“What do you guys know about male contraceptives, other than condoms, withdrawal and abstinence?” I asked my 9,000 Twitter followers this afternoon, who despite being usually chatty, largely refrained from responding. The few who responded, less than ten, mostly mentioned vasectomies. One asked, “isn’t there a male version of The Pill now?”
Photo by Grace Hebert.
Yes. Well, sort of. A lot of potential solutions to the question of a male version of the contraceptive pill have been discovered, but they remain in various phases of testing.
In 2003, the National Institute for Family Planning in Beijing published a paper describing largely positive results for a monthly injection of testosterone undecanoate, which showed to be 94% effective in preventing pregnancy. They are currently in phase III.
Adjudin, a non-hormonal drug capable of causing reversible infertility in rats, was in phase II of human testing in 2007. It was found that taking the drug orally required such high dosage that it could cause damage to muscle tissue and the liver. A solution to prevent this side-effect was found, and testing appears to be on-going.
Nifedipine, a calcium channel blocker, has been found to cause reversible infertility. Testing on mice, Israel’s Bar-Ilan University found that it effectively alters the metabolism of sperm, rendering them unable to fertilize an egg. A monthly pill for men, many reported in midsummer of last year, could be as close as five years away.
At around the same time Columbia University Medical Center announced that they were testing a compound that interferes with the body’s ability to use vitamin A, leading their male mice to become sterile for the course of treatment – without losing their desire to mate.
Phenoxybenzamine, which is commonly used to treat hypertension, and Silodosin, used to treat enlarged prostates, have been found to also block ejaculation, without affecting a man’s ability to achieve orgasm. In 2008, researchers set out to find drug alternatives that achieve the same effect, but are specific to the inhibition of fertility.
That’s just a handful. And then, of course, you have a variety of hormonal treatments, which directly affect the production of sperm, and which require support to maintain a man’s testosterone levels normal. One of them, presented as a variety of gels to be applied topically, was announced ready for testing in May of last year at the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center’s Male Contraceptive Clinical Trials Center.
But because so many of these potential anti-fertility options remain in various stages of testing, and because the notion of seriously interfering with one’s hormones is not one men are eager to pursue, many are opting for vasectomies.
In 2008, a piece in Details magazine reported on the sudden popularity of the procedure among men in their 20s and 30s:
Even after a less invasive no-scalpel technique was introduced in the United States in the mid-eighties, the surgery was considered an extreme measure. But lately, vasectomies are becoming the province of young, single men who claim to be tired of worrying about their partners' vigilance with the Pill. So rather than use condoms -- less than ideal in terms of pleasure and, compared with vasectomies, which have an estimated 1 in 2,000 failure rate, only so-so on the contraception front -- they're opting for a permanent fix.
In a follow-up this year, Details reported that the vasectomy business in this country is booming: “The Associates in Urology clinic in West Orange, New Jersey, has seen a 50 percent jump in the procedure. So you could stress over starting a college fund, or you could consider that you can get a vasectomy at Planned Parenthood for less than the cost of a Bugaboo Cameleon stroller.”
And why not? It’s a fast procedure, and one known to be reversible. Sort of. Eighty percent of the time, reversing a vasectomy restores fertility, but it has been found that waiting 15 years or more to have a vasectomy reversed leads to a significant drop in success rate. What doctors tell men who go in – that they had better consider their infertility permanent – is no joke, especially for younger men who choose to have it done as a means of preventing pregnancy scares then they’re not ready to have a family.
So why aren’t more people elated to hear about RISUG, a fully reversible, 100 percent effective, one-time procedure that injects a substance into the vas deferens that makes sperm incapable of fertilizing an egg without any blockage, mood swings or lack of desire?
Probably because they don’t know about it. A couple of months ago, Wired magazine ran a piece about it, which caught the attention of a few blogs, but by and large, no one seems to be too interested despite the fact that RISUG is in phase III of testing in India and testing has already started in the United States as well.
It’s hard to say why more media outlets don’t seem to care. Perhaps we’ve reached our limit for stories about options that are in the works and we know now that the process of approval is a long and arduous one; after all, while a 75 percent success rate in an anti-depressant would be considered a success, contraception presents a much higher threshold because it is something that is going to be used by healthy individuals. But conspiracy theorists around the blogosphere have also started to wonder whether it has anything to do with the threat this procedure presents to the pharmaceutical industry, who, no doubt, are well aware of the rising trend in vasectomies as Details reported three years ago.
Unlike the contraceptive pill, which is taken daily, and often for years, and these gel treatments that require continued application, and even the methods that require monthly injections, RISUG is a low-cost, one-time deal. According to Wired, “the syringe could end up costing more than the material it injects.” And where’s the profit in that?
THE STORY OF RISUG
In the 1970s, India was facing a terrible water crisis and the government was ready for science to lend a helping hand. They contacted 30-something Sujoy Guha, a professor at the Indian Institute of Technology campus in Delhi, who began working on a safe and cost-effective method of water purification immediately. He had an idea – to line contaminated rural pumps with a non-depleting substance that would kill bacteria.
The project was never completed because just a few years later, India found itself in the middle of a massive population boom and the government shifted gears. What they needed wasn’t water – they needed contraceptives. Guha had a moment of clarity: his idea for the pump could be applied to the vas deferens. All he needed was a substance that would not be depleted over time that could also affect sperm enough to prevent fertilization.
In 1979, 39-year-old Guha published a four-page paper outlining his idea, what would become the blueprint for RISUG. By then, he’d started testing styrene maleic anhydride (SMA), a polymer, in combination with the solvent dimethyl sulfoxide (DMSO), on male rats. As Bill Gifford writes for Wired:
As a high-molecular-weight polymer, the mixture was not absorbed by the body, nor was it flushed out by the flow of seminal fluid. It anchored to the inner wall of the vas, and in laboratory tests it appeared to be nontoxic. Plus, it seemed to retain its effectiveness indefinitely, like a magnet.
Each one of the 25 male rats on which he’d tried the procedure, as well as a number of control rats, were placed in a cage with three breeding females. After six months, none of the female rats in cages with rats that had undergone RISUG had become pregnant, whereas all the female rats in the control groups ended up pregnant. Another injection of DMSO proved effective in completely reversing the infertility in the test rats.
RISUG was then tried on monkeys with identical results. In 1989, it was injected into the first human subject. The results did not change. This also proved to be the case in 1993, when the results of the first clinical trial of RISUG were published. By the new millennium, RISUG was in phase III of clinical trials in India. In 2002, it was announced that the procedure was on track to be approved in India.
Then, they met a bureaucratic roadblock. From one day to another, RISUG’s testing virtually had to begin anew due to toxicity concerns of the substances being used. Guha was forced to start from scratch.
Fortunately for him, in 2001, Elaine Lissner, founder of the activist Male Contraception Information Project, stepped in, aware that RISUG was one of the most promising options on the horizon for men. By 2010, her foundation had purchased the rights to RISUG from Guha and put RISUG, now also known as Vasalgel, on the track to testing and FDA approval here in the U.S. In India, phase III testing has started, meaning RISUG could be available there in as little as two years.
The Revolutionary New Birth Control Method for Men by Bill Gifford contains more information about the procedure, how it works, its history, the key players in research, and the various hold-ups RISUG has encountered along the way. It is well worth the read.
AV Flox is the editor of Sex and the 405 -- what your newspaper would look like if it had a sex section.