPF train midwives to improve IUD insertion skills to reduce the number of expuslions. 2 OC studies are being conducted with FHI assistance. PMID:12340327
Background Pregnant women with prior venous thromboembolism (VTE) are at risk of recurrence. Low molecular weight heparin (LWMH) reduces the risk of pregnancy-related VTE. LMWH prophylaxis is, however, inconvenient, uncomfortable, costly, medicalizes pregnancy, and may be associated with increased risks of obstetrical bleeding. Further, there is uncertainty in the estimates of both the baseline risk of pregnancy-related recurrent VTE and the effects of antepartum LMWH prophylaxis. The values and treatment preferences of pregnant women, crucial when making recommendations for prophylaxis, are currently unknown. The objective of this study is to address this gap in knowledge. Methods We will perform a multi-center cross-sectional interview study in Canada, USA, Norway and Finland. The study population will consist of 100 women with a history of lower extremity deep vein thrombosis (DVT) or pulmonary embolism (PE), and who are either pregnant, planning pregnancy, or may in the future consider pregnancy (women between 18 and 45 years). We will exclude individuals who are on full dose anticoagulation or thromboprophylaxis, who have undergone surgical sterilization, or whose partners have undergone vasectomy. We will determine each participant's willingness to receive LMWH prophylaxis during pregnancy through direct choice exercises based on real life and hypothetical scenarios, preference-elicitation using a visual analog scale (“feeling thermometer”), and a probability trade-off exercise. The primary outcome will be the minimum reduction (threshold) in VTE risk at which women change from declining to accepting LMWH prophylaxis. We will explore possible determinants of this choice, including educational attainment, the characteristics of the women’s prior VTE, and prior experience with LMWH. We will determine the utilities that women place on the burden of LMWH prophylaxis, pregnancy-related DVT, pregnancy-related PE and pregnancy-related hemorrhage. We will generate a “personalized decision analysis” using participants’ utilities and their personalized risk of recurrent VTE as inputs to a decision analytic model. We will compare the personalized decision analysis to the participant’s stated choice. Discussion The preferences of pregnant women at risk of VTE with respect to the use of antithrombotic therapy remain unexplored. This research will provide explicit, quantitative expressions of women's valuations of health states related to recurrent VTE and its prevention with LMWH. This information will be crucial for both guideline developers and for clinicians.
The goals of this visit to China were to make contact with Chinese geneticists to discover what problems they feel they have to solve most urgently, what research they are undertaking, what services they need to provide, and to see what international links would be welcome. Basic problems in China include rapid population growth and lack of reliable population data. A new census was held in 1982, and valuable information has emerged. The population has reached 1015 million, nearly double the 1949 figure. In the early 1970s, Mao-Tse-Tung stressed the need to control population growth through late marriage, late childbirth, longer birth intervals, and the one child per couple policy. These ideas are reinforced by efficient contraceptive delivery, massive publicity, and strong social pressures aimed to keep the population within 1.2 billion by the end of the century. Women's average marriage age has risen from 19 in the 1950s to 22.8 in 1981; 69.5 of all women of childbearing age practice contraception, with 40% using the IUD, 37% tubal ligation, 11.9%, vasectomy and 6.3% oral contraceptives or injectables. This slowing in population growth makes it important for parents to be reassured their child will be born healthy and will survive. Every year in China, about 1/2 million or 18/1000 live births have a severe handicap, malformation, or genetic disease. Work on the incidence and distribution of disorders in China is selective. The prevalence of phenylketonuria (1/15,000) and congenital hypothyroidism is similar to that in Britain. Duchenne muscular dystrophy and hemophilia probably have a prevalence similar to that in Europe. Surveys and studies in Shanghai show that heart malformations were found in 6/1000 births, congenital dislocation of the hip in 4/1000, cleft lip and palate in 1.5/1000, club foot in 1/1000, and neural tube defects in .7/1000. A national survey of Mendelian and other eye disorders show prevalences of 1/5600 and 1.4/1000 births, respectively. Biochemical and molecular genetics in relation to genetic disorders is limited at present, but the work done appears to be soundly based. Clinical genetic services are also at an early stage of development; there are only a few specialists, and counselling is mainly provided by people trained in pediatrics, obstetrics, or family planning. China's great medical genetic challenge is to identify the specific major problems of each province and to establish appropriate genetic services, including counselling, prenatal diagnosis, dietary counselling, and selective abortion. PMID:12314923
Laurence, M; Harper, P S; Harris, R; Nevin, N C; Roberts, D F
The village of Bhorletar, in the middle hills of Nepal, is run by an elected Village Development Committee (VDC). It consists of 9 wards with a total of 3000 people. The village center is growing fast, with 35 new houses built in the last year. Bhorletar is 1 of 8 villages selected by the National Planning Commission and the World Conservation Union (IUCN) to develop and test a system of local environmental planning. The effort is a central part of the National conservation Strategy, which began in 1983. The task of drawing up environmental plans for Bhorletar and 7 other villages was begun in 1990 with the help of 2 nongovernmental organizations and the IUCN planning team. This included drawing up land use maps on forest patches, trees species, landslides, cropping patterns, and hazard-prone areas. Finally, an environmental plan based on this profile was defined by the villagers themselves and approved in meetings. Each village selected its own activities and was granted project funds to supplement the work of men and women from the village. These activities included community forest conservation; improved fuel-wood stoves; new latrines; protective dams and afforestation; improved roads; vegetable gardens and marketing; and a new health post. There is no health post in Bhorletar, and the nearest hospital is a 7 hours' walk away. Contaminated water, poor diet, and a polluted environment are the main causes of a child death rate of around 100 per 1000. Most of the women and girls were too busy with household and farming chores to attend the planning meetings or school. According to the profile, 99 men and only 5 women were practicing family planning. The only family planning commonly available has been an annual vasectomy camp. Women find sterilization services almost impossible to obtain, though they are increasingly using Depo-Provera injections at a health center in the adjoining village. Bhorletar's experience, and that of the 7 other villages, has proved that local communities can plan and carry out their own development programs. PMID:12287332
This articles focuses on John Paul II's 1993 Veritatis Splendor, an 1798 page encyclical letter to the Church's bishops on the crisis in the Catholic Church of family limitation and the implications for the laity and society. The communication states that a flexible interpretation of theology must be abandoned. Paul VI's 19963 Humanae Vitae is reportedly affirmed. John XXIII's spiritualism and concern with conscience is ignored. This encyclical is identified as not spoken "ex cathedra" or from the throne, which would have made the pronouncement true, unarguable forever, and subject to excommunication for those disobeying. Pope John Paul II is said to be preparing another encyclical on life issues and sexuality. Reference is made in this encyclical to devices that are acceptable to use to gauge a safe period for copulation without impregnation. The devices include the rectal thermometer and the calculator for determining the infertile days in the natural cycle. Veritatis Splendor's position on fertility is viewed as an issue of loyalty to the Church and not as an honest evaluation of the moral implications of artificial birth control. This encyclical comes closer to "ex cathedra" than the Humanae Vitae, which banned the birth control pill, IUD, spermicides, hormonal implants, vasectomies, and tubal ligation. Liberal Catholic theologians are reported to have interpreted Paul VI's statement that "God illuminates from within the hearts of the faithful and invites their assent," as a validation of dissent. Pope John Paul II closes the door to dissent in this proclamation. The Church also closes the door to free will for people to decide for themselves. The Jesuits, with different notions of divine will, are described as potentially concluding that the denial of free will and individual reason for the sake of Papal supremacy must be the work of the devil himself. For good Catholics this encyclical is interpreted as potentially forcing even stronger opposition to the Vatican's teachings and continued adherence to the dictates of their own conscience. A God who gave men and women the power of his reason would not allow the Pope, however infallible, to take this away. Among nonreligious thinkers the Catholic posture is viewed as very wrong on birth control. Divisions within the Church are expected to increase. PMID:12345270
In the past 5 years funding has declined in constant dollars for reproductive and contraceptive research and for the evaluation of long-term contraceptive safety; there has been a general increase in coordination and planning among publicly supported programs, as well as between these programs and private industry. There has been no substantial relaxation of regulatory requirements, and little has been done to make contraceptive research and development (R and D) more attractive to industry. The threat of liability suits and the difficulty in obtaining product liability insurance have become more salient than 5 years ago. This is increasingly restricting clinical research into new methods by both private industry and publicly supported research groups. Nonetheless some major advances have been recorded over the same period. The NORPLANT system, the Today contraceptive sponge, the TCu 380A (a copper-bearing IUD), and biphasic and triphasic pills have all become available in at least some developed and developing countries. In addition, several methods are in advanced stages of clinical trial (e.g., injectable contraceptives for 1 and 6 months' duration; an improved implant, a progestin releasing vaginal ring and Gossypol for sperm inhibition). Presented here are the results of a worldwide survey conducted by the Alan Guttmacher Institute (AGI) of funding for reproductive research, contraceptive development and evaluation of the long-term safety of existing methods. Requests for data on expenditures for 1980-1983 were sent by the AGI to funding agencies, R and D organizations and pharmaceutical companies in the US, Australia, Europe, India and Japan, reported to be doing contraceptive research. Detailed information was sought about fundamental research in reproductive biology, training of pre- and postdoctoral reproductive scientistis, applied research in contraceptive technology and evaluation of the safety of currently marketed contraceptives. An estimated US$154.8 million was spent in 1979 for all 3 categories of research; this amount declined by 12% in 1980. By 1983, expenditures in constant dollars were 79% of the 1979 figure. Contraceptive R and D accounted for 41% of the total expenditures during 1980-1983, fundamental for 52% and long-term contraceptive safety evaluation for 7%. The principal methods under investigation during this period were improved oral contraceptives, other ovulation inhibitors, post-ovulatory methods and pregnancy vaccines. Expenditures for contraceptive development are also presented by contributing organization (publicly supported, private industry and mission-oriented research projects). 46% of funds for evaluation of long-term safety of existing methods were spent on evaluation of oral contraceptives and 16% on the long-term risks of vasectomy. Investigations of barrier methods hardly played any part in overall research on safety in 1980 and 1981; but by 1983 these expenditures were 2nd only to those for the pill. Over the 4-year period, 63% of the funds spent on all types of research were for projects involving female reporduction, 18% for male reproduction and 19% for both. PMID:3843535
Atkinson, L E; Lincoln, R; Forrest, J D
These recommendations for secondary prevention of clinical coronary cardiopathy are the result of a symposium attended by 46 experts belonging to the councils on arteriosclerosis, clinical cardiology, epidemiology, and prevention and rehabilitation of the International Society and Federation of Cardiology. Secondary prevention of coronary cardiopathy refers to measures designed to prevent deterioration or death in patients with clinical manifestations of coronary cardiopathy. Such measures in addition to drugs include health actions that may improve the status of various coronary risk factors: the patient's life style should stress maintenance of proper weight, regular physical exercise, reduction of saturated fats and cholesterol in the diet, and elimination of smoking and excessive alcohol consumption. It is considered reasonable to control hypertension through the most innocuous means possible, but findings of the few existing controlled studies of effects of treatment of hypertension in coronary cardiopathy are complex. Drug treatment may be necessary for most patients, but nondrug measures should be added when possible. Various proofs including results of some controlled studies justify the recommendations for reducing elevated levels of serum cholesterol and low density lipoprotein cholesterol through dietary measures. Optimum plasma cholesterol levels are 5.2 mmol/1 or less, and the upper limit is 5.7 mmol/1. The rules for secondary prevention are the same for diabetics as for nondiabetics, but some special precautions are necessary in diabetics. Habitual and vigorous physical activity has been associated with a decline in the incidence of coronary cardiopathy in different population studies, although there has been no demonstration that exercise can alter the progression of atherosclerosis or improve collateral circulation. Stress should be recognized as a risk factor and included in secondary prevention, but the concept that stress is the key risk factor in coronary events is in conflict with a large body of scientific evidence. Oral contraceptives (OCs) tend to increase boood pressure and weight as well as serum triglyceride levels, and to reduce glucose tolerance and high density lipoprotein cholesterol in some formulations. OCs also affect the integrity of the vascular endothelium and alter blood coagulation, fibrinolysis, and platelet function. These thrombogenic changes are intensified with age, especially after 35, and with smoking. OCs are innocuous in women under 35 with no history of venous or arterial disease or pulmonary embolism and who have normal blood pressure and serum cholesterol levels. Patients using OCs should control their blood pressure and weight and be alert to any symptoms of thrombotic episodes. The risk/benefit ratio of longterm estrogen treatment in meno- and postmenopausal women with coronary cardiopathy has not yet been established. Apart from 1 study in primates, there is no evidence that vasectomy should be considered either indicated or contraindicated for coronary patients. Beta blockers, platelet function inhibitors, anticoagulants, and other drugs are under active study for secondary prevention of coronary cardiopathy. PMID:2858911
China's family planning program is described in reference to its goals, approaches, and achievements. Between 1949-83, China's population increased from 541 million to 1,024,950,000. The population has a young age structure, and the median age is 22.9 years. 80% of the population is rural, and 90% of the population lives in the southeastern region of the country. In view of this demographic situation, the government recognizes the need to control population growth. China's goals for the year 2000 are to increase industrial and agricultural input by 400% and to keep population size below 1.2 billion in order to ensure that per capita income increases. In accordance with these goals, the government, in 1979, began advocating a 1-child policy. To ensure the survival of single children, the government also launched a program to upgrade maternal and child health (MCH). In some rural areas and among certain minority groups, the 1-child restriction is not applied. Family size goals will vary with time. These variations will reflect the need to maintain a balance between economic growth and population growth. A variety of incentives are used to promote the 1-child family. For example, single children receive medical and educational benefits, and in some rural areas, the parents of single children can obtain additional land contracts. Economic disincentives are also used. The government seeks to obtain compliance with the policy primarily through educating the public about the consequences of uncontrolled population growth. All channels of the mass media are used to deliver the messages, and the publicity campaign is especially intensive in rural areas. A comprehensive plan to provided family planning and population education for middle school students is currently being implemented. Each local area develops its own fertility control plan. This plan is then incorporated into the nation's overall plan and the overall plan is implemented from above. Family planning workers bring free contraceptives directly to the people, and family planning motivators are found in almost all villages, neighborhood committees, factories, and military units. As a result of these efforts, China made great strides in controlling population growth and improving MCH during the last decade. The birth rate declined from 27.93 to 18.62, and the total fertility rate declined from 4.01 to 2.48. 124 million couples were practicing contraception by the end of 1983. 41% used IUDs, 37.4% relied on tubal ligation, 12.9% relied on vasectomy, 5.1% on oral contraceptives, and 1% on other methods. The quality of maternal and child care also improved. 92.7% of all deliveries are now performed by trained midwifes. Infant and maternal mortality rates declined considerablely in recent years. Currently the respective rates are 35.68/1000 live births and 0.5/1000 live births. In 1983 alone, the gross national agricultural and industrial output increased by 46.1%. Since 1979 per capita income increased annually by 18.3% among rural residents and by 10.7% among urban workers. China controls and operates its own population program, but in recent years, it increased its cooperation with UN Fund for Population Activities, other UN agencies, and nongovernment agencies. China recently completed its 3rd national census, and demographic research institutes have been established in 10 universities. PMID:12266994