Male Contraception: Present and Future, 1995
An international symposium on "Male Contraception: Present and Future" was organized by M. Rajalakshmi, Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi, India from November 27-29, 1995. The symposium was financially sponsored by the following: Contraceptive Research and Development Programme, International Committee for Research in Reproduction, International Society of Andrology, United Nations Population Fund, United States Agency for International Development, United States National Institutes of Health, and the World Health Organization.
The Symposium was inaugurated by J.S. Bajaj, Member Planning Commission, Government of India who highlighted the need for research in the area of male contraception and reproductive health. J.C. Pant, Secretary, Ministry of Health and Family Welfare, Government of India, was the Chief Guest during the inaugural ceremony. The representatives of WHO and UNFPA also highlighted the need for intensive research in male contraception to make it a reality. Egon Diczfalusy (Sweden) delivered the keynote address entitled "From mankind to humankind: Reproductive Health and Gender Equity" to a well attended audience from India and abroad. Dr. Diczfalusy reminded us of the importance reproductive health has assumed today in human development.
Subsequent to the keynote address, there was an overview of the priority areas of research in male fertility regulation for the World Health Organization (WHO) by Mr. Griffin and for the Indian Council of Medical Research (ICMR) by B.N. Saxena. The major sessions on various aspects of testicular and post-testicular physiology started with a presentation by Norman Hecht (USA) on "Male Contraception: novel cellular targets and molecular approaches for suppression of spermatogenesis." He focused his discussion on specific targets in the testis that are amenable to intervention by strategies dependent upon recent biotechnological advances. Dr. Hecht paid special attention to unique testicular processes and molecules whose function(s) can be perturbed by using state of the art molecular biology procedures which would make these targets suitable for male contraception research.
Intratesticular cell-to-cell communications, particularly with reference to the Leydig cells was discussed by Ilpo Huhtaniemi (Finland) in his lecture on "Paracrine and autocrine regulation of Leydig cell function." He observed that the majority of paracrine effects which have been demonstrated so far used in vitro testicular cultures and testicular extracts. He emphasized the lacunae in our knowledge as to when altered paracrine or autocrine regulation would form a key determinant in the physiological or pathological function(s) of the testis. F.F.G. Rommerts (The Netherlands) presented "An unorthodox view on the regulation of Sertoli cell and germ cell activities." He paid particular attention to low affinity "receptive sites" present on testicular cells and showed that the mode of steroid action based on these low affinity "receptive sites" could form an important complementary mechanism for the regulation of spermatogenesis.
In the next major session on post-testicular physiology, four papers were presented on various aspects of accessory organ functions including sperm maturation, tissue prorenin-renin-angiotensin system (PRAS) and sperm function tests. Nancy Alexander (USA) discussed the non-genomic membrane progesterone receptor present on human sperm membrane that does not have progestational activity. A. Mukhopadhyay (Germany) reviewed the data on the presence of PRAS in the male reproductive tract and evaluated the hypothesis that tissue PRAS is crucial for the maintenance of male fertility. Kirchhoff (Germany) discussed the role of the epididymis in sperm maturation and explained in detail the characterization of epididymis-specific proteins involved in sperm maturation. K. Gopalakrishnan (India) highlighted the various sperm functional tests which are available to evaluate the functional competence of spermatozoa.
Thus, on the first day, the participants were exposed to various targets where male contraception development can be directed including spermiogenesis, Leydig cells, Sertoli cell - germ cell interactions, sperm maturation in the epididymis, sperm capacitation and the acquisition of fertilizing capacity by the spermatozoa. It was felt that a new lead in male contraception can come only from basic science research based mainly on the availability of new tools and techniques.
The sessions on the second day covered various methods that are being used to inhibit male fertility. These were categorized as: 1) hormonal methods; 2) vasocclusive procedures; and 3) immunocontraception. The topics covered under hormonal methods included presentations on the preclinical evaluation of androgens by M. Rajalakshmi, clinical studies using testosterone enanthate alone for male contraceptive development by Christina Wang (USA), results of clinical trials using progestogen-testosterone combinations by K.M. Arsyad (Indonesia), data on the combined administration of levonorgestrel and testosterone enanthate as a promising male contraceptive approach for the rapid and effective suppression of spermatogenesis by William J. Bremner (USA), and results of studies on the use of GnRH agonists/antagonists and testosterone combinations by H.M. Behre (Germany).
The session on the evaluation of methods for vasocclusion included surgical and nonsurgical methods. F.P. Soonawalla (India) covered the safety and reversibility of vasectomy while Dr. S.K. Guha (India) discussed the current status of development and clinical testing of male intravasal contraceptives. Dr. Soonawalla pointed out that "no scalpel" vasectomy has to be done with additional skill and care. D.M. Soebadi (Indonesia) discussed the results of use of medical grade silicone rubber for vasocclusion, as an alternative method for male contraception. The styrene maleic anhydride being tested by Dr. Guha and the silicone plugs by Dr. Soebadi are already in Phase II clinical trials and hopefully would enter Phase III clinical trials within 5 years. L.J.D. Zaneveld (USA) presented the clinical data on the use of a vas blocking device called the SHUG.
The session on immunocontraception in the male looked at the possibility of using antiGnRH vaccine (G.P. Talwar, India), antisperm vaccine (C. Shaha, India) and a vaccine based on epididymal proteins (P.S. Cuasnicu, Argentina).
The Round Table Sessions on the last day were preceded by lectures on the various dimensions of reproductive health in men (S. Roy, India) and our current knowledge on the acceptability of fertility regulating methods by men (K. Ringheim, USA). The acceptability of male methods, both by men and women, is an important issue that was addressed in this session. It was felt also that the monitoring of the long-term effects of male contraceptive agents would be an essential need when such methods become available.
A large number of young scientists attended the symposium and presented over 100 posters on various aspects of male contraception, both basic and applied. Five of the best posters and abstracts, each chosen by a panel of senior scientists, were given awards. Dr. Wang (USA) presented an overview of the symposium presentations. The symposium was closed formally by H. Gabelnick (USA).
M. Rajalakshmi, India