What we know about the male contraceptive pill – 03/24/2019

In the era of equality, contraception remains a women's affair. Because, at least in six out of ten couples, they are the ones who use a contraceptive method to avoid pregnancy. But also because there are more than a dozen safe and effective options for female contraception – from the pill to the IUD through the badl ring, patches and hormonal injections , diaphragm, spermicides or tubal ligation, among others – and only three (vasectomy, condom and the unreliable reverse) for the man. Why this imbalance? Why is there still no pill for men?

"There are several lines of research, but It is complex because hormonal treatments that slow down sperm production can also slow down the bad drive.and then you no longer need contraception, "says Josep Lluís Ballescà, head of reproductive andrology at the Barcelona Clinical Hospital.

It is estimated that the human pill (gel or pill form) will not be marketed until 2032.

Rafael Oliva, head of the Research Group on Molecular Biology of Reproduction at IDIBAPS, acknowledges that there are currently many active research and different strategies for researching new male contraceptives, and says thatIt is possible that "the male pill is neither a pill nor a hormonal method".

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"Stopping the evolution of the egg as does the female pill is easier, but stopping millions of spermatozoa already formed and likely to be already in the duct is not performed immediately, It may take weeks or months"For it to be more difficult to control his effectiveness, he comments.And for this reason, he considers that other options of male contraceptives that work with other strategies, such as clogging Sperm exit, preventing their mobility, may come earlier or block the contact between the sperm and the egg.

However, some research teams, such as the one led by Gabriela Noé at the Chilean Institute of Reproductive Medicine, are convinced that "The male pill" (the hormonal contraceptive for men), is viable. Noah explains whatThey are about to start a clinical trial in ten countries with a gel that combines two hormones and which, applied daily on the skin, inhibits sperm production.

There are many areas of research, but they are complex because hormonal treatments that can slow down sperm production can also slow down your libido, which means you do not need contraception.

Josep Lluís Ballescà

Head of Andrology of Reproduction at the Barcelona Clinical Hospital.

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"Studies have shown that this gel suppresses sperm in most menAnd now, we want to badess whether this suppression has good contraceptive effectiveness, for which it is necessary the participation of couples, who will use the gel as the only contraceptive method "to check the effectiveness," says the researcher.

He adds that the side effects of the gel are similar to those of hormones in women, including a slight increase in acne and weight and mood changes.. "In many men, the use of hormones usually causes more anxiety than in women, but mostly because it is new to them and they are safe. expect the treatment to affect them, but this anxiety is regulated when they realize that the effects are real. " light, "said Noah.

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In the United States, another research team has also evaluates a hormonal compound that can be administered orally, like the female pill. And in the past, others have been tried percutaneously. But, experts explained at the last congress of the European Society of Contraception, even if these new clinical trials are going well and the deadlines and commitments are respected, the pill for men (in the form of gel or pill) will not be marketed before 2032.

"To move from the academic world to the market, the pharmaceutical industry must test these compounds in thousands of people and the industry invest a lot of resources and dedication in female contraceptives but was not involved in the male part, despite the fact that several effective hormonal regimens have already been described for the regulation of fertility in men, "Noah complains.

In stable couples, it is easier to consider shared contraception, but among young people and the rest of the population with high badual activity, it is difficult for men to want to prevent something that, in their opinion, does not occur. do not affect it, like pregnancy.

Roberto Lertxundi

Member of the steering committee of the European Contraception Society

Roberto Lertxundi, member of the Steering Committee of the European Society of Contraception, states that From a technical and pharmacological point of view, all tests on the pill for humans are hopeful."But it is expensive, and the industry does not see much hope in business because it thinks that the man will make the effort to take hormones if the impact of pregnancy concerns another person, even if it's about your wife. " And, in his opinion, First, the absence of male involvement at the time of contraception should be eliminated

Lertxundi says that the limited supply of male contraceptives is due to social and cultural reasons. "In stable couples, it is easier to think about shared contraception, but among young people and the rest of the population with high badual activity, it is difficult for men to want to prevent something that they think do not concern them, like pregnancy. "

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Mr. Ballescà, meanwhile, considers that it's the woman who decides to take responsibility for contraception because, especially with unstable partners, this is the only way to ensure that there is no risk of pregnancy. "Except in stable couples, I do not think that a woman is likely to have unprotected bad with a man he recently met because he says he does not have sperm, "he says.

Today, many women are reluctant to use hormones for many years – and in a couple that wants only two children, they will have to take contraceptives for about 30 years – but, moreover, surveys in different countries and with different ethnic groups show that men want to share the responsibility to plan and that young people want effective and reversible methods to regulate their fertility without depending on their partners

Gabriela Noah

Chilean Institute of Reproductive Medicine

Gabriela Noé admits that the use and promotion of male contraceptives have a lot to do with women: "Pstealing a contraceptive in men requires the participation of women because she is the one who gets pregnant and only with her can her effectiveness be proven. "But he also pointed out that if the industry did not invest in these companies because they did not see the companies, they should now rethink them because things are changing.

"Today, many women are reluctant to use hormones for many years -A couple who wants only two children will have to take contraceptives for about 30 years, but, moreover, surveys conducted in different countries and with different ethnic groups show that men want to share responsibility for planning and that young people want effective and reversible methods that allow them to regulate their fertility without depending on their partners ", explains the researcher.

The state of the investigation

As explained by the specialists of the National Institute of Child Health and Human Development, Eunice Kennedy Shriver (NICHD) – involved in the majority of male hormonal contraception projects – in a published review article in January, Several hormonal contraceptive agents have already started the clinical trial phase and there are other potential non-hormonal methods at the pre-clinical stages that seem to be working. Among them are:

Androgenic gel

The most advanced male hormonal contraception project is the gel that combines two androgens, which have already shown in the first phase of clinical trials that they are able to suppress sperm production. The specialists explain that if sperm production is reduced Below a certain level – one million per milliliter – sperm is no longer sufficient to cause pregnancy. A product that keeps it below this level will work as a method of contraception.

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Now, once its ability to reduce sperm production is measured, the second phase of the clinical trial focuses on exposing couples at risk of pregnancy to verify the actual effectiveness of fertilization.If all deadlines are met and the results are good, the market could be marketed from 2032.

Temporary implants

Among the non-hormonal contraceptive methods used in research, it should be noted that aims to mimic vasectomy but without surgery and in a completely reversible way. The strategy with which their developers work is to inject small gelatinous implants into the vas deferens, where the sperm pbades from the testicles to the ejaculatory cbad, allowing some fluids to pbad but acting as a plug for the sperm. For the moment, its effectiveness in animals has been proven.

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Block the contact with the egg

Other research teams are working on the development of non-hormonal compounds capable of inhibit the exchange of chemicals across the sperm membrane prevent the recognition of proteins from them and those of the egg, so as to prevent fertilization.

Paralyze sperm

Researchers at the University of North Carolina have tested on animals a compound called EP055 which does not affect the production of hormones or sperm, but paralyzes it. Specifically, the compound acts on sperm proteins by reducing the mobility of sperm, which can not advance into the bad and, therefore, can not fertilize the egg.

Source: The Vanguardia

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