POLL: Are men ready to take the contraceptive pill responsibly?
THE latest scientific hope in the search for an effective male contraceptive pill comes from researchers at the University of Minnesota.
Although they’ve made progress in finding the exact chemicals needed to bring about temporary infertility in men, we’ve seen headlines heralding the male pill as a ‘step closer’ since the 1990s.
It’s been more than 50 years since the contraceptive pill for women (heralded by some as the greatest scientific invention of the 20th Century) became available in Ireland.
In 1963, pharmaceutical companies succeeded in introducing the pill as a way to regulate women’s menstrual cycles and in 1972 The Rotunda became the first Irish maternity hospital to set up a family planning clinic that prescribed the pill.
Today, it’s the most commonly used form of contraceptive, next to condoms.
While developments in contraception have revolutionised the world for women (we’ve got implants, pills, patches, IUD, and IUS, to name a few), men are still faced with only two options: condoms or a vasectomy.
And so, the search for a contraceptive pill for men has come to be seen as a scientific hunt for the holy grail.
Almost every year new reports emerge promising a male pill is ‘one step closer’, but talk to researchers and even optimists say we are still seven to ten years away from seeing it prescribed.
The latest breakthrough comes from a group of scientists, including lead researcher Gunda I. Georg, PhD at the University of Minnesota College of Pharmacy, who presented their findings at the National Meeting and Exposition of the American Chemical Society in March.
In the past, researchers have banked on testosterone as the key to creating an effective hormonal male contraception, but because of the associated side effects — including infertility, weight gain, cholesterol, and loss of sexual desire — it’s now seen as pretty much a non-runner.
What Georg and her team have done sounds unintelligible to most of us (Science Daily reports that “the researchers are gaining a better understanding of how tweaks to the chemical structure of their test compounds affect the substances’ cellular interactions in the body”).
In plain speak, they are developing alternative compounds to testosterone and making chemical tweaks in an attempt to create a safe and stable male pill that could be swallowed, just like the pill women take.
This isn’t the only chink of hope for a breakthrough male contraceptive.
On the other side of the world, Dr Sabatino Ventura, a senior lecturer in drug development at Monash Institute of Pharmaceutical Sciences in Australia, has dedicated two decades of his life to finding a non-hormonal method of male contraceptive.
He’s working on a way to stop the transport of sperm. Ventura uses an aeronautical metaphor to explain his work.
Picture an airplane.
Take-off is ejaculate leaving a man’s body, but before it leaves it needs passengers (sperm) on board.
Ventura’s drug would silence the announcement in the airport terminal telling passengers to board, so the plane takes off empty.
Not as easy as it sounds.
“Men make a lot of sperm, about 1,000 sperm per second”, says Ventura, “so they are a lot harder to stop than a female who produces just one egg per month.”
Ventura believes a non-hormonal pill is the only viable solution, but how long will we have to wait?
He says he has “a good biological strategy”, which they’ve already shown works in genetically modified mice.
Now, he says, they are trying to develop chemicals to make it work in men.
Ventura asserts that while other forms of a male contraceptive in clinical trials are “close”, it will still be a “good five to 10 years away at least” before we have an oral male contraceptive.
And he stresses, “a lot of men won’t take something if they think it will make them less manly, or affect their sexual behaviour or affect their male characteristics”.
If it’s going to be viable it has got to be convenient, non-hormonal, and easily reversible.
As well as the scientific issues that stand in the way, according to Ventura, pharmas are just not interested in putting the money behind “risky” research, so progress is slow.
US-based Aaron Hamlin, the executive director of Male Contraception Initiative (MCI), says lack of funding is a common theme all over the world.
“If serious funding appears, we could have our first reversible male contraceptive in around 10 years. But if governments, philanthropists, and drug companies continue to ignore this issue, then we probably won’t see anything for at least a couple decades.”
Big pharmas are of course thinking about the bottom line, but even if they do come up with a pill that works, will men take it?
Hamlin argues men and women are ready for a male pill.
“The biggest prospective pro of a male contraceptive pill would be to give men a more effective option.
"For those who claim the condom as their primary method, they report a real-world pregnancy rate of 18% over the first year.
"Most men aren’t comfortable with slightly worse than a one-out-of-six dice roll each year.
“The focus on providing numerous contraceptives for women has had the benefit of giving women options.
“But excluding men altogether has had the side effect of putting a disproportional contraceptive burden on women. And that’s unfair to everyone.”
Ventura says the numbers speak for themselves; with an estimated 70m to 80m unwanted pregnancies worldwide per year, the more options available for contraception the more likely that number will come down.
“Men are starting to become much more willing to take control of their contraception, a lot of men are much more worried about getting women pregnant.
"I think it would take off and if one comes out, more would follow. That first one is the big hurdle,” says Ventura.
Other alternative male pills are being developed worldwide.
You might have heard of the “clean sheets” pill, which works by allowing orgasm without ejaculation, also known as a ‘dry orgasm’.
There’s Vasalgel — which works by having a hydrogel injected into the man’s sperm-carrying tubes, accessible much like a no- scalpel vasectomy.
The San Francisco-based researchers behind this are aiming for later this year to start Phase-I human trial.
In Indonesia, Gendarussa — based on a native shrub — is one of the furthest progressed of all the reversible methods of a male pill.
The team in Airlangga University in Indonesia has done work in Phase-II human clinical trials.
The aim is to produce an oral contraceptive that works by interrupting fertilisation between sperm and egg.
Anti-Eppin, another frontrunner, is a drug that affects the ability of sperm to swim so that it doesn’t reach an egg.
Anti-Eppin could be taken orally or placed as an implant under the skin.
But what do men and women think about the prospect of a male pill, and would they use it?
Rory is a married man in his early 30s and a father of one. I ask if he would consider taking a pill for men.
His answer is straight: As long as it was tried and tested and he wasn’t a “guinea pig”, then he would.
“Having a baby is the equal responsibility of a man and a women,” he says.
Next I ask his wife Sophie if she would trust him to take it? “I would... but I’d probably remind him regularly.”
She adds: “I’d need to be in a relationship for a few years to get to that level of trust.”
Couple number two — Tim, 34, and Maeve, 35 — say they’d also be happy to swap roles with the pill.
Tim says, in a relationship, he’d be happy to take control of the contraception (“what don’t men want to be in control of?”)
But what about his girlfriend?
“I’d trust him from a practical perspective, as in I know he wouldn’t forget but I may have a problem with my contraception being in someone else’s hands… even his.”
Helen, 32, who is getting married next month, echoes this view when she emails a reply to my question about her fiancé, Ben.
If it was safe, he’d take it, but would she trust him?
“I absolutely wouldn’t,” she says, “he’d never remember to take it.”
Back in 2011, Dr Susan Walker, senior lecturer in sexual health at Anglia Ruskin University, told the British Sociological Association annual conference that only 50% of the 134 women and 54 men she surveyed said they would use the contraceptive method when it came on the market.
Some 19% stated they definitely would not use a male pill, while 31% were unsure.
Dr Walker found that 52% of the women surveyed were concerned their partners would forget to take it.
Manchester-born documentary maker Tim Samuels has just completed a book (Who Stole My Spear?) about the challenges men face in the 21st century.
He’s thought about a male pill, but is conflicted.
“The inner-hypochondriac would wonder if there could still be unforeseen long-term consequences — and one day my sperm could keel over.
"But, in a relationship, it’d be another option for contraception. It could even be used to double up, just to be even more sure.”
For casual sex and flings, Samuel says he can’t imagine women buying into it.
“I can’t see many women trusting a guy who says, ‘Don’t worry love — I’m on the pill’.”
For many women, the thought of being able to say goodbye to the pill and its side-effects and risk (from mood swings to blood clots) will be welcome.
One woman on social media talked about the awful side-effects she had taking various forms of contraception (the coil and an implant). Both she and her husband use condoms but she says a male pill would “make both our lives easier”.
Of the more than 50 male friends, family, colleagues, and strangers on social media I asked, only one man said he wouldn’t consider taking the pill.
It seems men worldwide are just as open.
Aaron Hamlin of MCI quotes an international study from the journal Human Reproduction that indicated at least half of men would use a male contraceptive, even if it were hormonal (only one in eight said no outright).
Dr Sab Ventura says women’s trust issues are changing too. He cites new social science literature that says men are willing to take control and that women would trust their partners to take the pill.
If a male pill does make it to market, for the first time ever men might finally have an alternative to condoms (98% effective when used right, but seen by many to be a passion killer) or a vasectomy (see above).
While the Irish Family Planning Association isn’t involved in any research for a male pill, medical director Dr Caitriona Henchion says it “would very much welcome its launch in Ireland”.
I put Aaron Hamlin of MCI on the spot and ask him if he’d be willing to try the first male pill on the market.
His answer is a convincing yes.
“As a member of half the population that doesn’t want to have a child upon every act of intercourse, yes I would be among the first to try a new male contraceptive that made it to market.
"I’m just as excited as everyone else wondering, once funding is there, which method will make it first.”
Vasectomies are not something you hear about too much these days.
The Irish Family Planning Association says vasectomy is the most effective method of contraception with a failure rate of one in 2,000.
“It is a minor surgical procedure that seals the tubes which carry sperm from the testicles to the penis. The operation is carried out under local anaesthetic and takes about 10 minutes to complete.
"The one-time cost of vasectomy is much less than the repeat cost of other modern forms of long-term contraception,” says Caitriona Henchion, medical director of the association.
The Irish Family Planning Association carried out its first vasectomy in 1974.
Since then, it has carried out over 10,000 procedures but in 2015, only 19 men went to it for ‘the snip’.
Dr Henchion says that the reason this number is so low is because many GPs now provide vasectomies, “meaning men seeking the service have greater choice of provider”.
