Male Contraception

MALE CONTRACEPTION

Access to effective contraception is a prerequisite of reproductive health. If the goal of ensuring that every birth results from a planned pregnancy is to be achieved, a wide range of methods of regulating fertility must be available. Because women literally are left "holding the baby," family-planning organizations have traditionally concentrated on female methods.

New developments in the last 10 yr, including new formulations of the oral contraceptive pill, medicated intrauterine devices, and subdermal implants, have provided for women a wide range of contraceptive choice. In contrast, advances in male-directed methods have been confined to refinements in the type of condom and technique of vasectomy. It has been argued that research on new male-directed methods is unnecessary and that resources would be better directed toward making existing methods more widely available. Yet despite their limitations, up to 30% of couples worldwide use a male method of contraception. Moreover, recent research has demonstrated that, in many societies, men are prepared to share the responsibility of contraception more equally with their partners.

An individual’s requirements for contraception differ depending on their changing social circumstances. It is likely that the method of contraception that meets the requirements of an adolescent in an early exploratory relationship will differ radically from that which is suitable for a stable couple that has completed its family. Thus, the development of new, effective methods of male contraception has been identified as a high priority by international organizations including the World Health Organization.

Stereotypes about men are the most common source of skepticism about the feasibility of new male contraceptives. Many people believe that men are too irresponsible or untrustworthy to participate in family planning. Others believe that men won’t use a method of contraception that requires trips to the doctor or uncomfortable injections. However, numerous studies show that these beliefs are not grounded in fact.

Despite the drawbacks of the currently available male contraceptive methods, men around the world are already active and responsible family planning participants. The disadvantages of the two most common male contraceptive methods are not trivial: vasectomies are not readily reversible, and condoms have a high typical use failure rate. Despite this, one in three married couples in Australia and New Zealand rely on vasectomy for their contraception, one in six in the United States, and one in twenty worldwide. Condoms account for an additional 13% of contraceptive use in developed countries. Studies show that men want access to better contraceptives. In a recent study of British men, 80% placed a hypothetical male pill as one of their top three contraceptive choices. Another study found that over 60% of men in Germany, Spain, Brazil and Mexico were willing to use a new method of male contraception.

The idea that men cannot handle the responsibility of contraception is akin to saying men can not raise children, it is based on a variety of negative male stereotypes, which are contradicted by the available evidence and would be hotly contested by millions of responsible men and their partners.

The idea that men would not be willing to use pills, get injections, or undergo medical procedures for contraception is contradicted by all the available evidence. Again, men already undergo medical procedures for vasectomy, and the contraceptive preference study results reported above show their enthusiasm for a hormonal contraceptive.

The experiences of researchers prove that men will go out of their way to get access to new male contraceptives. Researchers are sometimes flooded with volunteers and men wanting more information. At the conclusion of a World Health Organization hormonal method trial, 85% of the volunteers would have preferred to continue rather than returning to their previous contraceptive methods. This is despite the experimental nature of the contraceptive and weekly injections!

When presented with safe and reliable contraception, it is unlikely that men will reject a method because it involves a drug or a medical procedure. As is true of female contraceptives, different methods of male contraception will be accepted by different cultures. It is unlikely that a single male contraceptive would be acceptable to all the world’s men; yet no female contraceptive is right for all women, and this certainly has not been a deterrent to the development of female contraceptives.

In this paper I summarize the research of scientists around the world who are working toward new forms of contraception for men. Although several of these contraceptives are close to market, none are currently available. Some methods are still in basic science stages, some have been tested in animals only, while some have entered the process of clinical trials required for government approval.

Heat methods

It is widely anecdotally known that prolonged stints in a hot tub or tight brief-style underwear can decrease a man’s sperm count. Men might be able to use this to their advantage as a source of inexpensive self-administered contraception. Researchers are trying to determine the reliability of the contraceptive effect of wet heat and suspensories.

Vas occlusion methods

The Intra Vas Device (IVD) is a set of tiny implants that block the flow of sperm. There are two IVD designs in clinical trials. One is a pair of soft, silicone plugs made by the Shepherd Medical Company in the United States. The other is a urethane tube lined with a tiny nylon sieve made by the Foshan Medical Company in China.

The US design of the device is made in several sizes, and comes with a patented insertion tool (Burton 2004). In 2004, Shepherd Medical received funding to support their IVD research from the National Institutes of Health.

The Chinese design has already completed Phase II clinical trials. The trial compared the IVD to no-scalpel vasectomy (NSV), and found that the men with IVDs were more satisfied and reported fewer side effects.

US design

The US IVD is two sets of tiny, pre-formed, flexible silicone plugs which are inserted into the vasa deferentia, the tubes carrying sperm from the testes. The device is sized to the width of each recipient’s vas deferens, filling the lumen (the opening in the vas tube) but not stretching the tube. Two plugs are inserted in the same vas with a small space between them. If sperm pass around the first plug and enter the space between the two plugs, the second plug blocks them.