Update on Male Hormonal Contraception: Is the Vasectomy in Jeopardy?

GJ Manetti and SC Honig

Disclosures

Int J Impot Res. 2010;22(3):159-170. 

In This Article

Follow-up Semen Analysis Studies

For a contraception method to be effective and reliable with a reversible method, follow-up semen analysis data need to be readily available. With vasectomy, once one or two post-vasectomy semen analyses show no sperm, typically no further follow-up is necessary. However some partners of men may request or require regular semen analysis testing. Historically, this required a doctor's visit or lab drop off. Furthermore, as men's participation in the contraceptive process grows and population growth continues to represent a global concern, the demand for safer, cheaper and more reversible methods will increase as well. As we move toward this goal, a useful adjunct to measuring sperm suppression with a contraceptive may be the home immunodiagnostic SpermCheck® ContraVac, Charlottesville, VA, USA; Vasectomy kit. This home kit uses monoclonal antibodies that recognize the sperm-specific acrosomal protein SP-10. Although the second WHO study noted a significant difference in pregnancy rates between azoospermic patients and severely oligospermic (0.1–3 million sperms per ml) patients, most male contraceptives target sperm concentrations < 1 million sperms per ml. In a cohort study of 144 post-vasectomy semen samples, the device registered a negative result in sperm concentrations of approximately 385 000 sperms per ml. The test was positive in 100% of cases if sperm concentrations were greater than 385 000. More importantly, the device had a negative predictive value of 97% below this value.[99] The availability of a home test for easy confirmation and low-cost follow-up will make this a more palatable option to the average couple. Although this test will not differentiate between motile and nonmotile sperms (and therefore is not recommended after vasectomy), if we are testing for a value of less than 1 million sperms per ml, it should be very reliable.

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