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Male contraception

  
 
Closed for Business Time
09:56 / 24.04.07
My partner has started thinking of discontinuing her use of hormonal contraceptives (the Pill) after a good few years of use (5, I think), and has asked me to consider what I could do to take on the task of preventing unwanted pregnancy. I've started researching the subject, and to be honest, the options in male contraception doesn't look as safe as those for females (barring abstention). I might be wrong. And I fully acknowledge the potentially dangerous and/or highly undesirable side-effects that can result from women's use of contraceptives.

Unpacked - In the West (including AUS/NZ afaik), there are only a very limited amount of options available, consisting of

Abstention: The only 100% safe method we know of so far (apart from removal of the testes). Not an option for me and my partner.

Withdrawal (pulling out/coitus interruptus): Not safe at all, with failure rates as high as 28% (ref). I wouldn't be too happy with this. Can't speak for my partner on this one, though.

Condoms: Typical use pregnancy rate ranges between 10-18% (ref). The only male contraceptive that is widely recommended for preventing STDs, though it doesn't protect from STDs that are the result of infection through non-genital sex. I have issues with condoms aside from their dubious value as contraceptives, but I'll leave those out of this discussion.

Spermicides: Foams, jellies, creams, films and similar materials that are inserted into the vagina in order to render the sperm non-fertile. Ref. Quoting from the link: The effectiveness rate of spermicides depends largely on whether they have been inserted correctly and if they are inserted no more than one hour before sexual intercourse. The failure rate among typical users ranges from 5% to 50% depending on these two factors.
These numbers aren't very encouraging to me.

Vasectomy: Cutting the vas deferens, preventing the sperm from being ejected from the the male's body. If the surgery is successful, this is 100% effective, but my dad knows that's not always the case... Also, it isn't reversible. I might not want kids now, but I will in the future I imagine now.

Natural birth control methods: Everything that excludes all barrier, hormonal, chemical, and surgical birth control methods, such as condoms, the Pill, IUD, spermicides and sterilisation. This can include anal and oral sex, in fact all types of sex where sperm does not enter the vagina. These could be considered 100% effective, but I'd like to continue having genital intercourse. NBCMs also includes the Rhythm method. Again, I'm sceptical here - typical use pregnancy rates using RM are as high as 25%.

For future developments, these links will provide much info on the state of the field:
malecontraceptives.org and the Male contraception information project.

Personally I like the looks of RISUG and heat methods.

The male Pill... first of all, there are many known problems with female hormonal contraception techniques. Similar problems are likely to arise for men. Secondly, the main reason the MP is the new technique that looms largest on the horizon is that it could mean big bucks for Big Pharma. RISUG and heat-based contraception (and maybe others too) are both cheap, easy to administer and doesn't mean following a pill-popping/hormone-injecting regime with high monetary and, potentially, medical costs and risks. All good things in my book.

Now, over to you.
 
 
Evil Scientist
10:23 / 24.04.07
Vasectomy: Cutting the vas deferens, preventing the sperm from being ejected from the the male's body. If the surgery is successful, this is 100% effective, but my dad knows that's not always the case... Also, it isn't reversible. I might not want kids now, but I will in the future I imagine now.

Not strictly true, it is possible to have a vasectomy reversed.

This from Wikipedia:

Although men considering vasectomies should not think of them as reversible, and most men and their spouses are satisfied with the operation, there is a procedure to reverse vasectomies using vasovasostomy (a form of microsurgery). It is, however, not effective in all cases, with the success rate depending on such factors as the method used for the vasectomy and the length of time that has passed since the vasectomy was performed. There is evidence that men who have had a vasectomy produce abnormal sperm, which would explain why even a mechanically successful reversal does not always restore fertility.

Which, I admit, isn't going to necessarily fill you with confidence.

However, another option is that you store some sperm so that should you want kids in the future you have the option to concieve with your partner via artificial insemination.

RISUG is currently only in the experimental stages and, as far as I am aware, has only been proven to be reversible in non-human subjects so far.

Heat contraception is not something I would rely on personally. There has only been small scale studies into it's effectiveness so far (although those links may say different but I can't get at them through my workplace BB filters).

Condoms and spermicides can be used in conjunction, which should lower the risk of conception.
 
 
Closed for Business Time
10:51 / 24.04.07
Yeah, I was a bit too gloomy re vasectomy.. Apparently the definitive Western study of heat as contraception is Kandeel & Swerdloff's 1988 study. The abstract reads

A large body of research confirms the vulnerable nature of spermatogenesis to relatively small increases in testicular temperature. Other physical properties of electromagnetic and ultrasound waves have additive or synergistic effects to those of heat and allow disruption of spermatogenic processes at minimal temperature elevations. In addition, there is a rebound in sperm count following heat-induced suppression of spermatogenesis. These findings suggest the theoretical viability of testicular heating as a reversible method of male contraception in humans. However, before heating techniques can be used for male fertility control, several questions remain to be investigated. The lowest effective doses and the lowest frequency of application of each method of testicular heating necessary for inducing and maintaining a reliable infertile state must be established. It must be determined whether long-term exposure leads to permanent damage or compromise of testicular elements or functions, and whether exposure to simple heat, electromagnetic waves, or ultrasound induces significant changes in the biological constituents of human semen. Also unclear is the exact mutagenic potential of thermal agents on the human gonads. Another research question is whether scrotal warm sensory input rises during testicular heating to a level that is sufficient to alter body core temperature. Rapidly advancing knowledge of biologic constituents of human semen and the increasingly available detection methods of these constituents will enhance research in these areas. It is through such research that the safety, efficacy, and applicability of thermal manipulation of spermatogenesis as a method of male contraception will be established or refuted. Kandeel, F. R., & Swerdloff, R. S. (1988). Role of temperature in regulation of spermatogenesis and the use of heating as a method for contraception. Fertil Steril, 49(1), 1-23.

From here:
What are the next steps for male contraceptive research?
A concerted research effort in the following eight areas would ensure that a new male contraceptive is available sooner rather than later:

Tripterygium wilfordii (TW) and Tripterygium hypoglaucum (TH) are readily available and known to have contraceptive effect; since they have been used for millennia, their side effects are well understood. In conjunction with Chinese researchers, the World Health Organization conducted research to successfully purify extracts of TW in the 1980s and 1990s. Rather than allowing this research to go to waste, systematic studies must clarify the optimal contraceptive dose.
Dr. Christina Wang and Dr. Ronald Swerdloff ’s studies on the effect of heat as a booster for hormonal methods should be encouraged and expanded, and Dr. Roger Mieusset and Dr. Louis Bujan ’s proposed study on artificial cryptorchidism should be funded. Additional knowledge on how heat affects the testes and DNA (and whether it has any impact on hormones) might allow us to feel more confident in using artificial cryptorchidism, a method that is free and already available to men everywhere in the world.
The lack of studies on ultrasound (a heating method of contraception - my note) is an egregious omission. Respected scientists should be engaged to duplicate Dr. Fahim ’s animal studies in order to confirm or disprove effectiveness. Any study should also monitor hormone levels and the structural health of the testes. A simple, cheap contraceptive that can be either medium-term or permanent would be an incredible boon.
The IVD plug showed excellent results in its latest test. The NIH has shown courage in making a grant to support a larger clinical trial on the IVD plug, and the results are eagerly awaited. The NIH should be thanked for its decision and encouraged to follow through with this method.
Though miglustat (Zavesca®) is systemic in its effects, and though it is a patented medication with a price barrier, it still merits study because the drug is already approved for other uses in both Europe and the United States . Clinical trials will determine whether the contraceptive dose is small enough, as hoped, to eliminate side effects. The National Institutes of Health is now funding a seven-man study in Seattle (ClinicalTrials.gov, 2005). This research should be applauded and encouraged.
Only a single study would be needed to determine whether nifedipine truly has a reliable contraceptive effect. Nifedipine is usually used as a blood pressure medication, but high blood pressure can reduce fertility, confounding the results. However, nifedipine is also used as a migraine treatment. Dr. Susan Benoff has proposed collaborating with a colleague who runs a headache clinic to test nifedipine’s effect on fertility. A simple set of before-and-after sperm tests could determine whether this widely-used drug is also a contraceptive. Such a study should be funded immediately.
Funding should be made available to publish the results of the World Health Organization’s large study of no-scalpel vasectomy (NSV) versus medical polyurethane plug (MPU) versus chemical vas occlusion. Publishing the study results would prevent the work done so far from going to waste and provide definitive data on these methods.
Finally, only when RISUG studies are initiated outside India can we say that we are truly making an effort to develop a practical male contraceptive. This method has been shown to provide years of contraception for men with a single ten-minute procedure. It is reversible in animals (including nonhuman primates) and is also likely to be reversible in humans. U.S. and international government agencies must support and encourage India in its long-term follow-up and reversibility trials, while simultaneously beginning toxicology studies of their own. Approval under the new harmonized U.S./European Union/Japanese regulations would open the door to approval in most of the rest of the world.
 
  
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