Contraceptives for men in a post-Ro world

before the teacher Dobbs vs Women’s Health Jackson The decision ended the constitutional right to abortion in the United States, and Aaron Zelesick thought a vasectomy might make sense for him one day.

“My partner and I make decisions together and work together on the direction of our lives. We do not plan to have children, and this is consistent with my values ​​of shared responsibility for contraception,” the 39-year-old eco-organizer explains.

But when the U.S. Supreme Court’s decision arrived, Zelizek finished waiting. “I thought, ‘I need to put my actions together and do this,'” says Zelesk, who lives in Wisconsin, where there is a near-total abortion ban. “Given the current environment, vasectomy looks almost like a political act.”

Following the cancellation of the June 24 decision Raw vs. WadeInterest in vasectomy jumped significantly.

The Cleveland Clinic Center for Male Fertility saw a twofold increase in vasectomy inquiries in July 2022 compared to July 2021, according to center director Sarah Feig, MD. “We’re also getting more young people who don’t have children, which was a rarity before,” she says. “The changes are very significant, and peers across the country are seeing something similar.”

For decades, men only had vasectomy or condoms as contraceptive options, and many are interested in the updated options. In one survey of 1,500 American men between the ages of 18 and 44, 70% said they were severe or somewhat severe. Interested in the new male contraceptive?. That was before Dobbs resolution.

Now, after decades of work, researchers are slowly getting closer to a variety of male contraceptives, from the barrier method to the long-elusive “male pill.”

“Given the current environment, vasectomy seems almost like a political act.”

Aaron Zeleski
Vasectomy patient

All of this just can’t come soon enough for Stephanie Page, MD, PhD, a contraceptive researcher at the University of Washington School of Medicine in Seattle.

“We are facing what has become a crisis in unplanned pregnancies in this nation, and we know that there are enormous health and economic consequences of unplanned pregnancies,” Page says. “We need expanded contraceptive options for men if we are to protect the health and well-being of men, women and their offspring.”

surgical solution

appreciate 5% of American men between the ages of 18 and 45 They have undergone a vasectomy.

This is lower than in some other Western countries, such as Canada and the United Kingdom, where Procedure rates range from 17% to 22%.

which is less than the parallel procedure of the American woman, tubal ligation, which is close to 20%. Some experts find that worrisome. “Every year in this country, 25 to 30 women die of tubal ligation,” says Mark Goldstein, MD, a physician who specializes in vasectomy at Weill Cornell Medicine in Manhattan. “No man in North America has ever died of a vasectomy.”

Vasectomy is a relatively simple procedure. The doctor makes one or two small incisions in the scrotum to access the vas deferens, the tube that carries sperm. The tube is then cut and its ends closed – with a ligature, clip, stitches, or ironing – so that sperm cannot enter the semen.

“It takes about 10 or 15 minutes, and patients can drive themselves home afterward,” explains Amin Harati, MD, director of men’s health at Johns Hopkins Medicine in Baltimore. Patients then need to take certain precautions afterward, such as not having sex or lifting weights for a week.

“No man in North America has ever died of a vasectomy.”

Mark Goldstein, MD
Weill Cornell Medicine

Vasectomy is 99% effective in preventing pregnancy. In comparison, condoms are 98% effective when used perfectly, but 87% effective as is usually used.

Vasectomy is not without risks, but complications are rare. Harati says about 1% to 2% of patients have long-term pain that affects their quality of life, although treatments can help.

Oftentimes, regret after the procedure is the biggest downside to a vasectomy, experts say. up to 6% of patients subsequently seek reversal. “In my practice, the people who regret the most are those who have a vasectomy in the midst of an active pregnancy and then the baby doesn’t continue to mature. In the vacuum of that loss, patients really feel the pain,” says Harati.

Reversing a vasectomy is not easy. For one person, it takes 4 to 6 hours. In addition, it is not guaranteed, with a success rate range from 73% to 91% Depending on how it performs. So doctors warn patients not to see the procedure as permanent. And even for patients who are confident of their choice, experts say banking sperm sometimes makes sense.

That’s what Jackson Bevin, 27, chose, even though he’s pretty sure he doesn’t want biological children. “If I ever want children, I plan to adopt because there are children who deserve families,” says the software engineer in Seattle.

Bevin called for a vasectomy consultation shortly after Dobbs. Although he does not currently have a partner, hearing concerns from girlfriends prompted him to act.

“A vasectomy is a tangible thing that I can do to help avoid putting a woman in a situation that could be very difficult,” he says. “But that’s also for me because I don’t want to deal with an unwanted pregnancy. It’s a win-win for everyone.”

Moving towards the ‘male pill’

When the birth control pill was introduced in 1960, it changed the lives of women and their partners. But similar birth control pills for men have long remained elusive.

For example, major drug companies are unwilling to invest in trials in light of past failures and uncertain demand, observers say. The basics of human biology also complicate matters. “While women produce one or two eggs per month, semen contains more than 100 million sperm,” Page says.

Then there are safety concerns. For example, in 2011, one study It is a male contraceptive due to hormone-related side effects, including depression and other mood changes.

Recent efforts to develop a male contraceptive have been successful in reducing side effects while ensuring efficacy.

Far from it is a male contraceptive gel that is applied to the shoulders. It’s a hormonal cocktail that impairs testosterone production in the testicles–which is essential for sperm development–and adds just enough back into the bloodstream to maintain features like men’s low-pitched voices.

The gel, which is currently being tested in 400 couples, suppressed sperm production in 90% to 95% of men who used it consistently in a previous, smaller trial, says study co-author Page. This degree of effectiveness is comparable to birth control pills for women.

“It’s easy. I rub the gel every day,” says Alex Springer, a 28-year-old co-experimenter. I also have regular sperm collections so they can check if we need to add another form of contraception, but that didn’t happen.”

Springer appreciated the opportunity to participate, in large part because his partner’s diabetes limits contraceptive options. “I’m a little sad that my time on trial is up and now we have to find an alternative method of birth control,” he says.

If all goes as planned, the next stage of the generation will be a stage three experience in about two years with about 2,000 pairs.

Meanwhile, Page, whose work is funded by a grant from the National Institutes of Health, aims to make pills with a hormonal mechanism similar to that in the gel. This is difficult in part because oral compounds can be rapidly metabolized. Until now, twice-daily doses have been necessary, increasing the odds that men will miss doses.

Now, researchers have formulated a once-a-day option and are testing various strengths to see how well they work at silencing sperm production. Although initial results appear to be good, longer trials are necessary to confirm efficacy and safety, Page says.

Then there is also the possibility of long-acting injections, but this research is still at an early stage, and is focused solely on the safety of the technique.

Overall, those involved say it could be 10 years before a hormone-based contraceptive finally hits drugstore shelves. But the researchers say they’re sticking to the long haul.

“I’ve been in this place for decades, and clinical trials can be slow, complicated, and at times discouraging,” Page says. However, it has been encouraged by recent research developments as well as the slight increase in experimental volunteers after Dobbs resolution. “People tell us they feel the urgency to increase their contraceptive options,” she says.

For those who don’t want hormones

While some researchers pursue a hormone-based approach, others are looking for ways to avoid messing with testosterone.

“Even if the side effects of [contraceptive] Hormones are moderate, people tolerate them differently. Also, patients with risk factors such as cardiovascular disease may want to avoid hormonal approaches,” says Gonda George, Ph.D., a contraceptive researcher at the University of Minnesota School of Pharmacy. “It comes down to having different options.”

George developed a male contraceptive that works by blocking a specific form of vitamin A that plays a role in sperm development. She says it’s not only 99% effective in mice and monkeys, but it’s also safe. “We gave the mice a dose 100 times, and they were fine,” she says.

The next step is human experimentation – not easy. “It’s too expensive to meet the standards needed for FDA scrutiny,” says George. So her university licensed the complex to a small pharmaceutical company that raised $15 million. George expects to launch the trial in early 2023.

Another promising approach focuses not on suppressing sperm production but stifling their ability to reach the egg. Working with mice and researchers at Weill Cornell Medical College in Manhattan has successfully disrupted an enzyme in semen that normally makes sperm swim. Next is working with rabbits.

If it works well, they’ll be one step closer to taking the pill shortly before sex – maybe 30 to 60 minutes – and it only lasts a few hours. “The goal is a contraceptive that you only take when needed,” explains Lonny Levin, PhD, one of the project’s co-chairs.

“We cannot have a unilateral effort continuously. The closer we get to justice, the better off everyone is.”

Alex Pastuzak, MD, PhD
University of Utah College of Medicine

Another method is to physically prevent sperm from leaving a man’s body.

One way to do this is to inject a gel into the vas deferens in a procedure similar to a vasectomy.

The difference is that the gel will dissolve, restoring fertility, explains Alex Pastuszak, MD, PhD, assistant professor of urology at the University of Utah School of Medicine in Salt Lake City and the consulting medical director for Contraline, a company that develops such a product.

“The goal is a ‘adjustable’ gel, which means the product will last for months or years depending on which version the patient chooses,” Pastuszak says. In September, Contraline began human trials in Australia to evaluate both the effectiveness and potential side effects of the gel.

“I’ve been in this place quite a bit and get excited about quite a few things, but I’m really excited about it,” Pastuszak says.

Men seem to find the method compelling, too. In fact, thousands volunteered to participate before the recruitment began, according to Pastuszak. “I’ve been really encouraged by the number of men coming forward,” he says.

For Pastuszak, male contraception is partly a matter of fairness. “We can’t have a continuous unilateral effort,” he says. “The closer we get to the stock, the better off everyone is.”

Leave a Comment