FROM: ELissner@...
DATE: Tue, 15 Jun 2004 17:16:05 EDT
SUBJECT: Re: [malecontraceptives] Wet Heat, RISUG and Vasectomy

Hi JP,

Thanks for your thoughts on the KnotMag piece. Here are a few comments.

<< In discussing simple wet heat, this article discourages its use,
saying,

<< "But don't grab your bubble bath and meat thermometer just yet. The
problem with this method is that it hasn't been thoroughly studied.
What limited research has been done appears very promising, but most
was done in the early 20th century with small sample groups. And if
you heat the testicles too much, it can cause permanent infertility."

<<Obviously TOO MUCH heat can cause permanent infertility, but the
question is whether a person could tolerate sitting in a hot bath
which is hot enough to cause permenant infertility. Voegeli said
that no one could. The Knot Magazine article states, to the
contrary, that simple wet heat "CAN cause permanent infertility." To
say this means something different than to say that some people have
evidence which indicates permanent infertility MAY be possible. To
say that it CAN cause permanent infertility indicates that known
cases exist. As far as you know, do such known cases exist?>>

No, I don't know of any such cases. I think you're correct, that the
word
"might" would be more appropriate. We really don't know, since we
have so
little research! But no, I don't know of any cases in which extended
use of wet
heat or artificial cryptorchidism caused permanent infertility. I think
this would be more plausible with the ultrasound method, or if one
found a way to
use temperatures higher than 117 degrees (such as by using one of the
hot wax
baths which are sold for soothing aching joints).

The author of the article is not an expert in the field. Despite the
inaccuracy in wording (which, I agree, gives the impression that if
you soak a few
minutes too long you could be in trouble), I think his overall message is
sound: that this is not a method to begin lightly. It is important
that it be
used by men who are willing to read up and understand what they are
doing.
Maybe someday we will see a world in which the NIH has done so much
research that
these precautions are no longer necessary, and little testicular heat
packs
are sold in the drugstore right next to the condoms!

<< As you probably know, the website http://www.dontfixit.org says that
having a vasectomy invites all kinds of autoimmune disorders. If
simple heat can
indeed cause permanent infertility-- like vasectomy--might not this
sterilization technique be a safer alternative to vasectomy? >>

I think ultrasound may have potential as a safer alternative to
vasectomy,
but unfortunately we don't have the research we'd like to see. As
you pointed
out, I think it would be hard to get the water hot enough to cause
permanent
infertility with the wet heat method. Perhaps it is theoretically
possible if
one were to use the wet heat method all day, every day for some period of
time-- I don't know. One would have to look at which stages of
spermatogenesis
are affected by the heat. Drs. C. Wang and R.S. Swerdloff have done
some
such studies in their evaluation of heat as a possible booster for
hormonal
methods. A January 28, 2004 paper, for example, states that "the
mitochondria-dependent pathway is the key apoptotic pathway for heat
induced male germ cell
death in mice."

Regarding vasectomy and autoimmune disorders, I am not an expert on this
subject. I work to develop new options for men, so I don't feel a
need to take a
pro or con position on vasectomy. That said, the Fertility and
Sterility
review of vasectomy safety and effectiveness (Vol. 73 No. 5, May 2000)
addresses
this issue and is fairly reassuring. I believe there is also a new
review
of vasectomy effectiveness and safety which has been accepted for
publication
and will be released soon, so keep an eye out on Medline.

<<Then there is RISUG. This method presumably would also avoid
autoimmune issues (I think that I saw that you also wrote this
somewhere). If the autoimmune issue is a big concern, then is this
not a strong reason to replace vasectomy with RISUG? As far as I
know, possibly mistakenly, sterilization with RISUG is not the reason
for delaying its approval, but rather the reversal process. Am I
right? If so, could not immediate progress be made by offering the
sterilization process, but not the reversal process, to vasectomy
candidates?>>

I believe currently the biggest concerns about vasectomy are its general
irreversibility, the variations in success rates based on the skill of
the doctor
(a recent study quoted by Kaiser Network reported a 1% failure rate), the
occasional cases of testicular pain, and the time vasectomy takes to
become
effective. All of these issues would be addressed by RISUG, and I
believe there is
a VERY strong case for promoting RISUG research whether or not the
immunological stuff ever turns out to be an issue.

What's holding up RISUG research is quite complicated and has a lot to do
with politics and money, not the inherent merits of the method. I
look forward
to giving you a more complete analysis of RISUG's status in the upcoming
review paper.

Sincerely,

Elaine L~issner
Director, MCIP (Male Contraception Information Project)

=============================================================
In a message dated 6/2/04 2:28:35 PM, jp40177@... writes:



>> Dear Dr. Lissner:
>>
>> Thank you for your feedback on your efforts to get magazine articles
>> relating to RISUG. I am sorry for the disappointing turn of events.
>>
>> I read the Knot Magazine article with interest,
>>
>> http://www.knotmag.com/?article=1272
>>
>> In discussing simple wet heat, this article discourages its use,
>> saying,
>>
>> "But don't grab your bubble bath and meat thermometer just yet. The
>> problem with this method is that it hasn't been thoroughly studied.
>> What limited research has been done appears very promising, but most
>> was done in the early 20th century with small sample groups. And if
>> you heat the testicles too much, it can cause permanent infertility."
>>
>> Obviously TOO MUCH heat can cause permanent infertility, but the
>> question is whether a person could tolerate sitting in a hot bath
>> which is hot enough to cause permenant infertility. Voegeli said
>> that no one could. The Knot Magazine article states, to the
>> contrary, that simple wet heat "CAN cause permanent infertility." To
>> say this means something different than to say that some people have
>> evidence which indicates permanent infertility MAY be possible. To
>> say that it CAN cause permanent infertility indicates that known
>> cases exist. As far as you know, do such known cases exist?
>>
>> As you probably know, the website
>>
>> http://www.dontfixit.org
>>
>> says that having a vasectomy invites all kinds of autoimmune
>> disorders. If simple heat can indeed cause permanent infertility--
>> like vasectomy--might not this sterilization technique be a safer
>> alternative to vasectomy?
>>
>> Then there is RISUG. This method presumably would also avoid
>> autoimmune issues (I think that I saw that you also wrote this
>> somewhere). If the autoimmune issue is a big concern, then is this
>> not a strong reason to replace vasectomy with RISUG? As far as I
>> know, possibly mistakenly, sterilization with RISUG is not the reason
>> for delaying its approval, but rather the reversal process. Am I
>> right? If so, could not immediate progress be made by offering the
>> sterilization process, but not the reversal process, to vasectomy
>> candidates?
>>
>> I do not hear the RISUG promoters screaming about autoimmune hazards
>> of vasectomy, and that the operation should be discontinued and
>> replaced with RISUG to avoid these hazards. Is this because I am not
>> reading the right sources? Or is it because the autoimmune concern
>> is not really the big deal that dontfixit.org says?
>>
>> I would be grateful for whatever insight that you could provide, and
>> I thank you for all of your other efforts.
>>
>> jp
>>
>>




[Non-text portions of this message have been removed]