This patient education program explains the benefits and complications associated with the vasectomy procedure. This is a MedlinePlus Interactive Health Tutorial from the National Library of Medicine, designed and developed by the Patient Education Institute. NOTE: The tutorial requires a special Flash plug-in, version 4 or above. If you do not have Flash, you will be prompted to obtain a free download of the software before you start the tutorial. You will also need an Acrobat Reader, available as a free download, in order to view the Reference Summary.
Patient Education Institute
... 99:1073–1079. Selected Resources Vasectomy in the United States, 2002. Vasectomy is a medical procedure intended as ... estimated 526,501 vasectomies were performed in the United States in 2002, representing a slight increase from previous ...
A vasovasostomy may be performed on an outpatient basis with local anesthesia, but also may be performed on an outpatient basis with epidural or general anesthesia. Local anesthesia is preferred by most of my patients, the majority of whom choose this technique. With proper preoperative and intraoperative sedation, patients sleep lightly through most of the procedure. Because of the length of time often required for bilateral microsurgical vasoepididymostomy, epidural or general anesthesia and overnight hospitalization are usually necessary. Factors influencing the preoperative choice for vasovasostomy or vasoepididymostomy in patients undergoing vasectomy reversal are considered. The preoperative planned choice of vasovasostomy or vasoepididymostomy for patients having vasectomy reversal described herein does not have the support of all urologists who regularly perform these procedures. My present approach has evolved as the data reported in Tables 1 and 2 have become available, but it may change as new information is evaluated. However, it offers a logical method for planning choices of anesthesia and inpatient or outpatient status for patients undergoing vasectomy reversal procedures. PMID:3811050
Belker, A M
Vasectomy is the most common urological procedure in the United States with 18% of men having a vasectomy before age 45. A significant proportion of vasectomized men ultimately request vasectomy reversal, usually due to divorce and/or remarriage. Vasectomy reversal is a commonly practiced but technically demanding microsurgical procedure that restores patency of the male excurrent ductal system in 80-99.5% of cases and enables unassisted pregnancy in 40-80% of couples. The discrepancy between the anastomotic patency rates and clinical pregnancy rates following vasectomy reversal suggests that some of the biological consequences of vasectomy may not be entirely reversible in all men. Herein we review what is known about the biological sequelae of vasectomy and vasectomy reversal in humans, and provide a succinct overview of the evaluation and surgical management of men desiring vasectomy reversal. PMID:23248768
Bernie, Aaron M; Osterberg, E Charles; Stahl, Peter J; Ramasamy, Ranjith; Goldstein, Marc
Vasectomy is the most common urological procedure in the United States with 18% of men having a vasectomy before age 45. A significant proportion of vasectomized men ultimately request vasectomy reversal, usually due to divorce and/or remarriage. Vasectomy reversal is a commonly practiced but technically demanding microsurgical procedure that restores patency of the male excurrent ductal system in 80–99.5% of cases and enables unassisted pregnancy in 40–80% of couples. The discrepancy between the anastomotic patency rates and clinical pregnancy rates following vasectomy reversal suggests that some of the biological consequences of vasectomy may not be entirely reversible in all men. Herein we review what is known about the biological sequelae of vasectomy and vasectomy reversal in humans, and provide a succinct overview of the evaluation and surgical management of men desiring vasectomy reversal. PMID:23248768
Bernie, Aaron M.; Osterberg, E. Charles; Stahl, Peter J.; Ramasamy, Ranjith; Goldstein, Marc
In 1989, Pro-Pater, a private, nonprofit family planning organization in Brazil, used attractive ads with the message Vasectomy, An Act of Love to promote vasectomy. The number of vasectomies performed/day at Pro-Pater clinics increased from 11 to 20 during the publicity campaign and fell after the ads stopped but continued at higher levels. Word of mouth communication among friends, neighbors, and relatives who had vasectomies maintained these high levels. This type of communication reduced the fear that often involves vasectomies because men hear from men they know and trust that vasectomies are harmless and do not deprive them of potency. In Sao Paulo, the percentage of men familiar with vasectomies and how they are performed increased after the campaign, but in Salvador, knowledge did not increase even though the number of vasectomies in Pro-Pater clinics increased. Organizations in Colombia and Guatemala have also been effective in educating men about vasectomies. These successes were especially relevant in Latin American where machismo has been an obstacle of family planning programs. The no-scalpel technique 1st introduced in China in 1974 reduces the fear of vasectomy and has fewer complications than the conventional technique. Further trained physicians can perform the no-scalpel technique in about 10 minutes compared with 15 minutes for the conventional technique. In 1987 during a 1-day festival in Thailand, physicians averaged 57 no-scalpel vasectomies/day compared with only 33 for conventional vasectomies. This technique has not spread to Guatemala, Brazil, Colombia, the US, and some countries in Asia and Africa. Extensive research does not indicate that vasectomy has an increased risk of testicular cancer, prostate cancer, and myocardial infarction. Physicians are working on ways to improve vasectomy. PMID:12317726
There is far less information available for men about vasectomy than there is available for women about comparable contraceptive services. Also, men do not have medical check-ups on a regular basis, and therefore have less contact with medical practitioners during which vasectomy could otherwise be discussed. Vasectomy needs to be promoted in order for men to learn about and accept it as their contraceptive method of choice. To that end, Marie Stopes International (MSI) launches a vasectomy promotion campaign annually which includes advertising in local newspapers and upon billboards at football stadiums. The campaigns use light-hearted and bold ideas, with some shock value. This approach helps to relax men who otherwise tend to be wary of both the surgical procedure and subsequent consequences of vasectomy. Prevailing social norms should, however, guide the content of promotional campaigns. The UK is one of only a few countries in the world where about the same proportions of men and women use sterilization; 16% of men and 15% of women have been sterilized. A MSI campaign in the UK which began during fall 1997 prompted an increase in the number of inquiries about vasectomy at the Marie Stopes Vasectomy Clinic. Promotional campaigns in developing countries have also been successful. It is also important that campaigns be put in the larger context of promoting all contraceptive methods. PMID:12293534
Finger, W R
Vasectomy was performed in 90 men in Department of Surgery II of the University Central Hospital of Helsinki during the period January 1st, 1972 to December 31st, 1973. Operation was performed on an ambulatory basis under local anesthesia. After resection and ligation of vas deferens the cut ends were placed in different fascial planes in order to avoid recanalisation. The patients were mainly in the age group 31-40 years. Seven patients had postoperative complications, scrotal hematoma being the most common. Recanalisation was found in one patient, in whom a new operation was performed. The author stresses the importance of a correct vasectomy method, histological verification of the divided vasa and most of all the postoperative sperm analysis. Two negative sperm analyses with an interval of at least 1 month must be recorded before sterility can be confirmed. PMID:1209172
Vasectomy is discussed, and the advantages of a new vasectomy hook which has been modified by the author are reported. The difference between castration and vasectomy is emphasized. In castration, male hormone, sperm, and seminal fluid routes are cut. In vasectomy, only the vas deferens, the sperm route, is blocked. Vasectomy takes only 10-20 minutes to complete. There are 2 kinds of incisions to expose the vas: a single or median incision on the median raphe of the scrotum, and bilateral incisions just above the vasa. The length of the incision is about 1 cm. There are many indications for vasectomy including the prevention of future pregnancy, because the couple already has as many children as they can afford to rear. A preoperative interview is necessary in order to ascertain whether the couple are mentally competent and understand the operation. In the description of the operative techniques, Lee's vasectomy hook is discussed. It is stainless steel; pointed, tipped, and angular in shape, and its shaft is gradually enlarged in circumference. By using the vasectomy hook, the exposed vas is easily and bluntly separated from its coverings and held for the next step in the operation. After the operation, the patient is cautioned to use some type of contraceptive until it is determined that there are no sperm in his ejaculate. PMID:12177908
Lee, H Y
Preliminary data on 25 men who underwent vasectomy for contraception between June 1986 and May 1988 at the Marie Stopes Clinic--Nairobi is presented. The majority (76.0%) of the subjects were aged between 25 and 39 years. 68.0% had 4 living children or less. Professionals including lecturers, lawyers, teachers, engineers etc, formed 88.0% of the total. Three clients(12.0%) had documented complications; one had aseptic wound, one had haematoma and the last one had a failed vasectomy. All were treated successfully. Complications of vasectomy and the need for follow-up of vasectomised men are discussed. PMID:2791935
Lema, V M; Makokha, A E
Vaso-cutaneous fistulae occur rarely after vasectomy. We report three cases encountered in our hospital over the last 18 years and recommend technical considerations to avoid this complication. PMID:12625860
Guan, Meng; Dagnone, A Joel; Norman, Richard W
A program designed to improve the availability of vasectomy in public-sector clinics trained physicians at 43 facilities in no-scalpel vasectomy between 1993 and 1995. Among the 38 clinics that responded to a follow-up survey in 1996, the number of clinics providing vasectomies rose from 23 to 32, an increase of almost 40%, while the number of vasectomies performed rose by 18%. Seventeen of the 32 clinics performed more vasectomies after the training; 10 of the 17 had not previously provided the procedure. In-depth interviews with staff from seven sites that experienced large caseload increases and from seven that experienced decreases identified three elements for the successful establishment or expansion of vasectomy services-sufficient numbers of trained providers, funds to subsidize vasectomies for men who cannot afford them and activities to raise awareness about the availability of low-cost or free vasectomy. PMID:9258652
Haws, J M; McKenzie, M; Mehta, M; Pollack, A E
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Indications for hydrocele and spermatocele treatment are based on diagnosis with high-resolution ultrasonography. It must be clear whether hydrocele or spermatocele lead to impairment of the patient - asymptomatic findings do not need correction. In case of younger men, the wish for children must be taken into account as both surgical procedures may lead to infertility, especially spermatocele resection may lead to epididymal obstruction. Advantages and disadvantages of the intervention must be discussed with the patient in detail. In men with a planned vasectomy, the physician must be certain that the patient understands the definitive character of this form of contraception. Men who are not aware of this condition or have conflicts with their partners may not be the best candidates for surgical vasectomy. All three treatment options (hydrocelectomy, spermatocele resection, and vasectomy) may be accompanied by fertility preservation procedures (e.g., cryopreservation of semen prior to surgery). Alternatively, the surgery should not be performed if any doubts exist. Postoperative management includes follow-up examinations and in case of vasectomy after 6-12 weeks and several ejaculations at least two semen analysis with proven azoospermia after centrifugation (or <100,000 immotile spermatozoa) should be documented. Compliance of men is best when this follow-up appointment is already scheduled at the time of surgery. PMID:24806800
The effects of vasectomy on testes and related structures of animal species and men are largely disputable. These possible effects were studied in the ram, an established experimental animal model used to investigate genitalia pathophysiology. In each of five rams, vasectomy in the left spermatic cord was carried out; subsequently, the clinical and ultrasonographic features were monitored up to 12
Pagona G. Gouletsou; Apostolos D. Galatos; George C. Fthenakis
The effect of unilateral or bilateral vasectomy on testicular weight and basal testosterone production in vitro was studied in neonatal intact and hemicastrated rats. Five days after right-side vasectomy ipsilateral to vasectomy testicular weight increased, and basal testosterone production decreased. Ten days postvasectomy the changes were opposite, and affected both testes. In hemicastrated animals hemivasectomy did not interfere with compensatory hypertrophy but induced a significant decrease in basal testosterone production. The data of the present study suggest that in neonatal animals intact ductus deferens bundle(s) is also required for the full control of testicular weight and basal testosterone secretion. PMID:3752538
Gerendai, I; Nemeskeri, A; Csernus, V
Reviewed evidence concerning the psychological effects of vasectomy for American men. Surveys of postoperative sexual behavior and satisfaction and/or happiness were cited, as were data from studies employing clinical interviews and/or psychological tests. (Author/SB)
Bloom, Larry J.; Houston, B. Kent
ObjectiveTo compare the intra-operative experience and postoperative sequelae between the standard Marie Stopes scalpel vasectomy procedure and electrocautery non-scalpel vasectomy (ENSV) techniques.DesignRandomised prospective comparative study.SettingMarie Stopes vasectomy centres in the UK.ParticipantsA total of 325 men undergoing vasectomy between January and June 1999.InterventionRandom allocation to the two study arms plus questionnaires at 4 and 14 weeks postoperatively.Main outcome measuresEase and speed
Timothy Black; Colin Francome
Vasectomy is a commonly performed and relatively safe procedure, with low reported rates of psychological morbidity, though there is some variability across studies. Depression following a vasectomy is relatively infrequent. A married man aged 30 developed a chronic depressive episode, lasting four years and resistant to an adequate trial of fluoxetine, following a vasectomy. His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure – a belief that was shared by his family. Psychological complications of vasectomy have generally been studied under four heads: sexual dysfunction, effects on marital relationships, chronic post-operative pain, and other complications including anxiety and depression. These complications have generally been reported at higher rates in developing countries, and are linked to poor knowledge about the procedure and inadequate pre-operative counseling. The implications of the existing literature for the patient’s current complaints, and the mechanisms and risk factors involved, are discussed in the light of existing research. Suggestions for the prevention and treatment of post-vasectomy depression are also outlined. PMID:25553234
Vasectomy is a commonly performed and relatively safe procedure, with low reported rates of psychological morbidity, though there is some variability across studies. Depression following a vasectomy is relatively infrequent. A married man aged 30 developed a chronic depressive episode, lasting four years and resistant to an adequate trial of fluoxetine, following a vasectomy. His depression was heralded by a post-operative panic attack, and was accompanied by medically unexplained symptoms and the attribution of all his symptoms to the procedure - a belief that was shared by his family. Psychological complications of vasectomy have generally been studied under four heads: sexual dysfunction, effects on marital relationships, chronic post-operative pain, and other complications including anxiety and depression. These complications have generally been reported at higher rates in developing countries, and are linked to poor knowledge about the procedure and inadequate pre-operative counseling. The implications of the existing literature for the patient's current complaints, and the mechanisms and risk factors involved, are discussed in the light of existing research. Suggestions for the prevention and treatment of post-vasectomy depression are also outlined. PMID:25553234
Shaik, Subahani; Rajkumar, Ravi Philip
Vasectomy reversal (VR) has traditionally been performed with the operative microscope. Recently, robot assistance has been applied to VR. Retrospective chart review from a single VR center included men who underwent either robot-assisted VR (RAVR) or microsurgical VR (MVR) by a single fellowship trained microsurgeon between 2011 and 2013 and had a 6 weeks postoperative semen analysis. Fifty-two men who were interested in VR were counseled and given the option of RAVR versus MVR. Twenty-seven men elected to have MVR while 25 men elected RAVR. These included vasovasostomies and vasoepididymostomies in both groups, as well as redo VRs in men who had failed previous VR attempts by other surgeons. There was no statistically significant difference between the microsurgical group and the robot-assisted group, respectively, in overall patency rates (89% vs 92%), 6 weeks post-VR mean sperm concentrations (28 million ml-1 vs 26 million ml-1 ) or total motile counts (29 million vs 30 million), or mean operative times (141 min vs 150 min). There was a statistically significant difference in anastomosis time (64 min vs 74 min), however, clinically this only represented a 10 min longer anastomosis time in the early robotic experience, which was found to be decreasing as the case series continued. Transitioning from MVR to RAVR is feasible with comparable outcomes. PMID:25475663
Kavoussi, Parviz K
Objective Sterilization (tubal sterilization and vasectomy) is a widely applied contraceptive method worldwide. Although most studies have described sterilization as a safe method, there are reports of tubal ligation (TL) and vasectomy complications. The aim of this study was to evaluate the effects of TL and vasectomy on the serum oxidative stress, specifically prooxidant-antioxidant balance (PAB) and malondialdehyde (MDA) levels, over time. Methods Male and female rats were classified into vasectomy, sham-vasectomy, TL, and sham-TL groups, respectively. The PAB and MDA levels were measured on days 15 and 45 and months 3 and 6 after the intervention. For female rats, blood sampling was performed during the diestrous phase and estradiol and progesterone were also measured. Results Serum PAB and MDA increased after TL (p<0.05). Vasectomy increased serum MDA remarkably after 45 days, 3 months, and 6 months (p<0.05). After vasectomy, serum PAB also increased although not significantly. Serum estradiol and progesterone decreased remarkably in the TL group compared to the sham group (p<0.05). Conclusion Bilateral TL and vasectomy both increase the serum oxidative stress; however the imbalance after TL was very noticeable. As for the TL, the reduction of serum estrogen levels can be involved in this imbalance. Complications followed by TL or vasectomy could be due to increased levels of oxidants. Thus, prescribing antioxidants during and or after surgery may be a solution. PMID:22816074
Faramarzi, Azita; Seifi, Behjat; Shabanzadeh, Alireza; Ebrahimpoor, Mitra
The no-scalpel vasectomy technique was 1st assessed and reported in the US by a team of medical experts who visited the Chongqing Family Planning Scientific Research Institute to review new surgical contraceptive technologies in China. Soon, a training program was begun in Bangkok. In over 1300 no-scalpel procedures performed by the trainees, there was considerably reduced bleeding. In this group only 1 hematoma was reported, a rate of less than 0.1%. The physicians reported that the new technique took less time than customary methods. Whether no-scalpel vasectomies become new standard remains to be seen. To date the results have been encouraging. The next few years will be important in establishing the role of this technique in the US. PMID:12269069
Huber, D H
ObjectiveTo review the evolution of the procedure, the reoperation rate and efficacy data for vasectomies performed in Marie Stopes centres during the periods 1990-1994 and 1995-1999.DesignRetrospective review of re-operation rates and primary and secondary failures during the periods 1990-1994 and 1995-1999.SettingMarie Stopes vasectomy centres in the UK.ParticipantsA total of 41 123 men undergoing vasectomy.ResultsThe re-operation rate for the period 1990-1994
Timothy Black; Colin Francome
The epididymis is essential for the acquisition of sperm fertilizing ability and forward motility. After vasectomy, the flux and composition of the epididymal fluid are modified, causing possible sequelae to the occluded excurrent duct. Some of these sequelae may not be reversible following vasovasostomy, affecting sperm physiology and their fertilizing ability. We previously demonstrated that the epididymal expression in men of a major glycoprotein secreted by the epididymis, cysteine-rich secretory protein 1 (CRISP1), and its encoding mRNA are affected by vasectomy. In this study we showed that following vasectomy, the increased level of CRISP1 is not due to a secretory defect but to its accumulation in the intraluminal compartment of the cauda epididymidis. Western blot analyses were performed to determine the amount of CRISP1 associated with spermatozoa of men who had undergone surgical vasectomy reversal. Spermatozoa of vasovasostomized men are characterized by a significant increase (P < .05) in CRISP1 levels when compared with normal donors. There was no linear correlation between CRISP1 levels and the period of time elapsed between vasectomy and vasovasostomy. CRISP1 was also present in seminal plasma of normal and vasovasostomized men, but not in vasectomized individuals. The soluble concentration of CRISP1 was significantly higher (P < .05) in seminal plasma of vasovasostomized men when compared with normal men. Knowing that one of the proposed functions of CRISP1 is to modulate sperm capacitation, we evaluated the level of tyrosine protein phosphorylation of 2 AXAP proteins of the fibrous sheath, p81 and p105. Spermatozoa of vasovasostomized men were characterized by a 50% increase of protein tyrosine phosphorylation when compared to spermatozoa of normal men (P < .05). Our results are discussed with regard to the fertilizing ability of ejaculated spermatozoa of some vasovasostomized men. PMID:20378925
Légaré, Christine; Boudreau, Luc; Thimon, Véronique; Thabet, Michel; Sullivan, Robert
OBJECTIVE--To confirm or refute reports that vasectomy may increase the risk of cancers of the testis and prostate. DESIGN--Computerised record linkage study of cohort of men with vasectomy and comparison of cancer rates with those in the whole Danish population; manual check of all records of patients with testicular and prostate cancer diagnosed within the first year of follow up. SETTING--Denmark 1977-89. SUBJECTS--Cohort of 73,917 men identified in hospital discharge and pathology registers as having had a vasectomy for any reason during 1977-89. MAIN OUTCOME MEASURES--Observed incidences of testicular, prostate, and other cancers up to the end of 1989. RESULTS--The overall pattern of cancer incidence in the study cohort was similar to that expected nationally. No increased incidence in testicular cancer was observed (70 cases; standardised morbidity ratio 1.01 (95% confidence interval 0.79 to 1.28)). The incidence during the first year of follow up was also close to that expected (nine cases; standardised morbidity ratio 0.80 (0.36 to 1.51)). The incidence of prostate cancer was not increased (165 cases; standardised morbidity ratio 0.98 (0.84 to 1.14)). CONCLUSIONS--The incidence of testicular cancer in men with vasectomy is no higher than in other men. Vasectomy does not cause testicular cancer and does not accelerate the growth or diagnosis of pre-existing testicular neoplasms. Data concerning a causal relation between vasectomy and prostate cancer were inconclusive. PMID:8086866
Møller, H.; Knudsen, L. B.; Lynge, E.
In order to study the psychosexual changes and reactions of the vasectomzied males at the Margaret Sanger Research Bureau, a questionnaire was mailed to the first 236 consecutive clients who had the operation during the period October 1969-September 1970. 189 of the 236 men responded. All the men except 2 reported that their sexual desire was the same as or greater than before the operation. The 2 men reporting less sexual desire also complained of physical discomfort or pain during intercourse which may have been the reason for the decrease in desire. Nearly 2/3 of the total cases indicated an increase in sexual enjoyment; only 1 person reported a decrease. More than 1/3 of the men reported that they had an increase in their sexual frequency following the operation, and the remaining 116 men reported no change in sexual frequency. Regarding men's self-evaluation of ejaculation (volume), 3/4 of the men reported no change, 1/6 reported more, and 1/12 reported less. The sexual desire or enjoyment of wives as perceived by their husbands had either increased or remained the same as before the operation in all but 4 instances. Over 98% of the patients expressed satisfaction and were quite willing to recommend the vasectomy operation to others. All of the patients who responded said that they would still make the same decision again. PMID:12308788
Kohli, K L; Sobrero, A J
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. PMID:18930494
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.
In this interview, Dr. Li Shunqiang, who developed the no-scalpel vasectomy (NSV) technique, discusses his life and work. As a youth, Dr. Li, who was born into a farming family, noted that farm wives had large families to care for in addition to their other chores. He always felt that it was unfair for women to have to assume the entire responsibility for family planning. Thus, in the early 1960s, Dr. Li began his research on male contraception. By this time, concern had arisen in China about rapid population growth. Dr. Li performed his first traditional vasectomy in 1963. He soon found that the use of a knife in vasectomy was associated in the minds of his clients with castration. Therefore, Dr. Li began to try to develop a means of chemical vasocclusion. In 1973, this work led to the development of the NSV, in which the anesthetized scrotum is punctured (rather than cut) with a special instrument in order to allow access to the vas deferens. Dr. Li believes that the NSV should be promoted beyond Sichuan Province, and he intends to continue his efforts to improve the procedure. In order to expand the NSV throughout China, Dr. Li recommends that couples who wish to end child-bearing should be fully informed about male and female sterilization. Quality follow-up services should be available to acceptors. In addition, a pilot project should proceed large-scale promotion of NSV. High quality training must be given to the surgeons, and information, education, and communication activities should be used to create a social environment in which NSV will be accepted. Dr. Li is continuing his research in the areas of basic androgyny and pathology, biochemistry, and the male hormone system as well as in sterilization reversal. He is involved in NSV workshops and continues to refine the procedure. PMID:12346906
Several small, enclosed reserves in southern Africa are experiencing significant elephant population growth, which has resulted in associated environmental damage and changes in biodiversity. Although several techniques exist to control elephant populations, e.g., culling, relocation, and immunocontraception, the technique of laparoscopic vasectomy of free-ranging bull elephants was investigated. Bilateral vasectomies were performed in 45 elephants. Of these elephants, one died within 24 hr of recovery and two had complications during surgery but recovered uneventfully. Histologic examination confirmed the resected tissue as ductus deferens in all the bulls. Most animals recovered uneventfully and showed no abnormal behavior after surgery. Complications recorded included incisional dehiscence, 1 full-thickness and 2 partial-thickness lacerations of the large intestine, and initial sling-associated complications, for example, deep radial nerve paresis. One bull was found dead 6 weeks after surgery without showing any prior abnormal signs. Vasectomy in free-ranging African bull elephants may be effectively performed in their normal environment. The surgical procedure can be used as a realistic population management tool in free-ranging elephants without major anesthetic, surgical, or postoperative complications. PMID:24437080
Marais, Hendrik J; Hendrickson, Dean A; Stetter, Mark; Zuba, Jeffery R; Penning, Mark; Siegal-Willott, Jess; Hardy, Christine
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
Previous studies indicate that 7 days after testicular administration of naloxone, serum testosterone (T) concentration and basal T secretion in vitro decrease significantly. In neonatal rats, short-term (2 h) intratesticular treatment with 0.3 micrograms (D-Met2-Pro5)-enkephalinamide suppresses steroidogenesis. In the present study, testicular treatment with naloxone or enkephalinamide was combined with hemivasectomy (which also includes transection of the inferior spermatic nerve). When local treatment with naloxone was combined with vasectomy in 15-day-old rats, the opioid antagonist-induced increase in testicular weight, the decrease in basal T secretion of the treated gonad and the drop in serum T level could not be observed 7 days postsurgery, despite the fact that in immature rats, hemivasectomy, by itself, also reduces steroid secretion. Similarly, in 5-day-old animals, the short-term (2 h) effect of testicular enkephalinamide on T secretion was prevented by vasectomy. These data suggest that local testicular actions exerted by endogenous opioid peptides might be modulated by the inferior spermatic nerve. PMID:1436370
Gerendai, I; Nemeskéri, A; Csernus, V
Though nonscalpel vasectomy (NSV) technique was introduced in India in 1992 to increase male participation in family planning, it has failed to get adequate momentum and to achieve its goal. We conducted a cross-sectional questionnaire-based survey to get insight into apathy of men towards NSV. The study included 428 respondents. Most of the respondents (97.4%) were aware of NSV as a method for permanent male sterilization. The majority of them (97.2%) knew that NSV is done without any charge and cash incentive is given to the NSV client after the procedure. Though 68.0% respondents agreed that permanent sterilization is a possible option for them, only 34.1% respondents were willing to adopt NSV as a method of family planning. Fear of surgical procedure (40.7%), permanent nature of procedure (22.2%), and religious belief (19.0%) were the common reasons for unwillingness to adopt NSV. We conclude that there is a need to design and develop need-based information, education and communication (IEC) strategy to bridge the existing information gap among the eligible couples regarding NSV to improve its adoption. Involvement of community leaders and satisfied clients and utilization of television and radio would enhance the effectiveness of such interventions. PMID:23691369
Garg, Pankaj Kumar; Jain, Bhupendra Kumar; Choudhary, Deepti; Chaurasia, Ashish; Pandey, Satya Deo
This study was aimed to investigate the long-term effect of vasectomy using the bonnet monkey (Macaca radiata) as a primate animal model. Animals weighing around 6 to 8 kg were randomly chosen for bilateral, unilateral vasectomy and sham-control. The postoperative periods of six months and two years were considered as short and long-term, respectively. Sperm were collected and subjected to analysis before euthanasia. The testes and epididymides were excised from euthanized animals then embedded in paraffin. Normal histological changes were observed in sham-operated animals and short-term contralateral testes. In contrast, marked alterations were observed in the testes and epididymides of both short and long-term groups. Seminiferous epithelium was thinned out showing marked depletion of germ cells in long-term; only a thin layer of Sertoli cells, spermatogonia, and fewer spermatocytes were seen. Exfoliation of germ cells and the occurrence of multinucleated giant cells were common features in these tubules. The epididymal tubular lumens were greatly dilated with accumulated spermatozoa in short and long-term animals; significant defects were observed in the epithelium of the long-term animals. Microscopic spermatic granulomas were noticed in epididymides and the vas deferens. Large granulomas were seen in long-term vasectomized monkeys, frequently compressing the surrounding structures. These granulomas could be visualized in ultrasound, however, only at the late stage of its occurrence. Sperm collected from the unilateral vasectomized animals showed a poor motility score in the capillary mucus penetration test (CMPT). Results indicate that the changes observed after vasectomy might be due to pressure initially, whereas in the long-term the damage was supplemented by autoimmune attack. With immunoglobulin (IgG) deposition in contra-lateral unoperated testis of unilateral vasectomized animals it also showed degenerative changes and a concomitant drop in sperm quality. Although, granulomatous reactions were observed in the epididymis and vas deferens but testes were spared from such reactions even in the long-term. PMID:24593799
Seppan, Prakash; Krishnaswamy, Kamakshi
One-hundred-and-one men requesting vasectomy in 1985 for the purpose of limiting family size were admitted to a study of standard incision and monopolar diathermy, and a new percutaneous electrocoagulation vasectomy procedure. Semen specimens were tested at 10 and 12 weeks after surgery. Men were telephoned at 2, 12 and 24 weeks post-surgery to elicit complications and complaints. Half of the men having the standard incision procedure and about one-third of the men undergoing the percutaneous procedure complained of discomfort during the surgery. At the two-week telephone contact, 23% of those having the standard incision and 66% of those having the percutaneous procedure reported complications. There were few complications or complaints reported at the long-term follow-up contacts with either method; although twice as many men in the percutaneous group were not declared sterile by the end of the study period. Failure rates were 2.0% for the standard incision procedure and 7.8% for the percutaneous approach. PMID:2721193
Black, T R; Gates, D S; Lavely, K; Lamptey, P
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. PMID:22943659
Introduction and objective: Vasectomy is a well-established method in family control. Even though it is a safe and low risk operation, this surgery is invasive and difficult to reverse. Therefore the aim of this study was to investigate new non-invasive methods for occlusion of the seminal duct. Material and Methods: Seminal duct tissue was obtained from patients (n=30) suffering from prostate cancer and therefore undergoing prostatectomy. In a first set of experiments, the seminal duct was occluded by intraluminal application of Histoacryl® (Braun Aesculap AG, Tuttlingen, Germany). In a 2nd set of experiments, endoluminal laser induced occlusion was performed. Four different laser wavelengths (1940nm, 1470nm, 1064nm, 940nm) and different sets of laser parameters (e.g. power, exposure duration, fibre diameter, energy applied) were compared. Effectiveness of occlusion of the seminal duct was proven by post-treatment irrigation flow measurement, as well as by morphological analyses. To evaluate a potential damage of the surrounding tissue, external temperature was measured using a thermometer during laser application. Results: Intraluminal application of Histoacryl® induced an immediate and complete occlusion of the seminal duct. The underlying connective tissue maintained its functional integrity after this treatment. By laser light application to a Histoacryl® block, a hole could be created into the block thus indicating the possibility of recanalization. Treatment with laser energy resulted in shrinkage of the ductal lumen. The laser application generally caused necrosis in the epithelium and induced formation of vacuoles in the underlying connective tissue. As described for endoluminal varicose treatment, this distinct local reaction might result in an intense inflammation leading to a functional occlusion of the vas deferens. Conclusions: Both laser-induced occlusion and application of Histoacryl® are fast and simple techniques which may be able to achieve a functional occlusion of the seminal duct. The application of Histoacryl® additionally may be easily reversible by laser treatment.
Freitag, B.; Sroka, R.; Koelle, S.; Becker, A. J.; Khoder, W.; Pongratz, T.; Stief, C. G.; Trottmann, M.
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 platelet surface and activates FX to FXa. Human semen forms a semi-solid gelatinous coagulum, which then liquefies within 5-20 minutes in vitro. In spite of evidence demonstrating the importance of the seminal coagulation and liquefaction process in terms of global fertility and despite the fact that the seminal coagulum is composed of fibrin-like material, it has always been addressed from the perspective of High Molecular Weight Seminal Vesicle (HMW-SV) proteins (Semenogelin I and II) and their cleavage by prostate-specific antigen rather than the conventional hemostatic factors. In this study and as part of our continuing investigation of human seminal clotting factors, we report here on seminal FIX and FIXa in normal, subfertile, and vasectomized subjects. Factors IX and FIXa were studied in a total of 119 semen specimens obtained from subfertile (n=18), normally fertile (n=34), and fertile sperm donors (n=27) and vasectomy subjects (n=40). Seminal FIX and FIXa levels were also measured in a group defined by normality in several parameters derived from the World Health Organization fertility criteria and termed "pooled normal semen parameters." Both FIX and FIXa were quantifiable in human semen. There was a wide individual variation in FIX and FIXa levels within groups. Despite the group size, statistically significant associations with fertility-related parameters were infrequent. There is a positive correlation between FIX and its activation product, FIXa (n=36; r=0.51; P <.05). Factor IXa elevation in the high sperm-clump group was significant (P <.05), and days of abstention correlated with FIXa levels (n=63; r=0.3; P <.05). The key finding of the present study is that both FIX and FIXa are present in concentrations that are not dissimilar to plasma levels and that are apparently functional, as the activated form is also present. This fact, taken with other reports of coagulation factors in semen, raises the likelihood that a functional set of hemostatic coagulation proteins exists in semen, potentially to interact with the HMW-SV proteins and the prostate-specific antigen system. PMID:15611579
Lwaleed, Bashir A; Greenfield, Robert S; Hicks, James; Birch, Brian R; Cooper, Alan J
... Mechanisms Active Funding Opportunity Announcements, notices & mechanisms Small Business Programs Grant Programs for Small Businesses Peer Review ... Spotlights June Wrap-Up: Promoting Men’s Health New Research on Male Contraceptive Methods Men’s Health is the Focus in June All ...
... Bibliography Research Conferences Listserv Related Sites Surveys and Data Collection Systems Vital Statistics: Birth Data NCHS Home Surveys and Data Collection Systems Key Statistics from the National Survey of ...
's property may be impounded. " In addition, posters were placed in the trailer parks notifying residents of an upcoming neighborhood vaccination clinic, thereby giving pet ownezs the opportunity to acquire both legally required rabies vaccinations.... While anesthetized, the cats were vaccinated with a rabies vaccine approved for use in cats, given a subcutaneous injection of ivermectin to control intestinal parasites and ear mites, and licensed using an ear implant in the left ear. The tip...
Mahlow, Jane Caryl
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
The so called myths and taboos among the people of India are obstactes controlling population explosion and thereby the nation is being handicapped with economic development. To propagate awareness and information, the NSV Resource Center took up organising mega camps for the acceptance of NSV as the method of family planning and male participation. The awareness material has been developed to bring forth total sociocultural transformation through development of intense desire, strong determination, effective management and inclusion of a zeal of perpetual efforts both among the promoters and acceptors. The information modules have been developed to suit the requirements of various vehicles through which the message has to be spread. Awareness messages are generated through the inputs from sociocultural, economic, ethical, hygienic and administrative acumen. The materials prepared are disseminated through display hoardings, wall writings, distribution of pamphlets, audiovisual clips, face to face counselling, etc. Communication technology serves mobilising and educating people, especially rural populace. Some steps are suggested to reach remotest villages which are elaborated. Counselling is an essential part of motivation to the client. During the last 5 years a significant surge has been noticed in terms of access to new communication technologies. This may be employed to successfully implement the family planning programme. PMID:16910336
Sharma, R P
"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.
The effect of magazine advertising on vasectomy acceptance was tested in São Paulo, Brazil. Four advertisements ran for ten weeks in eight magazines. Clinic performance doubled during the campaign and stabilized at 54 percent higher than baseline. The advertisements selectively attracted the target audience without bringing in large numbers of ineligible candidates, completely avoided negative reactions, and recruited men previously unexposed to vasectomy. The cost of the advertising campaign was offset by additional revenue generated by the increase in vasectomies performed. The results suggest that while interpersonal communications can maintain performance in voluntary sterilization programs, mass media promotion may be necessary for program growth. PMID:2497560
Foreit, K G; de Castro, M P; Franco, E F
...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...
...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...
...Dental Care From Nonnaval Sources § 732.15 Unauthorized care. The following are not authorized by this part: (a) Chiropractic services. (b) Vasectomies. (c) Tubal ligations. (d) Breast augmentations or reductions. (e)...
Nearly 11 million Americans have chosen surgical sterilization as their contraceptive method; about 1,131,000 procedures were obtained in 1978, 670,000 women and 461,000 men. In 1960 the ratio of male to female sterilizations was 40% to 60%. In 1969 The Association for Voluntary Sterilization (AVS) opened the first vasectomy clinic in the U.S. at the Margaret Sanger Center, New York City. During 1970-71 more vasectomy clinics were established around the country. The medical profession began to provide vasectomy as an office procedure. The peak of the vasectomy movement occurred in 1971 when 6700,000 vasectomies were performed. Newer techniques for female sterilization appeared, minilap and laparotomy, which required less hospitalization and facilitated quicker recovery. It is unrealistic to expect sterilization to become the number 1 method for people who are under 29 or 30. The sterilization boom has peaked, and although the numbers of acceptors has increased every year since the 1960's, the level of growth has reached a plateau. PMID:12309668
INTRODUCTION Isolated duplication of vas deferens is a rare anomaly with only eleven cases reported in medical literature. Unawareness regarding this rare anomaly can lead to inadvertent injury to the vas during inguinal hernia surgery or failure of vasectomy procedure. PRESENTATION OF CASE A 27-year-old gentleman was diagnosed with isolated duplication of vas during left sided open inguinal hernia surgery. He had no other genito-urinary anomaly. Patient had an uneventful recovery from surgery. CONCLUSION It is a rare anomaly and unawareness regarding this condition can lead to catastrophic consequences during inguinal hernia and vasectomy surgeries. PMID:22096740
Khandelwal, Rohan; Punia, Sudhanshu; Vashistha, Nitin; Yadav, Siddharth; Singh, Arshdeep; Desai, Pragnesh; Jain, Sunil
Fertility control in wild horses has been attempted with both stallions and mares. Nonreversible surgical sterilazaiton by means of vasectomy has been successful in inhibiting reporcution in wild horses in Montana and Nevada. Administration of a microencapsulated form of testosterone to wild stallions reduced sperm counts and motility and foal counts. In a third approach, intraperitoneal SilasticTM implants containing ethinylesdtradiol
Jay F. Kirkpatrick; Turner J. W. Jr; I. K. M. Liu
BACKGROUND: Quantification of changes in semen may give insight into the testosterone (T)-induced disruption of spermatogenesis in man. METHODS: A model analogous to flushing of sperm from the genital tract after vasectomy was used to quantify the time course of semen changes in subjects participating in male contraceptive trials using 800 mg T-implant (n = 25) or 200 mg weekly
C. Garrett; D. Y. Liu; R. I. McLachlan; H. W. G. Baker
Objectives. To evaluate the effects of vasal obstruction on testicular structure, to determine if tissue and\\/or cell damage can cause significant reactive oxygen species (ROS) generation, and to correlate the histologic alterations to the measured levels of ROS products.Methods. To evaluate the effects of ROS generation in vasectomized testes, unilateral vasectomy was performed on 17 rats and tissue samples were
Kaan Aydos; Bora Kupeli; Tarkan Soygur; Ali Unsal; Esra Erden; Ozden Tulunay; Sadettin Kupeli
Srinivasan devotes a chapter to the differences between various s* *tates, and another to case studies* * health bud- get and has 300,000 employees. Yet the annual rate of population growth has in* *creased tubect* *omies being performed annually, and 600,000 vasectomies. There are incentives, in cash
McCarthy, John E.
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
David Sokal; Belinda Irsula; Mario Chen-Mok; Michel Labrecque; Mark A Barone
\\u000a This is an operation that is seldom indicated and normally used as a last resort, in the treatment of pain. The main indications\\u000a include post-vasectomy epididymal engorgement, complex epididymal cyst disease, chronic recurrent epididymitis, and epididymal\\u000a tuberculosis resulting in caseation and a firm expanding mass not responding to antibiotic treatment.
Hashim Hashim; Paul Abrams
DTP’s Biological Testing Branch oversees animal-production facilities that produce inbred, outbred, and hybrid strains of rats and mice. This program provides researchers nationwide with genetically defined, pathogen-free laboratory animals, as well as animal-related services such as jugular vein cannulations, vasectomies, ovariectomies, and castrations.
The defendant physician was charged with negligence and breach of contract in the performance of a tubal ligation on the plaintiff. After the plaintiff became pregnant and gave birth to twins, she and her husband sought damages for pecuniary losses resulting from the birth of twins, claiming that the defendant should have warned them of the risk of failure of the operation or mentioned the alternative of performance of a vasectomy on the husband. The Supreme Court of Victoria, Australia, held that the defendant had no duty to inform the plaintiffs of the risk of failure or the alternative of a vasectomy since his actions accorded with accepted practice within the profession. It also concluded that, even if he had warned the plaintiffs, they would not have withheld their consent to the operation. PMID:12289437
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. PMID:21933954
Drabovich, Andrei P; Jarvi, Keith; Diamandis, Eleftherios P
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
Male sterilization (vasectomy) is more successful, safer, less expensive, and easier to perform than female sterilization (tubal ligation). However, female sterilization is more popular, due to male fear of vasectomy complications (e.g. incision, bleeding, infection, and scrotal pain). The development of a completely noninvasive vasectomy technique may allay some of these concerns. Ytterbium fiber laser radiation with a wavelength of 1075 nm, average power of 11.7 W, 1-s pulse duration, 0.5 Hz pulse rate, and 3-mm-diameter spot was synchronized with cryogen cooling of the scrotal skin surface in canine tissue for a treatment time of 60 s. Vas thermal lesion dimensions measured 2.0 +/- 0.3 mm diameter by 3.0 +/- 0.9 mm length, without skin damage. The coagulated vas bursting pressure measured 295 +/- 72 mm Hg, significantly higher than typical vas ejaculation pressures of 136 + 29 mm Hg. Noninvasive thermal coagulation and occlusion of the vas is feasible.
Cilip, Christopher M.; 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 the scrotal skin to reduce both the laser power necessary for successful noninvasive laser vasectomy and the probability of scrotal skin burns. A mixture of DMSO/glycerol was noninvasively delivered into the scrotal skin using a Madajet. Near-infrared laser radiation with a range of average powers (7.0-11.7 W) was delivered in conjunction with a range of cryogen spray cooling rates (0.20-0.33 Hz) to the skin surface in a canine model, ex vivo and in vivo. Burst pressure (BP) measurements were conducted to quantify the strength of vas closure. A 30-min application of the OCA improved skin transparency by 26 +/- 5 %, reducing the 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 optical clearing agent reduced the laser power necessary for successful noninvasive thermal coagulation of the vas by approximately 25%. This technique may result in the use of a less expensive laser system 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 ~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.
Because of unavoidable complications of vasectomy, this study was undertaken to assess the efficacy and safety of male sterilization with a nonobstructive intravas device (IVD) implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy (NSV). IVDs were categorized into two types: IVD-B has a tail used for fixing to the vas deferens (fixed wing) whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A (n = 487), IVD-B (n = 485) or NSV (n = 487) groups and underwent operation. Follow-up included visits at the 3rd–6th and 12th postoperative months. The assessments of the subjects involved regular physical examinations (including general and andrological examinations) and semen analysis. The subjects’ partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests. There were no significant differences in pregnancy rates (0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV) among the three groups (P > 0.05). The cumulative rates of complications at the 12th postoperative month were zero, 0.9% and 1.7% in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method. PMID:24589454
Lu, Wen-Hong; Liang, Xiao-Wei; Gu, Yi-Qun; Wu, Wei-Xiong; Bo, Li-Wei; Zheng, Tian-Gui; Chen, Zhen-Wen
Because of unavoidable complications of vasectomy, this study was undertaken to assess the efficacy and safety of male sterilization with a nonobstructive intravas device (IVD) implanted into the vas lumen by a mini-surgical method compared with no-scalpel vasectomy (NSV). IVDs were categorized into two types: IVD-B has a tail used for fixing to the vas deferens (fixed wing) whereas IVD-A does not. A multicenter prospective randomized controlled clinical trial was conducted in China. The study was comprised of 1459 male volunteers seeking vasectomy who were randomly assigned to the IVD-A (n = 487), IVD-B (n = 485) or NSV (n = 487) groups and underwent operation. Follow-up included visits at the 3 rd -6 th and 12 th postoperative months. The assessments of the subjects involved regular physical examinations (including general and andrological examinations) and semen analysis. The subjects' partners also underwent monitoring for pregnancy by monthly interviews regarding menstruation and if necessary, urine tests. There were no significant differences in pregnancy rates (0.65% for IVD-A, 0 for IVD-B and 0.21% for NSV) among the three groups (P > 0.05). The cumulative rates of complications at the 12 th postoperative month were zero, 0.9% and 1.7% in the three groups, respectively. In conclusion, IVD male sterilization exhibits a low risk of long-term adverse events and was found to be effective as a male sterilization method, similar to the NSV technique. IVD male sterilization is expected to be a novel contraceptive method. PMID:24589454
Lu, Wen-Hong; Liang, Xiao-Wei; Gu, Yi-Qun; Wu, Wei-Xiong; Bo, Li-Wei; Zheng, Tian-Gui; Chen, Zhen-Wen
Adverse responses to protamine sulfate have been identified for many years. The antigen-antibody response to protamine sulfate results in a type I anaphylactic reaction. Manifestations of allergic reactions include hypotension, bronchospasm, and skin and mucous membrane reactions. The severity of the adverse responses may vary from mild to causing death. Several potential risk factors for adverse reactions to protamine have been identified, including insulin-dependent diabetes mellitus, vasectomy, allergy to fish, prior exposure to protamine sulfate, and the rate of infusion. A case study is presented, and strategies for improving patient outcomes are discussed. PMID:10580216
Porsche, R; Brenner, Z R
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
Our goal was to develop a robotic approach for vasoepididymostomy (RAVE) and vasovasostomy (RAVV) using a 4 arm High Definition Platform (Intuitive Surgical, CA) and present our human in-vivo results. All 3 RAVV procedures were successful and one patient had 102 million motile sperm/ml of ejaculate at 1 month post-op. The RAVE procedure patient only had a few non-motile sperm at 6 month follow up in his ejaculate. The use of robotics seems to offer advantages in terms of ergonomics and suture control. Further evaluation is needed to assess the clinical potential of robotics in vasectomy reversal.
Parekattil, Sijo J.; Cohen, Marc S.; Vieweg, Johannes W.
Use of the operative microscope marked a new era for microsurgery in male infertility and andrology in the 1970s. More than a decade has passed since the initial description of the first robotic-assisted microsurgical vasovasostomy. Large single-center series have recently been published on robotic-assisted microsurgery for vasectomy reversal, especially in the past few years. Multicenter studies are also beginning to be reported, and the potential for this new platform for microsurgery is starting to become more apparent. This article describes the basic technical details of robotic-assisted microsurgery in male infertility and andrology, and reviews the latest literature. PMID:25306167
Gudeloglu, Ahmet; Brahmbhatt, Jamin V; Parekattil, Sijo J
The screening and confirmatory tests available to a forensic laboratory allow evidence to be examined for the presence of bodily fluids. With the majority of evidence being submitted involving sexual assaults, it is important to have confirmatory tests for the identification of semen that are straightforward, quick, and reliable. The purpose of this study was to compare two commonly used semen identification kits utilized by forensic laboratories: ABAcard(®) p30 and Rapid Stain Identification of Human Semen (RSID™-Semen). These kits were assessed with aged semen stains, fresh and frozen post-vasectomy semen, post-coital samples collected on different substrates, post-vasectomy semen mixed with blood, saliva, and urine, a series of swabs collected at increasing time intervals after sexual intercourse, and multiple non-semen samples. The test kits were compared on the basis of sensitivity, specificity, and the cost and time effectiveness of each protocol. Overall, both semen identification tests performed well in the studies. Both kits proved specificity for identifying semen, however the ABAcard(®) p30 test surpassed the RSID™-Semen test in sensitivity, cost per test, and simplified test protocol. PMID:24237835
Boward, Emily S; Wilson, Stacey L
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. In this study, 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 6 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.
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. PMID:21116362
Parekattil, Sijo J.; Moran, Michael E.
Women in a small coastal village in western India were asked to explain their preference for female sterili-zation over modern reversible contraceptive methods. Married women aged 19+ years were interviewed in six focus groups (n=60) and individually (n=15) regarding contraceptive methods and their use and side-effects. Women publicly denied contraceptive use but privately acknowledged limited use. They obtained contraceptive information from other village women and believed that modern reversible methods and vasectomy have high physical and social risks, and fertility goals could be achieved without their use. Women felt that reversible contraception is undesirable, socially unacceptable, and usually unnecessary, although the achievement of fertility goals is likely due to the use of female sterilization with abortion as a back-up method. Economic migration of village men may also play a role. Although women with high social capital can effectively disseminate correct knowledge, the impact on the uptake of reversible method is uncertain. PMID:18686557
Hall, Mary Ann Kirkconnell; Stephenson, Rob B.; Juvekar, Sanjay
Duplication of vas deferens is a rare congenital anomaly. All previously reported cases of this rare anomaly were identified during procedures such as orchiepexy, inguinal hernia repair, vasectomy, varicocoelectomy, and radical prostatectomy. Here, we report a case of unilateral duplicated vas deferens noted in an adult cadaver during regular dissection for medical students. The right spermatic cord contained 2 separate and completely developed cord-like structures. Both cords communicated separately with the tail of the epididymis. When traced cranially, both traversed the inguinal canal as content of the spermatic cord and finally fused at the level of the deep inguinal ring. No other variations were found in the testis or epididymis, and no variations were seen in the left spermatic cord. In addition, no associated renal abnormalities were noted. PMID:23560239
Sirasanagandla, Srinivasa Rao; Nayak, Satheesha B.; Jetti, Raghu
Duplication of the vas deferens is a very rare congenital anomaly in which two vasa deferentia coexist within the spermatic cord. Duplication of the vas deferens can be found during herniorrhaphy, vasectomy, and varicocelectomy performed on the spermatic cord or around the spermatic cord. However, it is estimated that the incidence of duplication of the vas deferens is under-reported and under-recognized. Unless anomalies of the vas deferens such as duplication of the vas deferens are recognized by surgeons, it will be difficult to reduce vas deferens injuries and achieve a satisfactory surgical outcome. In addition, care should be taken in cases of duplication of the vas deferens because it can be complicated by non-testicular genitourinary anomalies. We report a case of duplication of the vas deferens discovered during routine varicocelectomy. PMID:24459663
Lee, Jun Nyung; Kim, Hyun Tae; Chung, Sung Kwang
In March 2009, a 25-yr-old captive female African elephant (Loxodonta africana) underwent an exploratory laparoscopy after several weeks of diarrhea, submandibular and ventral edema, and swelling on medial and lateral aspects of all feet. Although there have been recent advances in laparoscopic vasectomies in free-ranging African elephants in South Africa utilizing specially designed rigid laparoscopes and insufflation devices, this was the first attempt at using these same techniques for an exploratory purpose. The elephant was sedated in a static restraint chute and remained standing for the duration of the procedure. Laparoscopy provided visibility of the dorsal abdomen, enabled collection of reproductive tract biopsies and peritoneal fluid samples, and allowed for instillation of antibiotics and crystalloid fluids directly into the abdominal cavity. Abdominal exploration, collection of tissue samples, and local therapy is possible via standing laparoscopy in megavertebrates. PMID:25632688
Sweet, Julia; Hendrickson, Dean A; Stetter, Mark; Neiffer, Donald L
The San Francisco Men's Reproductive Clinic in Chinatown has been disseminating general health and contraceptive information as an adjunct to the women's family planning clinic at Health Center 4. Most of the diverse group of patients are in their 20 's, 15% are over 40. The men receive checkups, sex counseling, contraceptive devices, vasectomy referrals, treatment of sexually transmitted diseases, and general information on blood pressure, heart disease, cancer, nutrition and occupational health. The clinic operates one day a week at two locations under a grant from HEW. Response from males in the community has been enthusiastic, especially in how staff has responded to their needs. The clinic's outreach program has had no trouble locating men in the community. PMID:12277855
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
In an interview with Family Planning World, Helen Axby of the Marie Stopes Clinics explains that the organization's growth at a time when the number of abortions in Great Britain has begun to decline is due to successful management and marketing. Although the British government provides from abortion services, the Marie Stopes Clinics performs over 25,000 abortions a year. According to Axby, the main reason for this is that government restrictions have created a cumbersome process where women often wait 3-4 weeks to receive an abortion. At the Stopes clinics, women receive prompt treatment in a comfortable setting. A consultation is scheduled within a day or two following the initial phone call, and the operation is scheduled at the woman's convenience. Axby explains that the organization conducts extensive advertisement in the Yellow Pages, local newspapers, and women's magazines. Though the clinic operates for profit, its services are far less expensive than what it would cost to obtain them at other private offices. In 1990, the organization grossed about 6.2 million pounds (profits were around 1 million pounds). The profits are used to fund overseas projects. Because of the decline in the number of abortions in Britain, Axby expects the organization to earn less this year. However, Marie Stopes clinics plans to fight to increase its market share of family planning services. Its fastest growing service is vasectomy. Relying on the noninvasive bipolar diathermy technique, the Stopes Clinics have made vasectomy a more simple and comfortable experience for men. Other services include employee screening (for pap smears, breast checks, etc.). Finally, Axby says that the organization might also increase its market share by acquiring its competitors. PMID:12284512
Snyder, J D
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
Any successful development program that combines family planning, nutrition, and parasite control such as the integrated project, must include effective information, education, and communication (IEC) components. The Population an Community Development Association (PDA), the largest nonprofit organization in Thailand provides a network of family planning service delivery composed of volunteer distributors including midwives, school techers and shopkeepers. Reliability and accessibility are the 2 important elements. A concerted media campaign which exposes people to condoms and other contraceptives helps desensitize an otherwise "too personal" issue. The problem which confronts family planning communication is how to counteract the sensuous messages form advetisers while focusing on mundane topics such as maternal and child health, responsible parenthood, and family budgets. The PDA has tried to use the same attractions to promote family planning. It distributes promotional items such as T-shirts, pens towels and cigarette lighters bearing family planning messages. In addition to the use of television and radio, PDA also utilizes every possible channel of communication. Approaches include: the Youth-to-Youth Program; informational exhibits; video-mobile vans which visit schools and factories; and the holding of PDA's vasectomy festivals. Informational exhibits on family planning and health care use a variety of audio-visual methods. Video is an effective communication medium. The PDA video material ordinarily consists of family dramas illustrating good and bad family planning practices. By holding vasectomy festivals, PDA provides a media-attracting forum to educate the public and promote vasectomey as the most effective birth control method. Mass media campaigns must be linked with fieldwork outreach. PMID:12314464
Since 1975, sterilization operations, on both men and women have been performed with increasing frequency within the National Health Service in the North Tyneside Area in northeast England. A prospective study was undertaken to discover some of the reasons why healthy young men and women chose surgical sterilization rather than use the established reversible methods of family planning available to them. The study examined some of the characteristics of those requesting sterilization, attempted to understand why they did so at that particular time, and assessed the patient-perceived morbidity resulting from this elective procedure. The study population included all individuals referred for consultation following the patient's request for voluntary sterilization by vasectomy or occlusive tubal surgery, during the period of 1 year (August 1, 1980-July 31, 1981). Women sterilized in association with a pregnancy outcome were not included in the study. Data on pregnancies and sterilizations in North Tyneside demonstrate a rapid increase in requests for vasectomy after 1975. Patients requesting sterilization were admitted to the study during the initial out-patient appointment with their surgeon. Couples seeking sterilization show similar age range for men (mean 34.2) and women (33.1). The proportion of patients who were not married at the time of the operation is perhaps a reflection of doctors' increasing willingness to perform sterilizations on the unmarried, and of individuals to seek such surgery in a committed manner. The increasing tendency for requests to be received from people still in their early 20s is seen as a problem. Data indicates that married people who request the operation at an early age are also those who were married under age 21, started a family immediately and with a 25% divorce rate. At the other end of the age range, couples who ahve been sucessfully using oral contraceptives have become concerned about its safety, especially after age 35. Data indicates husbands are prepared to admit to their worries about longterm pill use and to request an alternative method of fertility control that involved them instead of their wives. Comparisons between the results of this survey and those of the Teeside survey on female sterilization between 1966-70, indicate a change in usage. The greatest difference in practice over the 12 year period was in the use of coitus interruptus, which declined sharply. It is suggested that the continued rise in the demand for sterilization may be a function of the economic recession, a relationship which needs further investigation. PMID:6725306
The idea that men should participate in family planning by playing an active role in contraception has become more acceptable in recent years. Up to the present the condom and vasectomy have been the main methods of male contraception. There have been and continue to be efforts to develop an acceptable hormonal contraceptive involving testosterone (T) suppression. However the off target affects, delivery of the analogs and the need for T replacement have proven difficult obstacles to this technology. Research into the development of non-hormonal contraception for men is progressing in several laboratories and this will be the subject of the present review. A number of promising targets for the male pill are being investigated. These involve disruption of spermatogenesis by compromising the integrity of the germinal epithelium, interfering with sperm production at the level of meiosis, attacking specific sperm proteins to disrupt fertilizing ability, or interfering with the assembly of seminal fluid components required by ejaculated sperm for acquisition of motility. Blocking contractility of the vas deferens smooth muscle vasculature to prevent ejaculation is a unique approach that prevents sperm from reaching the egg. We shall note the lack of interest by big pharma with most of the support for male contraception provided by the NIH. PMID:24368213
Murdoch, Fern E; Goldberg, Erwin
150 boys and girls in rural Hyderabad, ranging from 8-15 years of age, were assessed for physical and sexual growth, knowledge about human reproduction, attitudes toward family planning and the source of their knowledge. Most of the children were 11-13 years of age and Hindus, while 50% were school-going (Table 1). Girls exhibited an increase in height at 10-11 years of age and weight at 12 years, began puberty at 11-13 years and attained menarche at 13-14 years while the boys increased in height and weight at 14 years, began puberty at 11-13 years and achieved ejaculation at 14-15 years (Figures 1-2; Tables 2a-2b). 80% of the girls and more than 50% of the boys over the age of 11 years had some knowledge about pubertal changes, sexual growth, conception, child birth, tubectomy and vasectomy but only 20% were familiar with temporary contraceptive methods--Loop, pills and condom (Table 3). The main source of information among boys was friends and family planning propaganda while the girls it was elders, friends and family planning propaganda (Table 4). Most of the boys and girls were in favor of implementing family planning, opted for a family size of less than 3 children, desired a male child and chose 15 years for girls and 18 years for boys as the ideal marriage age (Table 5). PMID:680959
Kishore, N; Mathur, Y C; Qureshi, S; Pershad, B
Telomeres, the protective structures at the outmost ends of chromosomes, shorten in all somatic cells with each cell-division and by cumulative oxidative damage. To counteract that these shortened telomeres are passed on to offspring, the telomeres are elongated by the enzyme, telomerase, during human spermatogenesis. A few groups have tried to elucidate this process by measuring telomerase activity in the various cell-types during spermatogenesis, but until now, no one has ever measured telomere length (TL) during these different stages in humans. Some groups have measured TL in spermatozoa and surprisingly found that telomeres of older men are longer, than those from younger men. To elucidate this phenomenon we investigated if the distribution of TL over the various precursor germ cells in old males differed from young males, perhaps indicating a more ubiquitous telomere elongation in testes from older men. We therefore obtained testicular biopsies from 6 older and 6 younger men undergoing vasectomy. The cells were suspended as single cells and smeared onto slides, followed by characterization of cell stages by phase contrast microscopy. Mean TL in individual cells was subsequently measured by telomere QFISH. Our data revealed no difference in the TL profile during spermatogenesis between younger and older men. All men had a similar profile which strongly resembled the telomerase expression profile found by others. This indicates that the longer telomeres in older men are not caused by a wider window of telomere elongation, stretching over more cell-types of spermatogenesis. PMID:23764353
Jørgensen, Pernille Bach; Fedder, Jens; Koelvraa, Steen; Graakjaer, Jesper
In the context of an extension of Axelrod's model for social influence, we study the interplay and competition between the cultural drift, represented as random perturbations, and mass media, introduced by means of an external homogeneous field. Unlike previous studies [J. C. González-Avella et al., Phys. Rev. E 72, 065102(R) (2005)], the mass media coupling proposed here is capable of affecting the cultural traits of any individual in the society, including those who do not share any features with the external message. A noise-driven transition is found: for large noise rates, both the ordered (culturally polarized) phase and the disordered (culturally fragmented) phase are observed, while, for lower noise rates, the ordered phase prevails. In the former case, the external field is found to induce cultural ordering, a behavior opposite to that reported in previous studies using a different prescription for the mass media interaction. We compare the predictions of this model to statistical data measuring the impact of a mass media vasectomy promotion campaign in Brazil.
Mazzitello, Karina I.; Candia, Julián; Dossetti, Víctor
The Japan Family Planning Association (JFPA), begun in 1955, is a private self-supporting organization in cooperation with the government and local agencies. JFPA supports family planning and maternal health programs at the grassroots level by training family planning workers in a 40 hour course, publishing a monthly newsletter, producing educational materials, distributing contraceptives, operating family planning clinics, telephone counseling, and genetic counseling by physicians. Most of its workers are midwives who now work in hospitals and public health nurses. Contraceptive methods in use in Japan are: condoms 77% behavioral methods 31%, female sterilization 5.8%, IUD 5.3%, pill 1.7%, vasectomy 1.6% and spermicides 0.5%. 65% of the condoms are sold in pharmacies, but a large proportion of contraceptive supplies are distributed by home visitors working with the JFPA. These workers are highly skilled and tactful in approaching clients, avoiding embarrassment in front of elderly or adolescent family members. They are supervised by JFPA mobile guidance teams regularly. the JFPA insists on its financial self-reliance to maintain independence, worker morale, and fiscal responsibility. To maintain self-reliance, no new facilities will be opened, although the emphasis will shift toward reducing the high abortion rate in women over 30 and in adolescents. PMID:12342109
Object Meningioma is a disease with considerable morbidity and is more commonly diagnosed in females than in males. Hormonally related risk factors have long been postulated to be associated with meningioma risk, but no examination of these factors has been undertaken in males. Methods Subjects were male patients with intracranial meningioma (n = 456), ranging in age from 20 to 79 years, who were diagnosed among residents of the states of Connecticut, Massachusetts, and North Carolina, the San Francisco Bay Area, and 8 counties in Texas and matched controls (n = 452). Multivariate logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between hormonal factors and meningioma risk in men. Results Use of soy and tofu products was inversely associated with meningioma risk (OR 0.50 [95% CI 0.37–0.68]). Increased body mass index (BMI) appears to be associated with an approximately 2-fold increased risk of developing meningioma in men. No other single hormone–related exposure was found to be associated with meningioma risk, although the prevalence of exposure to factors such as orchiectomy and vasectomy was very low. Conclusions Estrogen-like exogenous exposures, such as soy and tofu, may be associated with reduced risk of meningioma in men. Endogenous estrogen–associated factors such as high BMI may increase risk. Examination of other exposures related to these factors may lead to better understanding of mechanisms and potentially to intervention. PMID:24484233
Schildkraut, Joellen M.; Calvocoressi, Lisa; Wang, Frances; Wrensch, Margaret; Bondy, Melissa L.; Wiemels, Joseph L.; Claus, Elizabeth B.
Reproductive health programs have focused their attention on women; in general, they have not worked much with men. Gender is not only a determinant of inequality, but it also provides explanations for the different factors that have an impact on men and women's health, their disease and their death. This article addresses the factors that are prioritized over the information and decisions concerning the exercise of sexuality and how to regulate reproduction. With regards to the beginning of sexual life, men seem to start earlier, in average, they have their first sexual relation at 16.8 years old. As to the use of contraceptive methods, currently 54.2% of men declare to use them. Out of these, 39.5% choose modern methods whereas 14.5% prefer traditional ones. In Peru, among the modern methods available are the barrier methods (the condom being the most used), the chemical methods or spermicides, and the surgical methods (vasectomy). Among the traditional ones are the "rhythm" based on abstinence during the fertile phase of the menstrual cycle, and the coitus interruptus. The father's role is one of power. Gender relations are relations of power, and parenthood is part of these relations. The father is, above all, the provider of filiation. Marginalization of men in the reproductive process is evident. Their support to their partner is suboptimal, whether it is during pregnancy, during delivery or to prevent the death of the mother. PMID:24100826
The government of Bangladesh and the World Bank commissioned a Compensation Payments Study, carried out in 1987, to assess the merits and demerits of payments for sterilizations to clients, medical personnel, and intermediaries who motivate and refer clients. The study conclusively shows that the decision of Bangladeshi men and women to undergo sterilization is a considered and voluntary act, taken in knowledge of the nature and implications of the procedure, and in knowledge of alternative methods of regulating fertility. There is a high degree of client satisfaction among those who have been sterilized, although among clients who had fewer than three children, 25 percent expressed regret that they had been sterilized. Money may be a contributing factor to the decision to become sterilized in a large majority of cases, but a dominant motive for only a very small minority. Payments to referrers have fostered a large number of unofficial, self-employed agents--particularly men who recruit vasectomy cases. These agents provide information about the procedures for being sterilized, particularly to the poor. They also concentrate on sterilizations to the exclusion of other methods, and are prone to minimize the disadvantages and exaggerate the attractions of sterilization. PMID:2038754
Cleland, J; Mauldin, W P
Bioethics has still not acquired an identity of its own in Peru. The Ethics Committee of the Peruvian Medical School and the National AIDS Commission are review committees that deal with ethical problems arising in practice. Doubts regarding quality control of the drugs being tested have been raised in research on human subjects. Questions related to reproduction are very important. There is a high incidence of adolescent pregnancies, and illegal abortions result in many deaths and hospitalizations of women in serious condition. Birth control methods, such as vasectomy, conflict with attitudes about manhood in Peruvian society. Euthanasia is prohibited by the Ethical Code of the Peruvian Medical School, and legislation penalizes assisted suicide. Organ transplantation is hindered by concerns over early declaration of death. Handicapped children are often rejected by society owing to an absurd belief in the possibility that disorders such as Down's syndrome are contagious. The Ministry of Health requires state hospitals to accept AIDS patients, but instances of rejection are still reported. PMID:2144140
Zuloaga, R L
Acceptable antifertility drugs for men are proving difficult to produce. Such drugs must aim to achieve complete azoospermia over a long period. This requirement may be relaxed only if it can be shown that the residual sperm produced by men whose spermatogenesis has been suppressed by antifertility drugs to oligospermia are incapable of fertilizing ova. Hormonal methods involving suppression of the secretion of gonadotrophin hormones by the pituitary gland invariably require androgen supplementation, and the use of steroids either alone or in combination requires careful monitoring for their side-effects. A chemical (non-hormonal) approach involving the incapacitation of sperm in the epididymis has been shown to be feasible in animal studies using ?-chlorohydrin and 6-chloro-6-deoxy sugars, although such compounds cannot be developed for human use because of their toxicity. Immunological approaches have the inherent problem of delivery of the antibody to the target. While the search for new and safer chemical and hormonal approaches goes on, the recent evidence that vasectomy offers a safe surgical option leaves responsible men with some choice to add to the condom. PMID:3091279
Waites, G. M. H.
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. PMID:22069412
Ehsanpour, Soheila; Mohammadifard, Maedeh; Shahidi, Shahla; Nekouyi, Nafise Sadat
Surgical sperm recovery has become a well-established procedure to obtain spermatozoa for intra-cytoplasmic sperm injection (ICSI). Although a tendency exists to treat all azoospermic patients by ICSI using surgically retrieved sperm, vasovasostomy remains the gold standard for post-vasectomy azoospermia. In men with obstructive azoospermia in whom vasovasostomy is not indicated, sperm can be easily obtained by either aspiration from epididymis or testis, or a testicular biopsy. In about half of men with non-obstructive azoospermia, sperm may be obtained by testicular biopsy but unfortunately no accurate tests are currently available to predict successful recovery. In these patients, not only recovery rates are limited but also the chance to establish an ongoing pregnancy is decreased compared to men with normal spermatogenesis. When no spermatozoa are recovered after testicular sperm extraction (TESE), the use of donor sperm or adoption is indicated. Given the extremely low pregnancy rates, ICSI using round spermatids is not an option and remains unlawful in some countries. PMID:21117934
From a population of men applying for voluntary sterilization, 100 consecutive cases were selected according to the following criteria: (1) each man had fathered at least two children; (2) at the time of the request for a vasectomy the man's wife was pregnant; and (3) a complete prevasectomy semen analysis, including sperm morphology, was available. The usual parameters of human semen evaluation are reported: the mean volume of the ejaculates was 3.3 ml +/- 0.84 SD (range, 0.5 to 11 ml); the mean sperm density was 81 million/ml +/- 57 SD (range, 4 to 318); while the geometric mean, which according to the sample distribution is more representative, was 68. The mean percentage of motile sperm was 63% +/- 16 SD (range, 10 to 95%); the grade of forward progression was 3 +/- 0.55 SD (range, 2 to 4); and for sperm morphology the mean number of sperm with oval heads was 75% +/- 6 SD (range, 21 to 90%). Statistical comparison of these findings with those of our previous study of the semen of 1300 fertile men revealed complete agreement; minor statistical differences, on single parameters, with three similar studies are indicated. A positive relationship between the different variables, sperm density and sperm motility (in percentage of motile sperm and degree of forward motion), as well as between the two variables of sperm motility and sperm morphology to the other variables was confirmed. PMID:1183628
Sobrero, A J; Rehan, N E
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). PMID:23241637
Parekattil, Sijo J; Gudeloglu, Ahmet
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. PMID:20579640
Borrero, Sonya; Abebe, Kaleab; Dehlendorf, Christine; Schwarz, Eleanor Bimla; Creinin, Mitchell D.; Nikolajski, Cara; Ibrahim, Said
The reliability of a Korean black goat (Capra hircus coreanae) to detect estrus in Himalayan tahrs (Hemitragus jemlahicus) for an artificial breeding program was investigated. Estrus in six female Himalayan tahrs was synchronized using fluorogestone acetate (FGA) sponges. Thirteen days later, 200 IU of PMSG and 100 IU of hCG were injected before removing the sponges and simultaneously injecting 5 mg of PGF2? the next day. Penetration of the cervical canal and the thickness and location of red crayon marks were examined 40~43 h later. Two females treated with sponges containing 60 or 45 mg of FGA had estrogen levels of 8.7 and 11.1 pg/mL, respectively. No red marks were found on the backs of these two tahrs. The remaining females had higher levels of estradiol, and the red crayon marks were clearly shown. The cervical folds of these tahrs were readily penetrated and the insemination gun was smoothly inserted into the uterine body. In conclusion, a Korean domestic goat with its chest crayon-harnessed was successfully used to detect estrus of Himalayan tahrs. This technique might be utilized as a part of breeding programs for wild goats and avoid the need for a vasectomy of conspecific males. PMID:24690603
A minimum bonus of Rs.100.00 ($6) will now be paid to any employed person voluntarily undergoing sterilization in Sri Lanka. Women will be given 7 days extra leave and men 3 days. The bonus is compensation for out-of-pocket expenses and time for recovery. Many public and private corporations, e.g., the tea industry, pay sterilization bonuses, sometimes in excess of Rs. 100. A bonus of Rs. 500 is awarded women and Rs. 300 is awarded men by rubber, tea, and coconut plantations owned by the state. It is hoped that all adults in Sri Lanka, including the unemployed, will soon be covered by a system of sterilization bonuses. A UNFPA-sponsored project will equip 85 of the country's 117 smaller hospitals and train their staff to perform vasectomies and mini-lap operations under local anesthesia. 7 out of 10 of 370,000 births per year occur in hospital or some other medical facility. Population committees have been set up in several districts with divisional and village committees backing them up. These committees will be used as centers for discussion, motivation, provision of services, and referral. The Ministry for Family Health and the Community Development Services Organization will expand the provision of Depo-Provera, which is increasingly popular in Sri Lanka, especially among Moslem communities. PMID:12309762
The discussion identifies some of the issues in counseling for sterilization and outlines the information which the counselor should make available to the couple. The most appropriate person to counsel a couple about sterilization is usually their general practitioner. He/she already will have some background knowledge about the couple, which will shorten the information-gathering part of the counseling process and help in understanding the problems the couple may experience in reaching their decision. Wherever the couple is seen, more than 1 consultation may be necessary. The basic requirement for counseling is an unhurried and nonthreatening atmosphere. Except in the unusual but increasing case of the man or woman without permanent partner, it is mandatory to see the couple together. This may seem obvious, yet many sterilizations (particularly for women) are still being carried out after a consultation with only 1 partner. Even though the counselor may already know the couple well, it is worth reviewing certain features of their situation. Age has been considered 1 of the most important factors in deciding whether to "allow" a sterilization. There is some disagreement among surgeons and gynecologists about this, so it is important to know what is available locally. If the couple have children and the vast majority of those requesting sterilization do, the age of these may be insignificant. Pregnancy is not a good time to make irreversible decisions, so immediate postpartum sterilization should probably be avoided except where the couple's decision predates the pregnancy. In the years since the liberalization of the divorce laws in the US, there has been a steady increase in the frequency of 2nd and 3rd marriages. In view of this, careful consideration should be given as to whether vasectomy, or female sterilization is appropriate. A high percentage of those who request a reversal of sterilization had their operation at a time when their relationship was unstable or had recently broken up, suggesting that some attempt should be made to assess the stability of the relationship. Many will choose sterilization as a last resort, having failed to find a reversible method of contraception which suits them. This is reasonable if all the possibilities have been explored, but many women who are happy on the combined oral contraceptive are being encouraged to change this for a sterilization at an unnecessarily early age. Couples need to know what is involved in sterilization, and the counselor requires local knowledge for this. In addition to knowing the technical details of the operation and understanding that its effects are only on fertility, there are a number of other points that should be discussed. These include: the failure rate, the reversibility of sterilization, the need for at least 2 sperm-free postoperative samples of seminal fluid before vasectomy can be considered effective, and the possibility of regretting the decision. PMID:4011572
Parsons, A D
Large, population-based studies of semen quality are encumbered by the logistics and expense of obtaining semen samples from men who live in a variety of locations. A prototype semen collection and transportation kit, the TRANSEM100, can be distributed to study participants and then directly shipped to a central laboratory for analysis. This study was designed to evaluate the ability of male volunteers to correctly use the kit. Thirty volunteers aged 20 to 44 years with no history of diabetes, recent chemotherapy, fertility problems, or vasectomy were recruited through a newspaper advertisement, interviewed to obtain demographic information, and instructed on the use of the kit. Twenty-six of the initial subjects provided at least 1 semen specimen using the kit and returned the specimens by overnight delivery to the laboratory for analysis, 25 completed a follow-up interview on the use of the collection kit, and 20 submitted a second semen sample using the same method. The average volunteer was white, 27.8 years old, and held at least a college degree. Forty percent of the volunteers were married. In general, participants correctly followed the instructions for collecting, packaging, and shipping the semen samples. Volunteers were instructed to collect samples after at least 2, but no more than 7 days of abstinence. For the first and second samples submitted, participants collected semen samples after an average of 3.3 and 3.9 days of abstinence, respectively. Seventeen (65%) of the samples from the first sampling period and 16 (80%) of the samples from the second period were received in the laboratory the day after they had been collected. In summary, the TRANSEM100 may prove to be useful for collecting human semen in field studies. Further testing of this method is warranted to evaluate preservation of sample quality and use of the kit by men among diverse socioeconomic groups. PMID:10819457
Royster, M O; Lobdell, D T; Mendola, P; Perreault, S D; Selevan, S G; Rothmann, S A; Robbins, W A
Hormonal contraceptives include oral pills with lower steroid concentrations such as the triphasic gestodene. A dose of less than 20 mcg of ethinyl estradiol in the combined pill is effective. The use of RU-486 or mifepristone to inhibit ovulation or as a postcoital method is still being investigated. The vaginal rings that release 20 mcg of levonorgestrel (LNG) have a 97% rate of efficacy. There are newer types that release 30 mcg of LNG or desogestrel. A progesterone-releasing ring used during lactation is being studied. Among implants Norplant has been approved in many countries, including by the US Food and Drug Administration, with excellent results. In Brazil it continues to be banned. Studies have been initiated about implants, such as Norplant 11 and UNIPLANT. The studies conducted by the World Health Organization on injectables such as Cyclofem (which contains 5 mg of estradiol cypionate and 25 mg of medroxyprogesterone acetate) as well as Mesigyna (5 mg of estradiol valerate and 50 mg of norethindrone enanthate) are awaited. These two monthly injectables have minor side effects, produce regular cycles, and are highly effective. The use of GnRH analogues for ovulation inhibition are held back because of cost, dosage, and routes of administration The hormonal IUD releasing 20 mcg of LNG holds promise for high efficacy, probable protection against inflammations, and pronounced reduction of menstrual bleeding, particularly in long-term use. The frameless IUD, called Flexigard, consists of 6 fixed copper cylinders placed in the myometrium, which causes less endometrial irritation and less incidence of inflammation, pain, and bleeding. It has been in an experimental testing phase for some years. The female condom helps prevent STDs and is under the woman's control. Among male contraceptives, a hormonal method awaits development, while gossypol with the ability to inhibit HIV proliferation and the Chinese method of scalpel-free vasectomy are effective methods. PMID:12345521
Andrade, A T
Cryopreservation techniques play today a central role in assisted reproduction, as they enhance the overall efficacy of in vitro fertilization (IVF) treatments by allowing the banking of supernumerary embryos obtained in these treatments, and their later use. The transfer of frozen/thawed embryos was established nearly 30 years ago, and although it has been clinical routine for a long time, the importance of freezing embryos has been newly emphasized. As recognized downsides of IVF treatment include the high prevalence of perinatal complications due to multiple births, the recommended practice of transferring fewer embryos in the fresh IVF treatment cycle, with the goal of performing single embryo transfer and the cryostorage of remaining embryos for their later use in frozen-thawed cycles, one at a time, is currently the trend. Also of great importance, cryopreservation techniques for spermatozoa and oocytes have additionally permitted gamete storage for long-term and the implementation of several new treatment modalities for assisted reproduction. Most of these methods are applied today in clinical programs of fertility preservation and third-part reproduction, such as sperm- and egg donor programs. Use of frozen thawed sperm has been in clinical use for over 50 years and banking sperm has been routinely offered to men, usually before gonadotoxic treatments, but also in many cases, practised as a "safety policy" previously to a vasectomy. Freezing methods for women's egg have required a much longer time to achieve a comparable effective clinical standard. Only recently, with the development of vitrification of oocytes, the clinical standard was recognized and since 2013 when the label "experimental" was removed, the freezing of oocytes could be regarded as an established method, and its use extended into clinical practice for fertility preservation but also performed after personal requirements, so called, "social freezing". PMID:25714875
Rodriguez-Wallberg, K A
The introduction of the technique of intracytoplasmic sperm injection to achieve fertilization, especially using surgically retrieved testicular or epididymal sperm from men with obstructive or non-obstructive azoospermia, has revolutionized the field of assisted reproduction. The techniques for the retrieval of spermatozoa vary from relatively simple percutaneous sperm aspiration to open excision (testicular biopsy) and the more invasive Micro-TESE. The probability of retrieving spermatozoa can be as high as 100% in men with obstructive azoospermia (congenital bilateral absence of the vas deferens, status post-vasectomy). However, in non-obstructive azoospermia, successful sperm retrieval has been reported in 10-100% of cases by various investigators. The surgical retrieval and cryopreservation of sperm, especially in men with non-obstructive azoospermia, to some extent ensures the availability of sperm at the time of intracytoplasmic sperm injection. In addition, this strategy can avoid unnecessary ovarian stimulation in those patients intending to undergo in vitro fertilization-intracytoplasmic sperm injection with freshly retrieved testicular sperm when an absolute absence of sperm in the testis is identified. Several different methods for the cryopreservation of testicular and epididymal sperm are available. The choice of the container or carrier may be an important consideration and should take into account the number or concentration of the sperm in the final preparation. When the number of sperm in a testicular biopsy sample is extremely low (e.g., 1-20 total sperm available), the use of an evacuated zona pellucida to store the cryopreserved sperm has been shown to be an effective approach. PMID:23503963
Gangrade, Bhushan K
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
Genital tract reconstruction has been attempted in subfertile men with obstructive azoospermia (370 patients) or unilateral testicular obstruction (80 patients), and in vasectomised men undergoing reversal for the first (130 patients) or subsequent (32 patients) time. Histopathological changes in the obstructed testes and epididymes, and immunological responses to the sequestered spermatozoa have been studied to gain insight into possible causes of failure of surgical treatment. The results of surgery have been assessed by follow-up sperm counts and occurrence of pregnancies in the female partners. The best results were obtained with vasectomy reversal (patency 90%, pregnancy 45%), even after failed previous attempts (patency 87%, pregnancy 37%). Epididymovasostomy gave good results with postinfective caudal blocks (patency 52%, pregnancy 38%), while postinfective vasal blocks were better corrected by total anatomical reconstruction (patency 73%, pregnancy 27%) than by transvasovasostomy (patency 9%, no pregnancies). Poor results were obtained with capital blocks (patency 12%, pregnancy 3%), in which substantial lipid accumulation was demonstrated in the ductuli efferentes; three-quarters of these patients had sinusitis, bronchitis or bronchiectasis (Young's syndrome). There is circumstantial evidence to suggest that this syndrome may be a late complication of mercury intoxication in childhood. After successful reconstruction, fertility was relatively reduced in those men who had antibodies to spermatozoa, particularly amongst the postinfective cases. Similarly, impaired fertility was found in men with unilateral testicular obstruction and antibodies to spermatozoa. Mononuclear cell infiltration of seminiferous tubules and rete testis was noted occasionally, supporting a diagnosis of autoimmune orchitis; although rare, this was an important observation as the sperm output became normal with adjuvant prednisolone therapy. Images Figure 4 Figure 6 Figure 7 Figure 10 Figure 11 Figure 12 Figure 14 PMID:2241062
Hendry, W. F.; Levison, D. A.; Parkinson, M. C.; Parslow, J. M.; Royle, M. G.
Objective The National Survey of Family Growth has been a primary data source for trends in US women’s contraceptive use. However, national-level data may mask differences in contraceptive practice resulting from variation in local policies and norms. Study Design We used the Pregnancy Risk Assessment Monitoring System), a survey of women who are 2–4 months postpartum. Information on women’s current method was available for 18 reporting areas from 2000–2009. Using the two most recent years of data, we computed the weighted proportion of women using specific contraceptive methods according to payment for delivery (Medicaid or private insurance) and examined differences across states. We used log binomial regression to assess trends in method use in 8 areas with consecutive years of data. Results Across states, there was a wide range of use of female sterilization (7.0–22.6%) and long-acting reversible contraception (LARC; 1.9–25.5%). Other methods, like vasectomy and the patch/ring, had a narrower range of use. Women with Medicaid-paid deliveries were more likely to report female sterilization, LARC and injectables as their method compared to women with private insurance. LARC use increased ?18% per year, while use of injectables and oral contraceptives declined by 2.5%–10.6% annually. Conclusions The correlation in method-specific prevalence within states suggests shared social and medical norms, while the larger variation across states may reflect both differences in norms and access to contraception for low-income women. Surveys of postpartum women, who are beginning a new segment of contraceptive use, may better capture emerging trends in US contraceptive method mix. Implications There is considerable variation in contraceptive method use across states, which may result from differences in state policies and funding for family planning services, local medical norms surrounding contraceptive practice, and women’s and couples’ demand or preference for different methods. PMID:24237967
White, Kari; Potter, Joseph E.; Hopkins, Kristine; Grossman, Daniel
The introduction of the technique of intracytoplasmic sperm injection to achieve fertilization, especially using surgically retrieved testicular or epididymal sperm from men with obstructive or non-obstructive azoospermia, has revolutionized the field of assisted reproduction. The techniques for the retrieval of spermatozoa vary from relatively simple percutaneous sperm aspiration to open excision (testicular biopsy) and the more invasive Micro-TESE. The probability of retrieving spermatozoa can be as high as 100% in men with obstructive azoospermia (congenital bilateral absence of the vas deferens, status post-vasectomy). However, in nonobstructive azoospermia, successful sperm retrieval has been reported in 10-100% of cases by various investigators. The surgical retrieval and cryopreservation of sperm, especially in men with non-obstructive azoospermia, to some extent ensures the availability of sperm at the time of intracytoplasmic sperm injection. In addition, this strategy can avoid unnecessary ovarian stimulation in those patients intending to undergo in vitro fertilization-intracytoplasmic sperm injection with freshly retrieved testicular sperm when an absolute absence of sperm in the testis is identified. Several different methods for the cryopreservation of testicular and epididymal sperm are available. The choice of the container or carrier may be an important consideration and should take into account the number or concentration of the sperm in the final preparation. When the number of sperm in a testicular biopsy sample is extremely low (e.g., 1-20 total sperm available), the use of an evacuated zona pellucida to store the cryopreserved sperm has been shown to be an effective approach. PMID:23503963
Gangrade, Bhushan K
Successful noninvasive laser coagulation of the canine vas deferens, in vivo, has been previously reported. However, the therapeutic window for treatment is relatively narrow. This study determines the dependence of vas thermal coagulation on laser wavelength for development of a noninvasive laser vasectomy procedure. Noninvasive laser coagulation of canine vas tissue, ex vivo, was performed using three commonly available near-infrared laser wavelengths: 808, 980, and 1075 nm. Each laser delivered an average power of 9.2 W, 500-ms pulse duration, pulse rate of 1.0-Hz, and 3.2-mm diameter laser spot, synchronized with cryogen spray cooling of the scrotal skin surface for a total treatment time of 60 s. Vas burst pressures were measured to determine strength of vas closure and compared to previously reported ejaculation pressures. Gross inspection of vas and scrotal skin was also performed immediately after the procedure as an indicator of thermal coagulation and skin burns. The 1075 nm laser produced the highest vas burst pressures (288 +/- 28 mmHg), significantly greater than previously reported ejaculation pressures (136 +/- 29 mmHg). The 808 nm wavelength produced insufficient vas burst pressures of 141 +/- 61 mmHg, and minor scrotal skin burns were observed in at least one case. The 980 nm wavelength was unable to produce thermal coagulation of the vas, with low burst pressures (89 +/- 58 mmHg) and severe scrotal skin burns. The 1075 nm wavelength was the only near-IR wavelength that consistently thermally coagulated the vas with a strong degree of closure and without any scrotal skin burns.
Cilip, Christopher M.; Schweinsberger, Gino R.; Fried, Nathaniel M.
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. This study builds upon previously reported ex vivo tissue studies by exploring acute and short-term chronic in vivo canine studies. Isolation of the canine vas was achieved using a conventional vas ring clamp method. No perforation of the scrotal skin was necessary to occlude the vas. Laser radiation with a wavelength of 1075 nm, average power of 11.2 W, 500-ms pulse duration, 0.5 Hz pulse rate, and 3-mm-diameter spot was synchronized with cryogen spray cooling of the scrotal skin surface in a total of 8 dogs (n = 16 vasa) for a treatment time of 60 s. Burst pressure measurements were conducted at Days 0 and 21 (n = 8 vasa each day) to quantify the strength of vas closure. The vas was successfully thermally occluded in 15/16 (94%) procedures with 14/15 (93%) vas recording burst pressures above ejaculation pressure. One vas was not present, and another vas recorded a bursting pressure below ejaculation pressure. The coagulated vas bursting pressure averaged 283 +/- 34 mm Hg at Day 0 and 260 +/- 77 mm Hg at Day 21, significantly higher than reported vas ejaculation pressures of 136 +/- 29 mm Hg. Minor scrotal skin burns were observed during the recovery period. Noninvasive thermal occlusion of the vas is feasible in an in vivo canine model. Elimination of minor skin burns and longer term chronic in vivo canine studies are needed to confirm azospermia after vas occlusion without recanalization.
Cilip, Christopher M.; Ross, Ashley E.; Jarow, Jonathan P.; Fried, Nathaniel M.
The Population Institute of Wuhan University in China conducted a field study on the family planning (FP) program in several cities and counties of Hubei Province in 1989. It was found that a number of aspects of the program were incompatible with what was needed to deal with the eminent population growth. 1) There was a shortage of FP personnel at the grassroots level. Those who were responsible for the FP program were often too busy with other things or did not have sufficient knowledge or experience for the job. 2) Publicity about the government FP policy was inadequate in many local areas. Out of 1,263 women with 2 or more children who responded to the study, only 5.3% had heard about the policy, 26.7% never read about FP and 43.7% never thought about the government birth control policy when trying to become pregnant. 3) Knowledge about birth control methods was in adequate for the needs of the people. 85% of the respondents knew about birth control methods, basically the IUD and female sterilization. Only 14.4% knew about oral contraceptives, 1.8% about vasectomy, and 1% about injectables. Knowledge of the rest of the methods was no more than 1%. Even local FP workers did not know much more. For those women who did not want to use surgical procedures, no alternatives were known. Therefore, no contraceptive method was used, thus unwanted pregnancies occurred. 4) Some methods of FP publicity in rural areas were overly simplistic. To some local FP workers, publicity only meant writing slogans with FP messages on the wall. Quite a few local workers did not know FP policies and regulations. They simply said "You have to pay a fine if you have too many children," making people believe that the FP program was no more than a way to collect money. The information gathered from the survey showed that publicity and education are of great importance to a FP program. They can either help the program implementation or cause adverse effects. PMID:12317525
The world population, currently estimated to be almost seven billion, is expected to double in less than four decades. The projected population growth will cause severe competition for existing resources, not to mention the issue of overcrowding of the planet and additional greenhouse gases that will have an adverse effect on the ecological health of the planet. A recent survey conducted by the United Nations Population Control Division shows that the majority of today's young men in many countries are willing to participate in family planning by taking full control of their fertility, an important global health issue. However, the contraceptive needs of tens of millions of men/couples go unmet every single day and results in millions of unwanted pregnancies. Ever since the approval of the birth control pill by the Food and Drug Administration (FDA) in 1960, scientists have been hoping for a male equivalent. It has, however, been a difficult road, in part because of the complicated science of the male reproductive system. It is easier to control a monthly event of ovulation in women than to regulate the production of millions of fertile spermatozoa every day in men. Thus, the contraceptive options for men have not changed in decades and are still limited to the use of condoms, a timely withdrawal/pulling out (coitus interruptus) or vasectomy, a minor surgical procedure in which the vas deferens is occluded to prevent the release of spermatozoa during ejaculation. The first two approaches have a relatively higher failure rate, whereas the last approach is largely irreversible and not suitable for younger men. In this article, we will discuss various approaches currently available for men to take control of their fertility. Our intention is to discuss the details of three similar approaches that will provide safe, affordable and reversible contraception for men and are close to being approved for use by millions of men around the globe. The availability of safe, reversible and reliable male contraceptives will allow men and women to take full control of their fertility in family planning. PMID:24654689
Tulsiani, Daulat R P; Abou-Haila, Aida
Current contraceptive methods are not well-suited to many Americans. More safe and effective methods would be desirable. A report, "Developing New Contraceptives: Obstacles and Opportunities" was released in January 1990. It summarized 2 years of data collection by the Committee on Contraceptive Development which includes pharmaceutical company executives, physicians, reproductive biologists, public health, legal, and public policy experts, demographers, and economists. Barrier facing the development of new methods in the US were analyzed and ways to speed up research suggested. Particularly ill served are teenagers, young mothers, and comparatively older couples. The health risks of pregnancy, delivery, and labor "may be underrated." The pill is now the most common form of contraception in the US, followed by female sterilization, condoms, and vasectomy. 95% of women, aged 15-44, who have ever had intercourse, have used 1 or more contraceptive methods. Contraceptive discontinuation and failure rates are high, too. No fundamentally new contraceptives have been approved for use since the IUD and the pill in the 60s. Modifications of existing methods are in clinical trials. Obstacles cited were attitudes of the public, federal regulations and product liability, and the organization of and resources available for research. Public attitudes are very conservative. There is no great demand for more products. Since the 1960s, only 1 large pharmaceutical company (Ortho Pharmaceutical Corp.) is still involved in contraceptive research. Activity by small firms, nonprofit organizations, and universities has increased. Federal research funding in reproductive biology has only increased modestly since the mid 1970s. Private foundation support has dramatically declined. The time involved in the great costs of data required for Food and Drug Administration (FDA) approval have reduced research incentives. The average time it takes to get FDA approval has increased in the past 20 years. Weighing the risks and benefits of contraceptives is different from doing that with other drugs, yet FDA procedures do not allow for this. Product liability laws are different in each of the 50 states. Contraceptive development was greatly damaged by the mid 1980s insurance crisis. The committee recommended that the FDA put more importance on the effectiveness and convenience of new contraceptives. A comprehensive postmarketing surveillance system should be set up, and congress should pass a federal products liability law. PMID:2379571
In Rwanda in 1991, ONAPO had 89,491 new acceptors of family planning. The increase in new acceptors peaked in 1983 (227.33%) and bottomed out in 1991 (8.54%). During 1981-1991, the most accepted method was injectables followed by oral contraceptives (OCs). In 1991, new acceptors of barrier methods increased 82.91%. IUD acceptance had stagnated since 1985. The number of social/health settings dispensing contraceptives increased each year (18 in 1981 to 316 in 1991). During 1981-1991, 49 secondary family planning posts became functional to facilitate accessibility to family planning services. The number of new acceptors in July was two times more numerous than the monthly mean of new acceptors recruited in 1991. The districts of Byumba, Kigali, and Ruhengeri recruited more than 45% of registered new acceptors in 1991. Cyangugu district and Kigali city were in last place in terms of size of new acceptors. Gisenyi and Kibungo districts had no implant acceptors. Cyangugu, Gitarama, Kibuye, and Kigali districts had no vasectomy acceptors. Gitarama had the biggest proportion of OC acceptors, even bigger than that for injectables. Contraceptive use increased each year. Ruhengeri district had the largest number of contraceptive users (19,319) followed by Byumba and Kigali districts (17,876 and 16,220, respectively). More than 60% of contraceptive users depended on injectables. IUD use was rare, except in Kigali city (8.3%). OC use and injectable use were used equally in Kigali city (31.7% and 33.3%, respectively). Overall, OCs and injectables were used by 87.8% of contraceptive users. December was the worst method in terms of contraceptive use. In December 1991, the national contraceptive prevalence rate was 12.6%, lower than the 1991 goal of 15%. At the beginning of 1991, Kigali City had a rate higher than the objective. Between January and December, Kigali City's rate increased from 19.7% to 21.7%. Byumba district had the best performance (15.4% in January to 14.6% in December). PMID:12290185
Background In the Netherlands, caesarean sections (CSs) are rarely combined with tubal occlusion (TO), partly because discussing CS/TO near delivery is considered unethical and earlier hypothetical counselling – i.e. suppose you happen to need a CS – is rare. This results in more unintended pregnancies and is inconsistent with informed choice. We explored whether TO should indeed not be made routinely available to eligible women. Methods and Findings A questionnaire was mailed to 515 Para ?2 who underwent in the past ?1 CS. 498 (96.7%) responded. They were on average 35.3 years old, had 2.5 children, had undergone 1.6 CSs, and 3.3 years had passed since their index delivery, either a CS (393) or vaginal birth (105) after a previous CS. 87% of the 498 believed that pregnant mothers with ?1 children should be routinely counselled about CS/TO. Indeed, 58% and 85% respectively, thought women/couples expecting their second or third child should still be given the TO option days before delivery, if omitted earlier. Counselled women, 138/498 (27.8%), were far more often satisfied than those without CS/TO option. 33/393 had a CS/TO. None indicated regret in the questionnaire. Another 119 also would have elected a CS/TO if given that option. Therefore, 152 (38.7%) of 393 Para ?2 had or would have liked a concurrent TO. 118/119 wrote they still regretted missing this opportunity. The exception's husband had had a vasectomy. 100/119 were good TO candidates: they were ?28 years when they delivered an apparently healthy baby of ?37 weeks. The current contraceptive use of these 100 suggests that this group will have at least 8 unintended pregnancies before age 50. Conclusion The experiences and opinions of previous potential candidates for a CS/TO do not support the reluctance of Dutch obstetricians to counsel pregnant Para ?1 about the TO option for a (potential) CS. PMID:21445338
Verkuyl, Douwe A.; van Goor, Gerda M.; Hanssen, Marjo J.; Miedema, Margreet T.; Koppe, Marnix
The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was 5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods. PMID:2285962
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