Are There Better Male Contraceptive Options?Apr 10, 2014
Dr. Kirtly Parker Jones: Despite the many contraceptive options open to women, about 50% of American pregnancies are unplanned. So what are we doing wrong? Or maybe women need some help. It's time for men to step up when they're stepping out and be willing and eager to use their own methods of contraception. And it's really time for us - the scientists, clinicians, researchers and drug companies - to give guys something that really works.
This is Dr. Kirtly Jones from the Department of Obstetrics and Gynecology at University Health Care and this is The Scope of Male Contraception.
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Dr. Kirtly Parker Jones: So, for reversible contraception women have pills, patches, rings, mini-pills, shots, implants, IUDs, diaphragms, gels, abstinence and guys have condoms, withdrawal and abstinence. And the guys' methods take a lot of thinking at times when guys may not be thinking. We all agree that pregnancies should be planned and wanted and we all agree that men have been discriminated against in the development of reversible methods of contraception.
It takes 90 days to make a sperm. And men can make as many as 500 million or one half billion sperm a day. Yup, I said a day for the gold medal sperm producers. Methods for men, we could call MFM or not, have focused on stopping sperm production, stopping sperm maturation, and stopping sperm function - the swimming and getting into the egg - and stopping sperm from getting out.
Some methods for women are all about sperm as well. Most birth control pills work not just to block formation and release of the egg but keep the cervix mucus from letting sperm swim up to get to the egg. The two IUDs available act primarily on sperm. Copper IUDs kill sperm before they can get to the egg and the hormonal IUDs mostly work by thickening the mucus in the cervix so sperm can't get there.
Now half a billion sperm is a lot to stop. The methods mostly studied are hormone injections for men that stop production and replace testosterone that's lowered when sperm production is stopped. Some men had side effects; some men didn't get sperm counts to zero. It took several months for there to be no sperm. All those other sperm in the three-month pipeline were still on their way. And it took months for sperm to come back. We've had lots of efforts to try, nothing perfect yet, but I think we're coming along.
There's also research into a gel that's injected into the tube that takes sperm on their way out, the Vas, that blocks the Vas but another injection could dissolve the gel and open up the tube again. Sort of a reversible vasectomy. Great idea but it isn't here yet and it would require some technical skill on the part of the doctor.
The question is do we have to be perfect for men? No side effects, zero pregnancies, rapid reversibility. Women haven't had that luxury in their methods. So what should we do? What should we do for men? Do we wait for perfect or do we launch something that's pretty good?
So how does the arithmetic part come in? If we had a pretty good method for women, not perfect, and pretty good methods for men and everyone used a method then we would have belt and suspenders keeping our contraceptive pants up. If men used a method that had a 5 in 100 failure rate per year like the pill and women had the 5 in 100 failure rate which is in the pill then everyone was doing their part, the failure rate would be as low as about 2 per 1000 per year. And given that women may have to contracept for 30 years and men forever having a low rate per year is necessary when you want so many years to consider.
So studies of men around the world say that 30 to 50% of men would be willing to use their own method of contraception and 80% think it's a couple's issue, not just the woman's. So it's really time to do better for our guys. And to do better for our families. We need better methods for men. This is Dr. Kirtly Jones who believes that every child should be a planned and wanted child and this is The Scope.
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