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The safety evaluation following vas occlusion with RISUG ® and its reversal with DMSO and NaHCO 3 , using genotoxicity tests and apoptotic marker assays, was carried out in rabbits. Animals were divided into groups of sham operated control, vas occlusion with RISUG ® for 3 & 12 months, reversal with DMSO and NaHCO 3 after 3 & 12 months, respectively. Minimum incidences of micronuclei in erythrocytes and frequency of aberrant chromosomes were observed. Caspase-3 and TUNEL positive cells in testis and cauda epididymis sections were observed within control limits. Comet assay in leukocytes and testicular cells revealed damaged cell range at the control level. DNA damage in cauda epididymal spermatozoa was observed between 2-3 % by in vitro study and annexin V assay indicated a significant enhancement (p < 0.05) of positive cells in 3 months vas occlusion group. In conclusion, RISUG ® induced occlusion and its reversal has not been correlated with any toxicity., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Among the vas-based methods on trial, reversible inhibition of sperm under guidance (RISUG(®) ), a co-polymer of styrene and maleic anhydride is being projected as an effective alternative to No Scalpel Vasectomy. RISUG offers long-term contraception with safety, efficacy in human trials and can be delivered by no-scalpel injection. Currently, the procedure is under phase-III clinical trial. However, reversal of this vas-based drug-induced contraception needs to be established in animal models prior to clinical trials to ensure its claim as an effective alternative for vasectomy. In the present investigation, the relative suitability of dimethyl sulphoxide (DMSO) and NaHCO3 for RISUG induced long-term vas occlusion reversal was carried out in albino rats. Animals were allocated into four groups (n = 10), viz., sham-operated control (group-I), vas occlusion with RISUG for 360 days (group-II), vas occlusion with RISUG for 360 days and reversal with DMSO (group-III) and vas occlusion with RISUG for 360 days and reversal with NaHCO3 (group-IV). A variable response in fertility was observed in different groups. Absolute sterility in group III at all mating intervals, while, zero percent fertility in groups II and IV following 90 days of occlusion was observed. Following reversal restoration of fertility with DMSO at 45 days, whereas, reversal by NaHCO3 at 30 days was noticed. Ejaculated spermatozoa of RISUG injected and initial intervals of reversed animals exhibited various degrees of abnormalities. The testes exhibited focal degeneration in vas occluded animals. The occluded lumen of the vas deferens contained an eosinated polymer with exfoliated epithelium. Following vas occlusion reversal, a complete regeneration in the vas epithelium was seen. All other parameters remained unaltered. The reversal with NaHCO3 resulted into an early resumption of fertility when compared with DMSO and the procedure found to be successful, feasible and safe up to F1 generation. Thus, RISUG provides a hope for reversible male contraceptives., (© 2016 American Society of Andrology and European Academy of Andrology.)

Over the last two decades RISUG has been drawing attention in the field of male contraception. It promises to sterile men for a period of up to 10-15 years. According to recent studies in animal models, it proves to be completely reversible. Practically, there are no better options available that can assure complete sterility and precise reversibility. Regardless of so much of information available, RISUG is still holding up for many reasons, firstly, the available information engender bewilderment such as what is this copolymer, how does it work and is reversal really possible? Secondly, advancement of this outstanding invention is drastically slow and thirdly, effects of long-term contraception with RISUG and reports on evaluation of anomalies (if any) in F 1 , F 2 progenies, are lacking. In this review the lacunae as well as advances in the development of RISUG in the light of published work and available resources are pointed out. Formulation of the RISUG, its mode of action and clinical trials have been addressed with particular emphasis.

Evaluation of genotoxicity of RISUG® - a vas based contraceptive, was carried out in the present study. Animals were allotted into groups of sham operated control, vas occlusion with RISUG (5-7 μl) for 360 days and reversal by DMSO (250-500 μl) and 5% NaHCO₃ (500 μl). Blood samples and testis were collected at 360 days of vas occlusion and 90 days of vas occlusion reversal for comet analysis. Hydrogen peroxide induced samples were used as positive control. Olive moment, tail length and percentage DNA in tail were recorded with minimum variation in all groups for both leukocytes and testis. When compared with positive control the variation was highly significant for both 20 μM and 50 μM H₂O₂ (p<0.001). It is concluded that vas occlusion with RISUG at the contraceptive dose regimen is not associated with genotoxicity in leukocytes or the testis of pre- and post-reversal rats., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Ethnopharmacological Relevance: The manuscript is one of the series of attempts in authenticating scientific documentation of the seeds of Carica papaya being traditionally used for contraception., Aims of the Study: To establish safety of the methanol sub-fraction (MSF) of the seeds of Carica papaya as a male contraceptive following long term oral treatment., Materials and Methods: MSF was administered orally to albino rats at multiples of contraceptive dose (CD) at 50 (1x), 100 (2x), 250 (5x) and 500 (10x)mg/kg body weight daily for 52 weeks. Body weight, organs weight, morbidity, mortality, clinical chemistry, sperm analysis, histopathology and serum testosterone were evaluated to assess the safety and contraceptive efficacy., Results: MSF treatment at various dose regimens, daily for 52 weeks did not show significant changes in body weight, organs weight, food and water intake and pre-terminal deaths compared to those of control animals. Sperm count and viability in 50mg/kg body weight treated animals and the weight of epididymis, seminal vesicle and prostate of all the treated animals showed significant reduction compared to control. Cauda epididymal spermatozoa of 50mg/kg body weight treated animals were immotile. Azoospermia was observed in 100, 250 and 500 mg/kg body weight treated animals. Serum clinical parameters, serum testosterone and histopathology of vital organs were comparable to those of control animals. Histology of testis revealed adverse effects on the process of spermatogenesis, while the histology of epididymis, seminal vesicles and ventral prostate showed no changes compared to control., Conclusion: The long term daily oral administration of MSF affects sperm parameters without adverse side effects and is clinically safe as a male contraceptive., (Copyright 2009 Elsevier Ireland Ltd. All rights reserved.)

Apart from condoms and vasectomy, which have several limitations of their own, no other methods of contraception are available to men. Various chemical, hormonal, vas based and herbal contraceptives have been examined and few of them have reached the stage of clinical testing. Promising leads have been obtained from testosterone buciclate/undecanoate, alone or in combination with levonorgestrel butanoate or cyproterone acetate, RISUG, an injectable intravasal contraceptive and a few herbal products, particularly the seed products of Carica papaya. It is feasible that an ideal male contraceptive, that meets out all the essential criteria will be made available to the community in the near future.

Aim: To evaluate the antifertility activity of the chloroform extract of Carica papaya seeds by oral administration in langur monkey, Presbytis entellus entellus., Methods: The chloroform extract of Carica papaya seeds, 50 mg/kg/day, was administered orally for 360 days to adult male langur monkeys. The sperm characteristics by light and electron microscopy, the sperm functional tests, the semen biochemistry, the serum testosterone level, the Leydig cell function, and the histology and ultrastructure of testis were determined to evaluate the antifertility activity and the blood biochemistry and hematology, to evaluate the toxicology., Results: The extract gradually decreased the sperm concentration since days 30-60 of treatment with a total inhibition of sperm motility, a decrease in sperm viability and increase in sperm abnormality. Azoospermia was observed after day 90 of treatment and continued during the whole treatment period. Treatment withdrawal resulted in a gradual recovery in these parameters and 150 days later they reverted to nearly the pretreatment values. Morphological observation of the ejaculated sperm by light and scanning electron microscopy showed deleterious changes, particularly on the mid-piece. Sperm functional tests, viz., sperm mitochondrial activity index, acrosome intactness test and hypo-osmotic swelling test scored in the infertile range during treatment and returned to the fertile values 150 days after drug withdrawal. Histology of the testis revealed shrunken tubules, germ cell atrophy and normal Leydig cells. Ultrastructure of the testis showed vacuolization in the cytoplasm of Sertoli cells and germ cells. Loss of cytoplasmic organelles were evident in the spermatocytes and spermatids. Round spermatids showed loss of Golgi bodies, peripheral mitochondria and vacuolated cytoplasm, indicating maturational arrest. Leydig cell functional test indicated a mild inhibition of steroidogenic function. Haematology and serum biochemistry study disclosed no significant toxicological effect and the serum testosterone level was not affected., Conclusion: Carica papaya seed extract may selectively act on the developing germ cells, possibly mediated via Sertoli cells, leading to azoospermia.

The contraceptive effects of benzene chromatographic fraction of the chloroform extract of the seeds of Carica papaya have been reported in male albino rats at the dose regimens 5 and 10 mg/animal/day; oral for 150 days. The body weight, weight of testis, epididymis, seminal vesicle and ventral prostate remained unaltered during the entire course of the investigation. Total suppression of cauda epididymal sperm motility coincided with a decrease in sperm count, viability and an increase in per cent abnormal spermatozoa during 60-150 days observation period. Minor changes in the germ cell proliferations in the testis and vacuolization and pyknotic nuclei in the few epithelial cells of the cauda epididymis were observed. Histology and biochemical composition of testis and accessory sex organs, haematology and serum clinical biochemistry and serum testosterone levels remained unchanged throughout the course of the investigation. Test for estrogenicity indicated mild estrogenicity. Monthly fertility test showed negative fertility. All the altered parameters returned to normal level following 60 days withdrawal of the treatment. The results suggest that the benzene chromatographic fraction of the chloroform extract of the seeds of Carica papaya exerts antifertility effects in rats without adverse toxicity and that the effects may be directly rendered on the spermatozoa.

The contraceptive evaluation and toxicological effects of the aqueous extract of the seeds of Carica papaya in adult male rabbits have been reported. Thirty adult male rabbits were divided into five groups of six animals each; Group I, control; Groups II-V were administered orally with aqueous extract of the seeds of C. papaya at doses of 20, 50, 75 and 100 mg/kg per day for 150 days, respectively. The body weight, reproductive organs weight, semen analysis, semen biochemistry, toxicological profiles and the fertility status have been recorded. The aqueous extract failed to exhibit contraceptive effects at any of the dose regimens tested, contrary to the observations made in the previous studies. Unaltered toxicological profiles indicated that the drug was free of side effects. The results suggest that the failure of contraceptive effects may be due to species specificity, relative resistance of the animals to the drug or lack of potency of the extract due to factors generally affect biological activity of the plant preparations.

Ultrastructural changes in the vas deferens of langur monkeys after 150 days of vas occlusion with styrene maleic anhydride (SMA) and after 150 days of noninvasive reversal are reported. The vas deferens of the sham-operated control animals revealed active secretory and absorptive functions. The basal cells showed prominent nucleus and sparse cytoplasmic organelles, and the principal cells characterized by oval or irregular nucleus, well developed mitochondria, Golgi bodies, rough endoplasmic reticulum, secretory granules in the Golgi area, free ribosomes, and glycogen granules in the supranuclear region suggesting secretory function. Vesicles and stereocilia in the apex region suggested absorptive functions of the vas deferens. Vas occlusion by SMA resulted in exfoliation of epithelial cells, pyknotic nuclei, and vacuolated cytoplasm virtually devoid of cytoplasmic organelles and stereocilia. After noninvasive reversal, the vas epithelium regained a state of normalcy as evidenced by prominent plasma membrane, nucleus, cytoplasmic organelles, and stereocilia. The results suggest that the exfoliation of the epithelium due to vas occlusion by SMA regains normalcy after 150 days of noninvasive reversal.

The contraceptive efficacy and reversibility of the chloroform extract of the seeds of Carica papaya in adult male rabbits were investigated. Eighteen adult male rabbits were divided into three groups of six animals each; Group I--control, Group II--administered chloroform extract of the seeds of Carica papaya at 20 mg/animal/d for 150 d by gavage, and Group III--administered the seed extract at 50 mg/animal/d for 150 d. Body weight and organ weight, semen analysis, sperm morphology by scanning electron microscopy, semen biochemistry, histology of the testis, haematology, serum clinical biochemistry, and the fertility status of the control and the treated animals were evaluated. Body weight and the weight of the testis, epididymis, seminal vesicles, and prostate did not show appreciable changes. Sperm concentration showed a gradual decline, reached severe oligospermia (fewer than 20 million/mL) after 75 d treatment, and attained uniform azoospermia after 120 d treatment. Sperm motility and viability were severely affected after 45 d treatment and reached less than 1% after 75 d treatment. The morphology of the spermatozoa by scanning electron microscopy revealed membrane damage in the acrosome, bent midpiece, coiled tail, and detached head and tail. The levels of fructose, glycerylphosphorylcholine, acid phosphatase, and lactate dehydrogenase in the seminal plasma were unaltered. Histology of the testis revealed arrest of spermatogenesis beyond the level of spermatocytes. No toxicity was evident from the haematology and serum biochemistry parameters. The libido of the treated animals was unaffected and the fertility rate was zero. The effects were comparable in both the dose regimens (Groups II and III) and were restored to normal 45 d after withdrawal of the treatment.

Contraceptive efficacy, reversibility and toxicity, if any, of the benzene, chloroform and ethyl acetate chromatographic fractions of the chloroform extract of the seeds of Carica papaya have been investigated in adult male rabbits at a dose regimen of 50 mg/animal/day for 150 days of treatment. Body weight, semen analysis, hematology, serum clinical biochemistry and the fertility status of control and treated animals were evaluated. Chloroform and ethyl acetate chromatographic fractions did not produce appreciable changes in these parameters. However, the benzene chromatographic fraction resulted in uniform azoospermia after 15 days of treatment, which was maintained for the remainder of the 150-day observation period. The levels of fructose, glycerophosphocholine, acid phosphatase and lactate dehydrogenase in the seminal plasma were within the control range. Hematology and the serum clinical parameters showed no appreciable changes, indicating lack of toxicity. The libido of the treated animals was normal and the fertility rate was zero. Complete normalcy of altered parameters was observed 60 days following withdrawal of treatment. It is concluded that the benzene chromatographic fraction of the chloroform extract of the seeds of Carica papaya possesses reversible male contraceptive potential and the effects appear to be mediated through the testis.

In male langurs with azoospermia induced by vas occlusion with styrene maleic anhydride (SMA), the exploratory feasibility of azoospermia reversal by a new noninvasive reversal procedure has been assessed. Palpation, percutaneous electrical stimulation of the vas deferens, forced vibratory movement, suprapubic percussion, and per rectal digital massage of the vas deferens are the components of the multimodal noninvasive reversal procedure. The exploratory investigation reveals that a single application of the procedure leads to reversal of azoospermia. Normospermia with normal motility and viability appears after third ejaculation onwards after reversal manipulations. Ultrastructure of the spermatozoa, using scanning and transmission electron microscopy, revealed that the spermatozoa attained normalcy and sperm functional tests (i.e., hypo-osmotic swelling test, slide test for acrosome intactness, and test for sperm mitochondrial activity index) further confirmed the normalcy of the spermatozoa toward their fertilizing ability. Semen biochemistry appeared normal throughout the course of investigation. The morphology of the vas deferens, which showed exfoliation of the epithelium, was in the process of regaining normalcy after 90 days of reversal manipulations. The results suggest that noninvasive reversal technique offers the possibility of the functional azoospermia reversal within a short period of time.

The influence of the crude aqueous extract of Carica papaya L. (Caricaceae) seeds has been studied on semen profile, fertility, body and organ weight response, and toxicology in male albino rats. The extract was administered at the dose regimens of 10 and 50 mg/animal/day orally for 30, 60, and 90 days and 0.1 and 1.0 mg/animal/day intramuscularly for 15 and 30 days. Cauda epididymal sperm motility and count was reduced significantly at low and high dose regimens both in the oral as well as the intramuscular groups. The reduced sperm motility was associated with morphological defects. Testicular sperm counts were also reduced in all the treatment groups except the low dose intramuscular group. Fertility tests showed dose- and duration-dependent reduction and zero fertility was observed at high dose regimens of the oral and intramuscular groups following 60 and 30 days of treatment, respectively. Testicular weight was reduced in all the treatment groups, whereas accessory sex organs showed a variable response. Body weight and toxicological observations did not show any untoward response. Fertility and all other associated changes returned to normal within 45 and 30 days of treatment cessation in the oral and intramuscular groups, respectively. The data revealed that reversible sterility could be induced in male rats by papaya seeds aqueous extract treatment without adverse effects on libido and toxicological profile.

Crude chloroform extract of C. papaya seeds (5 mg/animal/day, po, for 20, 40 and 60 days) was investigated for contraceptive efficacy and related side effects in male albino rats. The crude extract reduced fertility to zero per cent by 40 to 60 days of treatment. Suppression of cauda epididymal sperm motility was the most pronounced effect of the drug administration. Scanning electron microscopic observations revealed treatment induced abnormalities in sperms. Cauda epididymal and testicular sperm counts decreased following treatment. Clinical parameters did not show any alterations. Results suggest that the contraceptive effects of chloroform extract of papaya seeds are mainly post-testicular in nature without influencing toxicological profile and libido of the animals.

Highly purified gossypol acetic acid (5 mg/day; oral) alone and in combination with potassium chloride (0.25 mg/day; oral) was tested in adult male langurs for 120 days to evaluate reversibility of its antifertility action and possible hypokalemia. The treatment resulted in severe oligospermia with impairment of sperm motility. Sperm morphological defects were evident. The functional activities of accessory sex glands and libido remained unimpaired. Occurrence of hypokalemia was found more pronounced in the gossypol alone group. Extensive renal potassium loss was evident and conversely the renal excretion of sodium decreased markedly. The activities of serum transaminases increased significantly. Other parameters of blood and of urine did not show any marked alterations. Complete reversal of the above changes was evident following 90 to 105 days of withdrawal of treatment. In conclusion, the oligospermia achieved was reversible and the hypokalemic response of langurs is similar to human and not related to impurity of the drug.

Daily oral administration of 1 mg/kg b.w. of cyproterone acetate and simultaneously administered testosterone enanthate (2 mg/kg b.w./15 days; i.m.) to adult male langur monkeys over a period of 90 days caused a gradual decrease in the count (to azoospermia) and motility of spermatozoa, concurrently with an increase in the percentage of non-motile as well as abnormal and immature sperm. Semen weight, volume, seminal fluid volume and circulating testosterone levels decreased nonsignificantly. Semen pH, libido and body weight remained unimpaired. The levels of SGOT, SGPT, serum alkaline phosphatase, LDH, bilirubin, Na+, K+ and hematological values did not alter significantly. All the changes were reversible. The results indicate that the combination regimen seems to affect the fertility in two ways, i.e. by inhibiting spermatogenesis in the testis and maturation process in the epididymis without altering the androgenicity.

Effects of cyproterone acetate, a synthetic steroidal compound, on the reproductive organs of female mice have been investigated. This agent caused reduction of ovarian weights indicative of suppression of pituitary gonadotrophins. Oestrogenic nature of cyproterone acetate was investigated in intact and ovariectomized animals taking uterine weight, vaginal keratinization and other biochemical oestrogen sensitive parameters. Cyproterone acetate in ovariectomized animals induced vaginal keratinization increase in uterine weight and uterine protein, RNA, glycogen and sialic acid contents. These effects were parallel to the effects of oestradiol dipropionate in ovariectomized animals, thus indicating oestrogenic activity of the compound.

Cyproterone acetate (1 mg/kg b.w. per day; oral) in combination with testosterone enanthate (2 mg/kg b.w. 15 days; i.m.) was administered for 60 and 90 days into adult male langur monkeys (Presbytis entellus entellus, Dufresne). Testicular weight and volume were reduced significantly. Spermatogenesis was suppressed but the interstitial cells appeared normal. Seminiferous tubules and Sertoli cell nuclear diameters were reduced significantly. The indices of testicular steroidogenesis, i.e. testicular total proteins, sialic acid, RNA and fructose showed a fall. On the contrary, cholesterol, total lipids, glycogen and phosphatases increased after treatment. Libido was not affected. Cessation of treatment resulted in a resumption of all the variables to normal levels within 90 days. The results reveal a reversible inhibition of testicular steroidogenesis which ultimately resulted in the disruption of spermatogenesis, a definite index of sterility. It is further emphasized that simultaneously administered testosterone enanthate maintains androgenicity.

Danazol (15 mg/kg b.w./day; oral) with combination of testosterone enanthate (5 mg/kg b.w./15 days; S.C.) was tested in male rabbits for reversible suppression of spermatogenesis. Semen analyses for efficacy and reversibility were performed biweekly. The regimen resulted in complete azoospermia or severe oligozoospermia in all the animals within 75 days of treatment accompanied with decreased motility, vitality and increased sperm abnormalities. Semen volume and pH did not alter significantly. Libido was unaffected. All seminal characteristics were within normal range after 115 days of recovery. In conclusion, the drug combination in given dose regimen resulted in reversible inhibition of spermatogenesis in rabbits.