Editor’s Note
December 2017

“What about men?” is one of our members’ most frequent refrains when it comes to talk of family planning — and not in the Portlandia sense of the phrase (tinyurl.com/PortlandiaMen).

Right now the chemical burden for contraception relies solely on the female. That’s an unfair balance in the equation,” says Charles Easley, an assistant professor at the University of Georgia, who is involved in the development of a male pill.

I agree with this understatement. I think most people would agree that it’s about time there was an effective, reversible method of male birth control besides condoms. Instead, it seems like we’re always a couple of years away from a pill or injection that will temporarily suspend male fertility. The drug trials continue without producing anything market-ready, and that’s been the case for many years.

A male pill remains elusive for a couple of reasons, Easley says. “I think there’s not much activity in this field because we have an effective solution on the female side.” Others describe the infinitely more difficult job of halting sperm production —
millions are created in the testes every single day — over stopping the release of one egg per month or preventing a fertilized egg’s implantation in the uterus.

Here are the reversible methods that have reached the stage of clinical trials (but don’t hold your breath — they’re still at least a few years away from FDA approval):

  • An injection to stop spermatogenesis (the creation of new sperm) was very effective in a multi-country trial, but caused such unbearable side effects that the study was ended early. (To the jeers, it should be noted, of women who have endured the side effects of hormonal contraception for over 50 years.)
  • Vasalgel has tested effective on monkeys but has not yet been tested on humans. The gel is injected into the vas deferens — the tubes that get snipped in a vasectomy — and blocks sperm from traveling from the testicles to the urethra, thus preventing sperm from leaving a man’s body. The gel can theoretically be dissolved when a man wants to resume his fertility. Another version of the gel, RISUG, is expected to launch in India over the next couple of years.
  • Bimek SLV is a valve operated by a switch that is implanted in each vas deferens (there are two, corresponding to each testicle) and can be manipulated through the skin by the user. The only test subject at this point is its creator, Clemens Bimek. Obviously.

For now, men are stuck with condoms, vasectomy, and withdrawal, and whatever method of birth control their female partners may be using.

Vasectomy is an excellent option for those who do not want biological children or have already had as many as they want. The Affordable Care Act doesn’t require vasectomy to be covered by insurance companies, so it’s up to individual insurers whether to cover it and to what level. (Three states — Illinois, Maryland, and Vermont — have laws requiring vasectomy coverage at no cost to the insured because their leaders understand that preventing unintended pregnancy is always the fiscally and socially responsible thing to do.)

And although not a perfect solution for everyone, the effectiveness (when used perfectly) of condoms at preventing pregnancy and sexually transmitted infections cannot be beat.

In the meantime, the role of men is primarily to support their female partners in using whatever method of contraception is right for them. That’s the majority of what the articles in this issue explore.

Marian Starkey
marian@popconnect.org

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