Continuing *Not* to Have Babies: the Future of Male Contraceptives

For women, a plethora of pills, patches and devices exist to stop “sperm meets egg” in any meaningful way. To be sure, not all of them work for all women, and expanding access to more women is a critical issue. Yet fifty years after the female pill came out, men who want to take comparable measures to prevent unwanted pregnancies are left wanting. Despite repeated promises and glimmers of hope, the multi-billion dollar pharmaceutical industry continues to offer nothing.

Men who want sex but don’t want babies are currently limited to the following options: the withdrawal method, condoms and vasectomy. These are all valid but problematic and highly situational solutions. Vasectomies are highly (>99%) effective at preventing pregnancy but are generally intended to be permanent as reversals are only successful about half the time.

Condoms are great for preventing STIs, but the contraceptive failure rate is higher than many people imagine. If used perfectly, they have a 2% chance of pregnancy from splitting or leakage. However they are undeniably fiddly things and due to inexperience or laxness, for most people it’s more like 16% over the course of a year. They must be used every time sex is initiated and they are often claimed to diminish sexual enjoyment somewhat. The withdrawal method is even riskier, with a 22% chance of pregnancy with typical usage during a year.

What’s missing is a safe, reliable contraceptive which men can take outside of imminent sexual situations and protect them from causing unwanted pregnancies. The benefits of male contraception would be huge for men and women both in and out of relationships. For security, two locks are better than one. If one partner gets difficult side effects, the other can take up the slack. If the sex is more casual, men can be saved that life-changing “We Need To Talk” text that comes three months down the line. The right of either partner to insist on a condom for STI or other reasons remains fully valid and legitimate.

Positive interest in male contraceptives is generally high. A survey of over 9000 men revealed that 55% would be willing to try out a male hormonal contraceptive pill, though this varied considerably with nationality. There are dissenters, those who believe male access to contraceptives would be a bad thing. These views may tend towards the misogynistic (e.g. “men don’t get pregnant so they shouldn’t have to take responsibility”) or the misandric (e.g. “men will forget to take it then lie”). Personally, I don’t believe men should be generalised in such a way, and an individual’s access to choice is of the utmost importance and the key issue here. It’s possible that a perceived lack of interest is one reason why pharmaceutical companies are unwilling to work on male contraceptives. They need a guaranteed market if they’re going to invest.

Even if minds can be changed, biology may not be so complicit. Male contraception is a vast numbers game – men produce 1,500 sperm per second and the average ejaculate contains a quarter of a billion of the little guys. Just one surviving sperm can be too many, so even 99.99% sperm death is too low. This makes managing women’s single egg release per month look easy!

The destruction must be total and yet totally reversible – a potential drug company’s margin for error is tiny. Make the drug too potent and you’ll render your man infertile. Make it not quite potent enough and you have a new human being in the making. The fact most men wanting contraceptives are healthy is also a problem for pharma companies. Cancer patients can and must tolerate horrendous side effects because the end goal is not-cancer. In healthy men, any side effects worse than extremely rare or extremely mild are unacceptable and drug companies simply won’t take the chance on them.

A combination of all these factors have made pharmaceutical companies very wary of male contraceptives, and so we live in a world where plenty of interesting developments hit the news before being abandoned, and male pills are perpetually five years away.

It may fall on charities and other non-profit organisations to bring about real change. Vasalgel, a mid-term gel injection treatment has been hitting the news recently after receiving a $50,000 grant to continue pre-clinical trials in baboons. After six months of use, no pregnancies have occurred so far. The non-profit Parsemus Foundation behind Vasalgel claims clinical trials could start as early as 2015 if this success continues.

I think it’s unsurprising but unfortunate that this progress is being carried out by non-profit organisations when the multi-billion dollar pharmaceutical industry could probably have cracked the problem long ago if they even slightly raised it up their priorities list. My hope is that the success of one male contraceptive ends the cowering of the pharmaceutical companies and gives them the financial confidence to continue their own development work.

This planet is straining to seven billion of us sustain us as it is, and too many people have too few options about their sex and reproductive life. While global access to basic contraceptives and education about their proper usage should remain the prime directive, the addition of male contraceptive options would allow individuals and couples to take more control over their future legacy.

For more details on current and upcoming projects, visit the male contraception information project website.

Men – would you use a male contraceptive if one was available? Would you prefer long-term infrequent solutions like injections or daily pills? What side effects would you tolerate?

Women – how do you feel the introduction of male contraception would change your sex life? Would you be keen for your partner to use it?


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