Types of contraceptives for men. Male contraception

Male contraception tomorrow!

E. G. Shchekina, National Pharmaceutical University

Not all people who are sexually active want to have children. And this creates big problems for them, especially when they do not know how to avoid unwanted pregnancy.

Contraception is not only protection against unwanted pregnancy. This is the preservation of your health and the path to birth healthy child whenever you want it.

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The term "contraception" means protection against conception and comes from two Latin words: “contra” “against” and “conceptio” “conception, perception.” This is where the term “contraceptives” comes from, in other words “ contraception" In the broader sense of the word, contraception is a method of birth control that interrupts the natural progression of events from conception to birth. Modern medicine offers many methods to prevent unwanted pregnancy. Unfortunately, it must be admitted that there is no ideal contraception in the world yet.

Types and means of contraception differ from each other in the way they influence the body, effectiveness and ease of use (calendar and temperature methods, method of interrupted coitus, barrier, chemical methods; intrauterine devices; hormonal contraceptives, sterilization).

However, it must be recognized that most modern contraceptive methods are aimed at women and only a few are designed for men. There is a huge amount associated with male contraception and psychological problems. Many men, as we know very well, consider taking care of pregnancy prevention to be a purely female responsibility. Men are known not to get pregnant, and that's probably why they... fewer women concerned about contraception issues. And yet, men can and should take all possible part in protecting their partners from unwanted pregnancy. For this there are special methods male contraception.

Coitus interruptus method(coitus interruptus) means withdrawal of the penis before ejaculation begins. The method can be considered one of the most unreliable. The fact is that even with exclusive self-control a large number of sperm may be released at the beginning of sexual intercourse. It is believed that the effectiveness of the method does not exceed 70%, i.e. almost every third act can be dangerous. In addition, constant interruption of sexual intercourse can lead to a decrease in potency in a man.

Male condom a dense latex elongated bag, worn before sexual intercourse on a man’s erect penis. A condom prevents sperm from entering the vagina during sexual intercourse and prevents vaginal discharge from coming into contact with the man's penis, which prevents the spread of sexually transmitted infections. The condom is put on by the partner immediately before sexual intercourse and removed immediately after the end of sexual intercourse.

This is the most widely used method of mechanical contraception. It has virtually no contraindications, protects against HIV infection, and is easy to use. However, the condom can break, and its use requires some skill.

Sterilization in men Called a “vasectomy,” it involves cutting the vas deferens, which carries sperm from both testicles. About a month after a vasectomy, a man becomes completely infertile. The operation is quite simple, lasts 1520 minutes, is performed under local anesthesia. The man can return home immediately.

There is also alternative technique, where specially designed miniature valves are inserted into the vas deferens, which can be opened and closed again at will with a very small operation. In addition, a no-scalpel vasectomy technique has been developed in China, where the entire operation is performed through a miniature incision 35 mm long.

The operation can be more than just surgery. Then a substance is injected into the duct, which hardens and gives a contraceptive effect. During temporary sterilization, a soft rubber “plug” is inserted into the vas deferens, which can then be removed.

Previously, the main disadvantage of a vasectomy was that a man would be unable to conceive a child for the rest of his life. Currently, the operation of “reverse vasectomy” has been developed, when the crossed vas deferens are sutured again, and the man again becomes capable of fertilization. The ability to conceive a child is restored in 90% of cases.

It is important to note that sterilization does not affect sexual desire, potency and erection. After all, the testicles continue to work, hormonal background is not violated.

Thus, surgical techniques male contraception is very reliable and relatively safe. Their disadvantage is the need surgical intervention, as well as the presence of a low risk of irreversible contraception.

There is also such a little known method male contraception, like male spiral. It looks like a miniature umbrella and is inserted through the head of the penis into the scrotum. At the end of the spiral there is a gel that has a spermicidal effect.

Also in ancient japan invented a method of male contraception known as the “samurai egg”. Its essence lies in the fact that a man holds his testicles for several minutes every day for two months. hot water(about 40 degrees). As a result, he is not in danger of becoming a father for at least the next six months. In normal condition, the temperature of the scrotum is not higher than 36 degrees. When the testicles overheat, sperm production is disrupted. By the way, the same effect is obtained if you sit behind the wheel of a car for more than four hours a day.

The idea of ​​creating a men's medicinal contraception It has long been of concern to researchers (and women especially). Promising directions development of male contraception is the creation vaccinations against pregnancy based on antibodies to sperm produced in men and women and causing immunological infertility, and male medicinal (hormonal and non-hormonal) contraception, which includes paths such as inhibition of spermatogenesis, decreased sperm activity, inhibition of epididymal function.

Not long ago, molecular biologists from the Salk Institute in California announced that they had found the desired target for chemical “sanctions” against sperm using a drug proposed to treat Gaucher disease (a rare genetic disease). This drug can be an ideal contraceptive for men.

This substance the alkylated iminosugar N-butyldeoxynoirimicin (NB-DNJ) was administered to male mice, and they became sterile after three weeks of use. The drug had no effect on testosterone levels or luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, indicating that NB-DNJ acts in a non-hormonal manner. According to scientists, infertility is ensured by a certain mouse gene encoding cell receptor to the enzyme phosphatidylinositol 3-kinase. A mutation in this gene disrupts the interaction of the enzyme with the receptor, which leads to “underripeness” of sperm precursor cells. Immature sperm of mutant males are not able to perform their fertilizing functions, so they, while remaining completely healthy, are infertile. After stopping the drug, male mice regained their fertility after three weeks, and their offspring developed normally.

The promise of this discovery is difficult to overestimate. Firstly, human spermatogenesis, like mouse spermatogenesis, is completely controlled by genes and, accordingly, enzyme-receptor systems. Secondly, in order to replicate the effect in mice in men, it is not necessary to interfere with human genes; it is enough just to develop a method of chemically blocking the necessary cellular receptors. Thirdly, the “mouse model” is natural and, as biologists have shown, safe. And if it is possible in the near future to find a way to reliably and reversibly block the enzyme-receptor interaction in human sperm, then civilization will have at its disposal effective and harmless birth control pills for men.

Inhibition of spermatogenesis, or male hormonal contraception

Contraceptives in this group were developed after examining patients with azoospermia who were diagnosed with hypogonadism with reduced production of FSH and LH. Steroid hormones suppress the production of gonadotropins and indirectly testicular function, including spermatogenesis. For the purpose of contraception, these drugs are used both in pure form, and in combinations. Let's name the most commonly used steroids.

Among the long-acting testosterone esters, the most fully studied testosterone enanthate. Administration 200 mg this tool weekly results in a 50% reduction in FSH and LH levels compared to basic level secretion, while the level of free testosterone in the blood plasma increases slightly. Sperm concentration when using testosterone enanthate ranges from 5 million/ml to azoospermia. After stopping the contraceptive, the level of gonadotropic hormones and sperm concentration return to the original amount.

From side effects are noted increased greasiness skin, acne, weight gain, enlargement muscle mass, occasionally gynecomastia and a slight decrease in the number of red blood cells. No significant changes in liver function, blood glucose and lipid levels were noted.

Combination testosterone enanthate and danazol allows you to reduce the use of contraceptives to once a month. Danazol is a synthetic analogue of 17-α-alkylated ethynyltestosterone. Its maximum dose is 800 mg. The effect is comparable to the effect of testosterone. Efficiency approaches 85%.

Progestin steroids include norethandrolone, norethindrone, R2323, megesterol acetate, depot medroxyprogesterone, etc. Progestins cause inhibition of spermatogenesis, but are necessary for a pronounced effect large doses. Taking these drugs, unfortunately, causes significant side effects, especially decreased libido. Low efficiency, pronounced side effects, and the long duration of recovery of spermatogenesis after the end of treatment do not contribute to the widespread use of progestin contraceptives.

19-nortestosterone — anabolic steroid with a weak gestagenic effect. IN medical practice has been used for the past 20 years. Causes a reversible decrease in sperm concentration up to azoospermia. No side effects were noted during use. The drug has virtually no effect on libido and erection; these properties make its use very promising, especially in combination with other drugs.

The combination of androgens and gestagens can significantly reduce their doses, which reduces the severity of side effects.

Most often used depot medroxyprogesterone acetate (DMPA) in combination with testosterone enanthate and cypronate, and norethindrone with 19-nortestosterone hexyphenylpropionate (anadur). The combination is taken once a month in the following doses: DMPA 150 mg, androgens 250-500 mg.

When studying the synthetically produced gonadotropin-releasing hormone agonist (nafarelin), its paradoxical effect was noted: when long-term use it inhibits the production of LH and FSH. This effect was the basis for it contraceptive action. Injections of 200400 mg of nafarelin in combination with 200 mg of testosterone enanthate cause inhibition of spermatogenesis.

The following methods of male contraception are currently being tested experimentally: the use of a synthetic gonadotropin-releasing hormone agonist; the use of inhibin, which suppresses FSH synthesis; immunization against FSH.

The creation of male hormonal contraceptives is very active all over the world.

Australian scientists reported the successful completion of preliminary trials of a new drug intended for male contraception.

Developed at the Institute medical research them. Prince Henry (Melbourne) drug is a combination of two sex hormones: testosterone and progesterone. The drug is introduced into the body in the form of implants (i.e., a tablet with active substance, absorption of which continues for 34 months). Its effectiveness is quite high throughout the year. The effect of the drug is completely reversible and is not accompanied by any serious side effects.

The pharmaceutical company Organon has created a contraceptive drug for men that is effective for three years. Active substance continuously enters the body from implants sewn under the skin. The active substance etongestrel is a hormone from the progesterone group that blocks the formation of sperm. Along with these medications, men will need to take testosterone injections every four to six weeks to maintain sexual function, which is reduced by the female sex hormone.

The German company Schering and its Dutch rival Akzo Nobel said they were ready to join forces with other firms to develop a contraceptive pill for men that could hit the market within the next 5-7 years. Scientists have already developed a prototype of an effective pill for men using synthetic hormone, which suppresses sperm production by slowing down the action of testosterone.

Researchers at the University of Edinburgh have developed a way to suppress sperm production while preserving normal level sex hormones in the body, which is a big step forward towards creating male hormonal contraceptives. The men took 150 or 300 micrograms of desogestrel, a synthetic hormone that is now the main component of female birth control pills. At the same time, each subject was implanted with one capsule with 200 mg of testosterone at the beginning of the study and another after 12 weeks. It turned out that desogestrel inhibits sperm production in men in the same way as it prevents ovulation in women. After 16 weeks, all men taking 300 micrograms of the drug showed complete suppression of sperm production.

After discontinuation of desogestrel, sperm concentration returned to baseline within 16 weeks. Side effects of the drug - mood swings, increased appetite and weight gain - developed rarely and were mild.

American scientists have discovered a protein in the tail of sperm that, if blocked, can make a man completely infertile. The effectiveness of this technique has already been successfully tested on mice. This protein is called CatSper. According to researchers from the Howard Hughes Medical Institute and Harvard Medical School, it is responsible for one of the last stages fertilization, when the sperm must penetrate the zona pellucida and connect with the egg.

They bred mice that lacked the CatSper protein. The mice were completely infertile. However, if the egg was previously deprived of the zona pellucida, fertilization occurred as usual. Apparently, the inability to penetrate the membrane was the only change on the part of the sperm.

All that remains is to find a substance that will block the protein. Then, for the purpose of contraception, both men will be able to take the medicine immediately before sexual intercourse, and women shortly after it. In the latter case, the effect will be on sperm that have already entered the woman’s genital tract.

German researchers from the University of Münster have successfully tested a contraceptive for men. All study participants were given the male sex hormone testosterone by injection every six weeks for 24 weeks, and they also received injections of the hormone norethisterone enanthate (NETE). The following side effects were noted: acne, pain at injection sites. Several people complained of sweating at night. The hormones caused an increase in cholesterol concentrations, but within normal values.

There are also non-hormonal male contraceptives. For example, agents that directly affect sperm activity. Gossypol, the best known drug from this group, is a natural product isolated from the seeds, stems and roots of cotton. It inhibits a number of enzymes contained in sperm and spermatogenic epithelial cells, namely lactate dehydrogenase and glutathione alpha transferase. This leads to a decrease in the motility of mature sperm and inhibition of spermatogenesis at the spermatid stage. When used, spermatogenesis is inhibited early stages and the motility of mature sperm decreases. Gossypol is prescribed daily for 2-3 months, and then switched to a maintenance dose once a week. The effectiveness of the drug reaches 90%. The most common side effects are increased fatigue (12%), gastrointestinal disorders(7%), decreased libido (5%), dizziness and dry mouth. The most serious complication is a decrease in the level of potassium in the blood, which can lead to problems with cardiac activity, but this is extremely rare. With long-term use of gossypol, spermatogenesis stops completely.

Drugs 3-indazole-carboxylic acids cause disruption of the meiotic process in spermatogenic epithelial cells. Currently in clinical trials.

Sperm-specific enzyme inhibitors act at the final stages of spermatogenesis. In particular, an inhibitor of acrosomal proteinase (acrosin) interferes with the correct formation of the acrosome, which makes fertilization impossible. This group of drugs is also being studied in clinical settings.

Inhibitors of epididymal function. Alpha chlorohydrin is a chemical derivative of glycerol. It blocks a number of sperm enzymes while they are in the epididymis, and also causes changes in the epididymal epithelium. The drug is prescribed at a dose of 3090 mg/kg body weight per day. The effect is to reduce the motor activity of sperm up to their complete immobility. The drug is toxic, which sharply limits its use.

Drugs 6-chloro-6-deoxysucrose and its derivatives block the processes of glycolysis in the epididymis. In this case, the number of sperm does not change, but a sharp decrease in their motility and pronounced morphological changes are detected. Dosages have not been fully developed.

Tripterygium Wilfordii plant used in traditional Chinese medicine. The amount of glycosides contained in it has a pronounced spermatotoxic effect at the level of the epididymis.

Research shows that the most rapid contraceptive effect occurs with drugs that affect mature sperm (their maturation in the epididymis, motility). In addition, after stopping taking these medications, fertility is restored quickly and in full.

Sperm activity is influenced by many medicinal substances. For example, the “male” contraceptive properties of such a widely known drug, like nifedipine. Nifedipine has no real prospects of becoming a contraceptive, and it has a large number of side effects. But this drug was perhaps the first to demonstrate the real possibility of modifying the biochemistry of sperm so that they lose their fertilizing ability. All that remains is to find other, safer application points chemical exposure on these cells and the problem of creating birth control pills for men will be solved.

Thus, in modern science There is an active search for the creation of birth control pills for men. Finding such a drug for men is much more difficult than for women. For a woman, it is enough to slow down ovulation once a month, certain period cycle, in male body Tens of millions of sperm are produced every day. To obtain a contraceptive effect, it is necessary to restrain or limit the process of sperm production to such an extent that the sperm loses its fertilizing ability. Sperm maturation takes 7778 days. The duration of this process also complicates the invention of a “male pill”: after all, it is necessary to find a substance that would act on the body for three months, suppressing sperm production and without affecting harmful influence to your health.

Male anti-sperm medications are still in development. And so far, no country in the world has a male contraceptive drug that has fully passed all the necessary clinical researches and was approved for sale.

However, the above factors indicate the prospects for further development of drugs in this group.

Literature

1. Dwek, R. A. et al. Targeting glycosylation as a therapeutic approach. Nature Rev. Drug Discov. 1, 65Dwek, R. A. et al. Targeting glycosylation as a therapeutic approach. Nature Rev. Drug Discov. 1, 652. Berg J., Hammon M. The modern management of the menopause. London-N. Y., 1993.
2. Abramchenko V.V. Perinatal pharmacology. St.-Pt., 1994.
3. Boroyan R. G. Clinical pharmacology for obstetricians and gynecologists: A practical guide for doctors. M.: Medical Information Agency LLC, 1999. 224 p.
4. Lawrence D. R., Benitt P. N. Clinical pharmacology in 2 volumes. M.: Medicine, 1993.
5. Manuilova I. A. Modern contraceptives. M., 1993.
6. Mikhailov I. B. Doctor’s handbook on clinical pharmacology. M., 2001.
7. Federal guidelines for use medicines(formulary system). Issue IV. M.: ECHO, 2003. 928 p.
8. Filippova I. A. Contraceptives: a complete reference book. St. Petersburg: JSC “VES”, 2000. 160 p.

Unfortunately, in last decades Medicine has concentrated on contraceptives for women, this is explained by the ease of developing such drugs. To avoid pregnancy, a woman only needs to block her egg once every 28 days. In the case of men, the situation is different - you need to stop the “army” of sperm, which is much more difficult. But effective contraception for men still exists, it’s time to consider these methods in more detail.

Five basic methods of male contraception

1. Interruption of sexual intercourse(efficiency - about 80%). The man must remove his penis from his partner's vagina before ejaculation. According to statistics, every fourth man uses this method.

Advantages:

• does not require the use of tablets or other means;
• free;
• does not harm the body.

Flaws:

• a man needs to be able to control ejaculation well;
• requires DC voltage during sexual intercourse, so as not to miss the right moment;
• does not protect against sexually transmitted infections;
• with prolonged use, it reduces libido.

2. Use a condom. Approximately 56% of men prefer condoms. This is the most popular and effective means of male contraception. Modern products are made from latex, a substance impermeable to sperm.

Advantages:

• highest efficiency (85-97%);
• protects against HIV and other sexually transmitted infections;
• ease of use and wide availability on sale.

Flaws:

• psychological discomfort and decreased sensitivity during sexual intercourse;
• requires some skills to use;
• not always available at the right time;
• sometimes men and women are allergic to latex;
• If used incorrectly, condoms break and slip off, resulting in loss of protection.

Despite all the shortcomings, the condom is considered the main means of male contraception. Apart from allergies, there are no other contraindications.

3. Vasectomy (sterilization). This surgery lasting 30 minutes, during which the ejaculatory streams intersect. Does not affect the potency and libido of a man. 2-3 months after sterilization, the need for other means of contraception disappears completely. Efficiency reaches 99%.

Advantages:

• high reliability;
• the operation is done only once.

Flaws:

• requires surgery;
• irreversibility (the man will no longer be able to have children);
• high cost;
• does not protect against sexually transmitted diseases;
• According to Russian legislation, sterilization is allowed only to men over 35 years of age who have at least two children.

This method is considered the most radical; after the operation, a man can no longer become a father; naturally, not everyone is happy with this prospect.

4. Male contraceptive pills. A new word in contraception. Like their female counterparts, they contain sex hormones. Increased content Testosterone in a man's blood prevents the formation of sperm. After the end of treatment, reproductive function is restored over time.

Birth control pills for men are still in development

These tablets are not yet available for sale, since the drugs are still at the stage of clinical trials. But many experts are already skeptical about these funds. The fact is that male reproductive cells mature within 70 days, that is, to prevent unwanted pregnancy, the pills must be taken regularly three months in advance. Side effects of such drugs are also possible.

Contraceptive pills for men cannot yet be called anything effective means contraception. It may still be years before these products become available on the market.

5. Male contraceptive implant. Another untested new product. This is a small (2.5 cm) object containing hormones that is injected under the skin. The drug suppresses sperm production and neutralizes a man’s reproductive function for some time. The only advantage of the implant is that there is no need to take other medications.

The disadvantages are the same as those of male pregnancy pills - they do not provide reliable protection and can cause negative hormonal changes in organism. There is also no need to talk about protection from sexually transmitted infections.

Conclusion: male contraception is effectively represented only by condoms; the use of other means is associated with certain risks.

In terms of reproduction, a man plays very important role in family formation. Over the past few decades, contraceptive methods have primarily been designed for women. However, recently, male contraception has become increasingly popular, especially in cases where the life partner is not ready to take contraceptives or does not allow her to do so.

Methods of contraception for men are aimed at inhibiting spermatogenesis and male maturation. Some methods of contraception prevent male gametes from entering the female genital organs.

How to protect against unwanted pregnancy? So, you can prevent unwanted pregnancy using the following methods of contraception for men: mechanical - using a condom; behavioral - abstinence from ejaculation, and, finally, surgical - vasectomy.

Contraception for men should be no less effective than for women, these drugs should act very quickly, have no side effects, and not affect potency and offspring. We should not forget that such drugs or preparations should be easily accessible and cheap.

Contraception for men: surgical method

The essence of the operation is blocking. Before the operation, the doctor will make sure that the patient understands the consequences and meaning of the operation. The specialist should tell the patient that this method of contraception does not protect against HIV and STIs, so the condom should be used as additional method contraception. Vasectomy does not affect potency. Surgery to restore fertility is not always successful. It should also be noted that surgeries to restore fertility are quite expensive. Vasectomy is enough simple procedure, which is performed under local anesthesia (takes about half an hour). However, there are contraindications to this manipulation: inguinal hernia, diabetes.

To carry out this operation, you can use three options:

In the first option, the vas deferens are fixed, the surgical site is infiltrated with a 1% anesthetic solution (procaine). The skin and muscle layer are cut above the vas deferens, the vas deferens are ligated (bandaged) and crossed. The sections are cauterized.

In the second option, the ducts are crossed without ligation and are cauterized to a depth of up to one and a half centimeters. After this, the crossed ends are closed.

In the third option, the vas deferens are punctured rather than incised. After anesthesia, a special ring clamp is applied to the vas deferens without opening the skin. After this, the skin and walls of the ducts are cut, then the ducts are isolated, and occlusion is performed.

Contraception for men: physical methods

Spermatogenesis can be blocked using ultrasound. Significant disadvantage this method is that irreversible processes develop in tissues. The synthesis of male reproductive gametes is also negatively affected by heat. An increase in body temperature inhibits spermatogenesis.

Contraception for men, use of hormones

Bioactive compounds (hormones) inhibit the synthesis of luteotropic and follicle-stimulating hormones and activate the formation of intratesticular testosterone. cannot be used in severe cases diabetes mellitus, hypertension, liver and kidney diseases, with mental illness And malignant tumors, oligozoospermia.

Contraception for men: immunological method.

Research in this area is aimed at creating an anti-fertility vaccine that would have high efficiency and didn't call side effects.

Contraceptives for men include not only the well-known condoms, but also other methods that make sexual intercourse protected and safe. Let's consider the main types of male contraception and the features of its use.

Types of protective equipment

Male contraception is a rather complex area modern medicine, because researchers It is quite difficult to develop drugs that block the action of a huge number of sperm. While the task of female contraceptives is to protect only one egg during the menstrual cycle from sperm penetration.

However modern man A person who takes a responsible approach to building relationships and family planning will do everything possible to protect himself and his partner from unwanted pregnancy. There are a variety of tools designed specifically for these purposes. The most common contraceptives include condoms, birth control pills, vasectomies, implants, and injections. Each technique has its own characteristics, disadvantages and advantages.

• Condoms.

Condoms are the most common and effective means of male contraception, allowing you to protect intimate intercourse by 98%. These latex products not only protect against unwanted pregnancy, but also protect both partners from venereal diseases and sexually transmitted infections. The modern consumer market offers a huge selection of condoms. Products have different colour, aroma, size and even special sensitivity enhancers. But many representatives of the stronger sex neglect this means of contraception.

Using condoms has a number of significant advantages. These include the following factors:

1. Availability - you can purchase products at any pharmacy, kiosk or supermarket.
2. Easy to use.
3. High level of protection against penetration of sperm into the vaginal area.
4. Protection against HIV infection and sexually transmitted diseases.

There are virtually no contraindications to the use of condoms, other than an increased individual tendency to develop allergic reactions. According to statistics, about 56% of the male half of humanity prefers this method of contraception.

The main disadvantages of condoms include the following:

1. The product may tear or slip during use.
2. Creating a certain psychological discomfort during an intimate act.
3. Decreased sensitivity during sexual intercourse.
4. For correct use requires certain skills in application.
5. These disposable products are not always available when needed.

• Hormonal remedies.

Hormonal male contraceptives are medications, the composition of which contains a special hormone that suppresses the activity and motility of sperm. Hormonal contraceptives are available in the following forms:

1. Pills.
2. Injections.
3. Capsules.
4. Gels.
5. Subcutaneous implants.

Contraceptive drugs for men contain a sex hormone called testosterone, since in large dosages testosterone is an effective means of preventing unwanted pregnancy. According to statistics, the effectiveness of this method of contraception is almost 99%. But hormonal pills and injections can provoke the development of the following side effects:

1. Increase in the size of the mammary gland.
2. Increased blood clotting.
3. Prostate enlargement.
4. Impaired functioning of the cardiovascular system.
5. The appearance of excess hair on a man's body.
6. Education allergic rashes on the skin.

There is also a theory that prolonged and uncontrolled use of hormonal contraceptives can cause male infertility. Therefore, in order to avoid the development of such undesirable reactions, before using a certain hormonal agent, it is recommended that you consult with a qualified professional first.

• Surgical techniques.

The most radical method of male contraception is a vasectomy. This procedure is a surgical procedure during which the vas deferens is cut. The operation has no effect negative influence on male potency, and the effectiveness of this product is 98%.

But having a vasectomy effectively denies a man the opportunity to become a father. Although modern Scientific research have proven the possibility of carrying out a subsequent operation to restore reproductive function in men who have undergone a vaectomy, no specialist can give one hundred percent guarantees.

According to current legislation, vasectomy is allowed only to representatives of the stronger sex over the age of thirty-five years, if they have at least two children.

The benefits of a vasectomy include:

1. One hundred percent reliability.
2. There is no need to use any other contraceptives.

The disadvantages of this procedure include the following factors:

1. The need for surgical intervention.
2. High cost of manipulation.
3. Vaectomy does not provide protection against infectious diseases sexually transmitted diseases.

TO surgical methods contraception may include sewing in subcutaneous implants that release testosterone, which blocks the processes of spermatogenesis, preventing fertilization. This effect is achieved due to the influence of contraceptives on the quality of the protein component of the sperm, which is responsible for fertilization. This technique is characterized high degree reliability and efficiency.

• Oral preparations and gels.

Contraception for men includes contraceptives intended for internal use. Tablets, which contain large doses of sex hormones, block the processes of sperm formation, which makes intimate contact safe in terms of protection against unwanted pregnancy. At the same time, in contrast to a vasectomy, upon completion of taking contraceptives reproductive function recovers over time.

Feature oral contraceptives is the fact that in order to achieve extremely favorable results, birth control pills must be taken at least three months before intimate contact. This is due to the fact that the process of maturation of male germ cells takes seventy days. However, doctors say that it is necessary to periodically take mandatory breaks of one and a half to two months when taking oral contraceptives. Thus, this method protection against unwanted pregnancy is suitable only for young people who have stable sex life and having a permanent partner.

In addition to hormonal contraceptives, good contraceptive effect gives use medications, which include cyproterone acetate. Tablets containing this substance have a temporary sterilization effect, significantly reducing the amount of sperm. After the use of the pills is stopped, the volume of sperm produced will gradually recover.

Birth control pills for men long-term use may trigger the development of the following side effects:

1. Depressive state.
2. Decreased muscle tone.
3. The appearance of mental disorders.
4. Increase in body weight.
5. Hair loss. Baldness.
6. The appearance of tumor growths in the testicular area, which can be both benign and malignant.
7. Azoospermia.
8. There may be a violation of the fertilizing qualities of sperm after stopping the use of oral contraceptives.

Birth control gel is another in a modern way male contraception. Part this drug includes male and female sex hormones that contribute to a significant reduction in the number of sperm in the ejaculate. Contraceptive gel is recommended to be applied daily to intimate areas of the body. The effectiveness of the drug is about 89%. Experts say that the gel has virtually no side effects, but this moment the product is under development and has yet to undergo a number of clinical trials confirming its safety.

Male contraception today is at the stage of active development. Most new modern means is now passing clinical trials, they will very soon appear on the consumer market and will be used in great demand. Indeed, according to statistics, about 97% of the stronger sex are ready to take responsibility for issues of protection from unwanted pregnancy.

In recent decades there have been significant changes in assessing the role of men in family planning and sexual and reproductive health. The role of men in family planning is extremely important. At times it has received insufficient attention because many effective methods contraception developed over the past 25 years has been intended only for women. Male contraception is of particular importance in cases where a woman cannot or is not ready to use contraceptives due to the current situation or health conditions.

Currently, there are three main groups of male contraception:

• preventing sperm maturation;
• inhibiting spermatogenesis;
• preventing sperm from entering the female genital tract.

CLASSIFICATION OF MALE CONTRACEPTION METHODS

The most common methods of contraception for men are:

• behavioral - abstinence, interrupted sexual intercourse;
• mechanical (barrier) - condom;
• surgical - DHS (vasectomy).

Contraceptives for men should:

• be no less effective than corresponding products for women;
• be acceptable to both partners, act quickly;
• do not give side effects (especially do not affect male appearance and potency);
• do not influence the offspring;
• do not cause irreversible impairment of fertility;
• be easily accessible and inexpensive.

SURGICAL CONTRACEPTION METHODS FOR MEN

Vasectomy. Male DHS involves blocking the vas deferens to prevent sperm from passing through. Vasectomy is a simple and reliable method of male contraception.

Contraindications for surgery:

• STI;
• inguinal hernia;
• severe diabetes mellitus.

A vasectomy is performed by a urologist on an outpatient basis, takes approximately 20 minutes and requires only local anesthesia.

Vasectomy technique:

• First option. The vas deferens located on both sides of the scrotum are fixed and the surgical site is infiltrated with a 1% procaine solution. The skin and muscle layer are cut above the vas deferens, the duct is isolated, ligated and transected. Each section can be cauterized or electrocoagulated. For greater reliability, it is possible to remove a segment of the vas deferens.
• Second option. The vas deferens is divided without ligation (called an open-end vasectomy) and cauterized or electrocoagulated to a depth of 1.5 cm. A fascial layer is then applied to close the crossed ends.
• Third option. A “dripless vasectomy” involves using a puncture rather than an incision to release the vas deferens. After local anesthesia A specially designed ring-shaped clamp is applied to the vas deferens without opening the skin. Then, using a dissecting clamp with a sharp end, a small incision is made in the skin and wall of the vas deferens, the duct is isolated and occluded. The failure rate of the male DHS method ranges from 0.1 to 0.5% during the first year after surgery. Complications of vasectomy: bleeding (less than 5% of cases), inflammatory reaction on sperm leakage and spontaneous restoration of ductal patency (less than 1%), usually soon after the procedure. Sexual activity using contraception can be resumed at any time after a vasectomy if the man wishes.

• use cold compresses on the surgical area to prevent swelling, pain, and bleeding;
• use scrotal suspensors for 2 days;
• exclude physical activity within 2 weeks (especially in the first two days);
• do not shower or bathe for the first 2 days;
• sexual rest for 2–3 days;
• contraception using condoms during the first 20 sexual intercourses (sperm can remain in the ducts below the ligation site and only after 20 ejaculations complete sterility is formed).

Informed consent. Before the operation, the doctor performing DHS is personally obliged to make sure that the patient fully understands the meaning and consequences of the operation. Need to pay Special attention to ensure that the patient understands the following points:

• this method of contraception does not protect against STIs and HIV, and therefore it is necessary to use condoms in addition to the chosen method of contraception;
• this method of contraception does not affect potency in any way;
• in some cases, restoration of fertility becomes impossible due to the patient’s advanced age, the wife’s infertility, or the impossibility of performing the operation, the reason for which is the method of DHS performed;
• the success of the reversibility of the operation is not guaranteed even if there are appropriate indications and a highly qualified surgeon;
• the surgical method of restoring fertility (for both men and women) is one of the most expensive operations.

PHYSICAL METHODS OF CONTRACEPTION

Blockade of spermatogenesis can be achieved using ultrasound. However, the resulting changes are irreversible, which is why ultrasound cannot be used for contraception. Spermatogenesis and sperm maturation are also negatively affected by heat. Warming the testicles to just body temperature leads to a decrease in sperm count and function.

HORMONAL MALE CONTRACEPTION

The principle of hormonal male contraception is:

• to suppression of LH and FSH;
• to the elimination of intratesticular testosterone;
• to the administration of testosterone to maintain androgenic effects.

Testosterone suppresses the pituitary secretion of LH and FSH, as a result of which the Leydig cells adjacent to the seminiferous tubules stop producing testosterone, and the level of androgens in the testicles necessary for spermatogenesis drops sharply. At the same time, exogenously administered testosterone ensures the preservation of general male characteristics. However, WHO research has discovered a phenomenon that has implications for future developments - ethnic differences in the sensitivity of spermatogenesis to the inhibitory effects of testosterone. Azoospermia developed in only 2/3 of whites, but in 90% of Chinese volunteers. This phenomenon still has no explanation, but allows us to hope for a faster introduction of male contraception in Asia.

Contraindications for use hormonal contraception for men:

• severe diabetes mellitus;
• hypertonic disease;
• hormone-dependent tumors;
• severe liver and kidney diseases;
• changes in the hemostatic system;
• infertility in a married couple;
• mental illness;
• prostate diseases ( benign hyperplasia, cancer);
• Oligozoospermia.

Contraceptive schemes:

• Testosterone in combination with gestagens. Taking 0.5 mg of levonorgestrel daily in combination with weekly testosterone injections is more effective than testosterone injections alone, as it results in faster and more pronounced suppression of spermatogenesis.
• Testosterone in combination with GnRH agonists. With long-term administration of GnRH agonists, an increase in LH and FSH levels is initially noted, but after some time it decreases. The contraceptive effect is achieved by suppressing the secretion of gonadotropins.
• Testosterone in combination with GnRH antagonists immediately reversibly blocks its receptors, effectively suppressing the secretion of LH and FSH and, accordingly, spermatogenesis.

Due to the fact that the use of hormonal contraception in men is currently at the development stage, there is no accurate data on the interaction of these drugs with other drugs.

Side effects are androgen-dependent complications (acne, mood changes) resulting from excess testosterone administered, observed on average in 21% of men.

IMMUNOLOGICAL CONTRACEPTION

The principle of the immunological approach to the regulation of fertility is to mobilize the body’s endogenous abilities to inhibit the reproductive process at critical stages. Research is aimed at creating an anti-fertility vaccine that would be effective, act reversibly and do not cause side effects with short-term and long-term use. The method is based on the formation of antibodies, which lead to immobilization and/or agglutination of sperm, binding of oocyte membrane receptors, i.e. ATs act as a “prefertilization contraceptive.”

In conclusion, we can say that among experimental methods In terms of effectiveness, practicality and acceptability, hormonal ones are recognized as the most promising for male contraception. The Weimar Manifesto of leading researchers in the field of male contraception called on pharmaceutical companies to actively support work in this direction.