Unfortunately the spammers who are registering are humans. This makes the captcha ineffective. Companies pay people in poor or desperate countries to go around to forums, register and make postings.
You will notice some of the spammers will even make up to 5 postings before introducing their spam. The postings are things like "nice car", "that's a good point", or other meaningless comments. This gets them past first post monitors (not used on our board).
What is being used is an additional question which is easily answered. "What is the first letter of Spam?". We used to have some acronyms like "What is the acronym for Buick, Oldsmobile, Pontiac?"
The only real good way to stop the human registrations from ever getting to post is to manually monitor the first posting to see that it seems genuine. If it doesn't, then the user's IP can be checked and usually determined to be a spammer. Unfortunately, there is the odd spammer located in the US! The disadvantage is that you need someone monitoring the site almost constantly to ensure reasonable time lapse between submission and posting.
What I do try to do to reduce the problem is in all countries where there are lot's of spammers, I take the IP which has been banned and block the entire area that the IP belongs to. This makes the site inaccessible to someone from the same area or building simply moving to another computer, getting another email and registering again.
a few minutes later...
Mmmm.... I just did a little reading and a good suggestion is to update the question regularly. That would stop it from being programmed into spam block busting programs. So I have changed the question to the bop answer. We'll see what happens over the next few days.
Let's have some suggestions for questions which can be easily answered by anyone who might like to use the board.