Authors: Matthiesson, Kati L.; McLachlan, Robert I.

Source: Human Reproduction Update, Volume 12, Number 4, July 2006 , pp. 463-482(20)

Publisher: Oxford University Press

Abstract:

Current male hormonal contraceptive (MHC) regimens act at various levels within the hypothalamic pituitary testicular axis, principally to induce the withdrawal of the pituitary gonadotrophins and in turn intratesticular androgen production and spermatogenesis. Azoospermia or severe oligozoospermia result from the inhibition of spermatogonial maturation and sperm release (spermiation). All regimens include an androgen to maintain virilization, while in many the suppression of gonadotrophins/spermatogenesis is augmented by the addition of another anti-gonadotrophic agent (progestin, GnRH antagonist). The suppression of sperm concentration to 1 × 10⁶/ml appears to provide comparable contraceptive efficacy to female hormonal methods, but the confidence intervals around these estimates remain relatively large, reflecting the limited number of exposure years reported. Also, inconsistencies in the rapidity and depth of spermatogenic suppression, potential for secondary escape of sperm into the ejaculate and onset of fertility return not readily explainable by analysis of subject serum hormone levels, germ cell number or intratesticular steroidogenesis, are apparent. As such, a better understanding of the endocrine and genetic regulation of spermatogenesis is necessary and may allow for new treatment paradigms. The development of an effective, consumer-friendly male contraceptive remains challenging, as it requires strong translational cooperation not only between basic scientists and clinicians but also between public and private sectors. At present, a prototype MHC product using a long-acting injectable testosterone and depot progestin is well advanced.

Keywords: contraception; FSH; LH; spermatogenesis; testosterone

Document Type: Research article

DOI: http://dx.doi.org/10.1093/humupd/dml010

Publication date: 2006-07-01

More about this publication?

• Human Reproduction Update, first published in 1995, aims to provide invited, comprehensive, authoritative, up-to-date critical and balanced reviews covering all areas of human reproduction including reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology and counselling, ethics and social issues. These papers are peer-reviewed to the highest editorial and scientific standards. Human Reproduction Update is published on behalf of the European Society of Human Reproduction and Embryology (ESHRE).

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