Endocrine approaches to male fertility control
Knuth, U.A.; Nieschlag, E.
Bailliere's Clinical Endocrinology and Metabolism 1(1): 113-131
1987
ISSN/ISBN: 0950-351X PMID: 3297020 DOI: 10.1016/s0950-351x(87)80055-1Document Number: 355386
Interference with spermatogenesis via endocrinological mechanisms has potential for male fertility control. The general concept of endocrine male fertility regulation involves combination of an antigonadotrophic substance with an androgen. At first, testosterone and its esters were thought to be ideal agents for steroidal inhibition of spermatogenesis. The failure of testosterone esters alone injected at reasonable intervals to induce consistent azoospermia or severe oligozoospermia led of treatment schedules with a combination of different hormones. Combinations of gestogenic compounds with testosterone esters were somewhat more effective, but azoospermia was achieved in only about 50% of volunteers. Luteinizing hormone-releasing hormone (LHRH) analogues, although considered by many to offer realistic potential for male fertility control, have not been successful so far, even when LHRH agonistic analogues are given by pump or implant. Trials of alternative androgenic substances with slow-release characteristics and without high serum levels after single injections, such as 19-nortestosterone, suggest an attenuating effect of high serum androgen levels after supplementation with available testosterone esters. Slow-release testosterone preparations under development and more advanced delivery systems for LHRH analogues appear to offer the greatest potential for advances in male fertility regulation. Requiring discussion is the question of whether 100% infertility is essential or whether severely reduced fertility would be acceptable to some sectors of the world population.