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Antiepileptic drugs (AEDs) that induce hepatic enzyme activity may alter the metabolism of most hormonal methods of contraception, and this may affect their contraceptive efficacy. There is also the potential for the hormonal method to affect the AED. Women may also be prescribed AEDs to treat conditions other than epilepsy, such as chronic pain and migraine. These effects should be considered in the choice of both the treatment of the 239 IntroductionEpilepsy affects up to 1.0% of the population. About half of these patients are women, many of childbearing age, and most of them will seek advice about contraception at some time. The choice of contraceptive method is influenced by many factors, and women will expect, and should receive, appropriate information about the various options for safe and effective contraception. 1 This counselling requires a consideration of the age of the patient, their socioeconomic and educational status, the type of epilepsy and the most suitable antiepileptic drug (AED) treatment. This short review summarises those factors specific to epilepsy that influence this choice and makes recommendations about contraceptive practice for these patients. This information also applies to women prescribed AEDs for the treatment of chronic pain conditions and migraine. In general, women on AEDs may use a hormonal contraceptive if they wish to do so, after a full discussion with their physician of the alternatives available and any recommended modifications of the chosen regimen that may be necessary.The optimal choice of hormonal contraceptive is affected by whether or not the prescribed antiepileptic medication induces liver enzyme activity [i.e. an enzymeinducing antiepileptic drug (EIAED)].Important Note: Some of the practical management suggestions in this review are not licensed and if used they should be prescribed on a 'named patient basis' 2 by a registered medical practitioner. These recommendations are indicated in the text by the abbreviation NL. Interaction of hormonal contraceptives with AEDsSome AEDs induce cytochrome P450 hepatic enzyme activity, which increases the rate of metabolism of both ethinylestradiol (EE) and progestogens, thereby lowering the blood levels of these hormones, perhaps by 50% or more (Tables 1 and 2), dependent on individual variation.It is therefore very important to know whether a patient is taking an AED that affects hormonal contraception (i.e. an EIAED) before prescribing a hormonal contraceptive, Contraception for women taking antiepileptic drugs

Sixteen thousand, seven hundred and ninety-six men underwent vasectomy between 1970 and December 1983 and have been reviewed. Post-operative side effects were few and significant complications were reported in 0.9%. Failure to achieve sterility occurred in 72 men, 69 of whom have been analysed. The early recanalisation rate was 0.36%. This rate was not influenced by the operative technique used, but varied markedly between individual surgeons. Experience and care with technique should result in a failure rate of 0.2% or better. There were six cases of late recanalisation in men previously thought sterile by two consecutive azoospermic analyses 4 months after vasectomy.