A possible birth control pill for men

Is he on the pill or isn’t he?

ABC News
By KATIE MOISSE
June 8, 2011

Birth Control Pill for Men: Would You Count On It?

Scientists could be one step closer to developing a birth control pill for men. A drug that stunts sperm production aced tests in mouse testes. And if it's proven to be safe and effective in humans, it could expand the prophylactic pool -- an exciting prospect at a time when roughly half of U.S. pregnancies are unintended.

But with the burden of pregnancy falling largely to females, some women say they wouldn't count on it alone.

"I think it depends on both the woman and the man," said Amy McCarthy, a 23-year-old web editor from Dallas. For McCarthy and her boyfriend of two years, Dave, the pill for men would be a welcome addition to the contraceptive repertoire.

"Dave is just as worried about the possibility of pregnancy as I am," McCarthy said, explaining that they already "double up" on birth control methods. "If anything, this is a really empowering development for men. Up until this point, they only had a few options to prevent getting their partner pregnant."

Such options, including condoms and spermicides, can help prevent pregnancy by stopping sperm in their tracks. But researchers at Columbia University Medical Center in New York City say the drug BMS-189453 can quickly and reversibly stop sperm production. Developed more than 10 years ago as a possible treatment for skin and inflammatory diseases, the drug's sperm-stunting potential was originally considered a toxic side effect.

"One company's toxin may be another person's contraceptive," said Debra Wolgemut, a professor of genetics as well as obstetrics and gynecology at Columbia University Medical Center in New York City and lead author of the study published June 4 in Endocrinology, in a statement.

Sperm production ramped up again when the mice stopped taking BMS-189453, and the drug did not appear to hamper their libido -- a troublesome side effect reported with other, hormone-targeting versions of the pill for men under development. But some doctors say the idea of quashing sperm production, even temporarily, can be scary for men.

"Sperm-making is a pretty delicate thing, and people do seem to have a concept of that," said Dr. Joseph Alukal, director of male reproductive health at New York University's Langone Medical Center. "How long did it take for women to get comfortable with the reversibility of the birth control pill? I'm not sure."

Nevertheless, Alukal said he thinks some men would welcome the option of a birth control pill.

"If you look at vasectomy, I there are plenty of men in committed relationships who choose to take onus of reproductive planning on themselves," Alukal said. "I think the same sorts of people would choose to look into something like this."

But for single guys, the pill might not fly.

"In modern society, there are all kinds of legitimate questions raised about the utility of a pill like this," Alukal said. Questions like, "Do you really expect guys to take, and their female partners to trust that they've taken it?"

McCarthy wouldn't.

"If I were dating around, though, there's no way I would trust someone that I'd been on just a few dates with [to take the pill]," she said. "I think for most men it just wouldn't be a thought that crossed their mind -- they're worried about getting HIV or gonorrhea, not having a screaming baby."

Personal Comment: We have seen buzz about a male pill before and so far it’s come to nothing. I would not trust ANY man to take a contraceptive pill to prevent me from becoming pregnant! I can see that for some men an effective and side effect free pill would be useful. If a man was afraid of being trapped into marriage by a woman who said she was on the pill but wasn’t in order to have him impregnate her that would be a great use of a male pill, but of course no method is 100% effective.

Then there is the procedure for determining if a guy who is taking the pill really is sterile. Men store sperm. So after a vasectomy a man has to ejaculate about 20 times to release all the stored sperm before his sperm count is low enough that he is basically shooting blanks. With a male contraceptive pill I imagine there will be an interval where he is still shooting live loads while his supply of stored sperm is depleted. How long that interval may be depends on how sexually active he is and will require trips to his doctor after several months to see if his sperm count is low enough. From a vasectomy site about confirming sterility:

“Since you are not sterile after your vasectomy, temporary male birth control is needed. At least 2 and sometimes more semen analyses are needed to confirm no moving sperm are present. Testing typically takes place at two months and then three months after your vasectomy procedure. If the 3 month test shows no sperm then the patient is cleared to return to have unprotected intercourse.”

So even when a male contraceptive pill becomes available and a guy starts taking it correctly unprotected sex with him will still be dangerous for two or three months.

I wouldn’t trust any man on a contraceptive pill unless it was to prevent HIM from becoming preggers, and that seems unlikely to be possible any time soon, transgendered males excluded. Since I’m the one who would have to deal with the consequences of an unintended pregnancy I want to ensure I’ve done everything possible to avoid testing positive for hCG, or that I have intentionally taken a greater risk myself.

The birth control riddle

The birth control pill, Ca 1960

The Wall Street Journal
April, 21, 2010
By MELINDA BECK

The Birth-Control Riddle
Fifty Years After the Pill's Debut, Almost Half of Pregnancies in the U.S. Are Unplanned

“Next month marks the 50th anniversary of the birth-control pill in the U.S. The dawn of dependable contraception not only ended the post-war baby boom, it also ignited the sexual revolution and helped millions of women to enter the work force.

Nowadays, women can choose from a bevy of birth-control options, including pills, patches and rings that allow them to have as few periods as they like, even none. Implants and intrauterine devices (IUDs) can prevent pregnancy for years at a time and eliminate the need to refill and remember. Morning-after pills that can decrease the risk from unprotected sex are available without a prescription even to teenagers. Women who want to end their fertility permanently can do so in a doctor's office without undergoing surgery. Abstinence is still taught in many schools and homes as being 100% effective if followed diligently.

On the 50th anniversary of the pill, WSJ's Melinda Beck tells Simon Constable on the News Hub what's new in birth control. There are more options than ever, but despite all the choices, some three million U.S. women have an unplanned pregnancy ever year.

Yet despite all these options, the rates of unplanned pregnancies remain high: Almost half of all pregnancies in the U.S.—some 3.1 million a year—are unintended, according to the most recent government survey, from 2001. One out of every two American women aged 15 to 44 has at least one unplanned pregnancy in her lifetime. Among unmarried women in their 20s, seven out of 10 pregnancies are unplanned.

An updated version of those numbers from the 2006 National Survey of Family Growth is expected to be released next month. But population experts don't anticipate much change; the rate of unplanned pregnancy was the same in 1994, and smaller studies have found that even newer birth-control methods haven't made much of a dent.

Birth Control Methods

Why are the numbers so high?

The answer is a complex tangle of cultural, religious, behavioral, educational and economic factors. Many of those unplanned pregnancies become wanted babies. About a million are aborted each year and others are miscarried.

Almost half (48%) of unintended pregnancies involve contraceptive failures. In 52% of the cases, couples used no birth control at all. Cost is a factor for some of them. Even though most insurers now cover contraceptives, co-pays and deductibles can still present obstacles.

And many young people are in "the fog zone" in which their beliefs about pregnancy don't match their behaviors, according to a 2009 report by the National Campaign to End Teen and Unplanned Pregnancy. In a survey conducted by the Guttmacher Institute of 1,800 single men and women aged 18 to 29, more than 80% of both sexes said it was important to them to avoid pregnancy right now, yet 43% of those who are sexually active said they used no contraception or used it inconsistently.

Some population experts say the rates of unintended pregnancy would be far lower if more women used IUDs and implants that prevent pregnancy for years at a time. Only about 3% of American women currently do.

"There are terrible misperceptions about these methods— and about all forms of contraception," says James Trussell, director of

the Office of Population Research at Princeton University.

Many traditional forms of contraception have been updated in recent years. Here's a look at the latest developments:

The New IUDs

The IUD got a bad name in the 1970s due to the Dalkon Shield, whose design turned out to make it easy for bacteria and STDs from the vagina to ascend into the uterus and fallopian tubes, causing pelvic-inflammatory disease (PID) and infertility. After hundreds of lawsuits and several deaths, the shield was discontinued in 1974, and doctors were urged to remove them from women in 1980.

IUDs available in the U.S. now are much safer. The ParaGard is made with copper that is toxic to sperm, lasts up to 12 years and doesn't affect a woman's hormone levels. Mirena releases a small amount of progestin that blocks ovulation, and lasts up to five years. Both are more than 99% effective at preventing pregnancy.

Jeffrey Peipert, a top researcher at Washington University in St. Louis, notes that about 18% of female ob/gyns have opted for IUDs. "The most educated consumers are using the most effective methods at high rates," he says.

Cost: $175 to $700 for years of protection.

Downsides: IUDs do not protect against STDs. The ParaGard may increase cramping. In rare cases, IUDs can slip out or push through the uterine lining.

The Implant

Another long-acting contraceptive is Implanon, a rod a doctor inserts in a woman's arm. It prevents pregnancy for up to three years.

A previous implant called Norplant was beset by lawsuits over side effects and scarring and withdrawn from the U.S. market in 2002.

Doctors are required to undergo special training to insert and remove Implanon, which is also 99% effective at preventing pregnancy.

Cost: $400 to $800 for up to three years' protection.

Downsides: Irregular bleeding, possible headaches, sore breasts, nausea, pain at the insertion site. No STD protection.

Hormone Pills, Patches And Rings

The first birth-control pills had very high doses of hormones, and side effects including mood swings, weight gain and blood clots were common.

Dosages have since dropped to about one-tenth of their original strength. There are far fewer side effects and a host of benefits, including regularized periods and reduced acne, bloating, premenstrual syndrome and less bleeding due to uterine fibroids. What's more, the longer a woman uses the pill, the lower her risk of ovarian and endometrial cancer.

Still, some women remain wary. "For some reason, it has a really bad rap," says Rachel Bernstein, an ob/gyn in Fort Lauderdale, Fla., who says she has to explain that these days, the benefits outweigh the risks.

Today, there are about 40 different brands of birth-control pills, most of which contain a combination of estrogen and progestin.

Other versions work the same way, including the NuvaRing, a flexible ring that is inserted in the vagina every month and worn for three weeks, then removed for one week, and the Ortho-Evra patch, which is replaced every week for three weeks, followed by a patch-free week.

Newer pills, like Seasonique, allow women to have only four periods a year; Lybrel, approved in 2007, is designed to be taken for 365 days straight with no period. Experts say there is no health reason that women need to have a period if they are not ovulating or building up uterine lining each month. The traditional pills were designed to include a monthly period in part so that women would be reassured that they weren't pregnant.

Hormonal birth control is 99% effective at preventing pregnancy if used correctly, but in average use, with some forgetfulness, it's only 92% effective.

Cost: $15 to $50 per month

Downsides: Women who have breast cancer should not take estrogen, but the pill does not seem to increase the risk of getting it. It can cause blood clots in rare cases. But, says Vanessa Cullins, vice president for medical affairs of Planned Parenthood Federation: "We have to keep these things in perspective. A woman's risk for those problems is substantially higher during pregnancy."

A more long-lasting form, the Depo-Provera injection, releases progestin only and prevents pregnancy for 12 weeks. It can be used by women who can't take estrogen and by those who are breast-feeding.

Cost: Each injection costs $35 to $75

Downsides: Possible weight gain, depression, blood clots and bone thinning; usually recommended only for women who can't use other forms.

Condoms, Caps And Sponges

Using a receptacle to contain sperm during sex literally goes back to caveman days: It's depicted on the wall of a cave in France from 12,000 B.C. Over the millennia, condoms have been made of paper, animal intestines, leather and linen (a favorite of womanizer Giacomo Casanova in 18th century Italy). Charles Goodyear paved the way for mass production of "rubbers" when he patented the vulcanization of rubber in 1843, and they were a mainstay of birth-control efforts until the pill emerged as more dependable and convenient.

The popularity of condoms soared in the 1980s, when the AIDS epidemic alerted public-health officials to the need for protection against STDs as well as pregnancy. Nowadays, condoms come in a variety of sizes, colors, materials and even flavors. Most are made of latex, but polyurethane and lamb-skin condoms are also available.

Cost: generally $1 each, but sometimes free; available without a prescription.

Effectiveness is still an issue. Roughly two of every 100 women whose partners use condoms correctly become pregnant each year, as do 15 of 100 women whose partners don't use them correctly.

Female condoms, plastic pouches inserted in the vagina before intercourse, are less effective. About five in 100 women who always use them correctly become pregnant each year, as do 21 out of 100 women who don't always use them correctly. They cost about $4 each and are sold without a prescription.

Other "barrier" birth-control methods include the Today Sponge, an updated version of the brand made famous on "Seinfield," that involves a spermicide-containing foam disc that covers the cervix and blocks sperm from entering; the FemCap, a reusable silicon cup filled with spermicide that covers the cervix, and the diaphragm, a much older rubber bowl filled with spermicide. Although all three are inexpensive, don't involve hormones and have few side effects, they are inconvenient, don't protect against STDs and are not very effective. Even with careful use, as many as 20 out of 100 women using them each become pregnant.

Even combined, they make up a very small percentage of birth-control users today. "There's a whole generation of women who didn't pick them up," says Mr. Trussell.

Emergency Contraception

Versions of "the morning-after pill"—a combination of hormones that abruptly halts ovulation—have been around quietly since the 1970s. In 1999, the FDA approved Plan B, a progestin-only pill that does the same, preventing pregnancy up to five days after unprotected sex or in case of a condom break or forgotten pill. It's currently available in three brands, Plan B, Plan B One-Step and Next Choice. Plan B and Next Choice are 89% effective if used within 72 hours after intercourse.

But emergency contraception is only effective if it is used every time after unprotected sex. "If you don't use it every time, then you are eventually going to get pregnant," says Mr. Trussell, who runs a Web site called Not-2-late.com with information on emergency contraceptives.

Cost: From $10 to $70, without a prescription for teens 17 and older

Downsides: They may cause temporary nausea, headaches and irregular bleeding; no STD protection.

Permanent Birth Control

Every year, about 700,000 U.S. women who no longer want children have a tubal ligation, a surgical procedure in which the fallopian tubes are cut and tied off. It's an outpatient procedure, but still requires a hospital stay and a cost of $5,000 or more.

A less-invasive version called Essure can be performed in a doctor's office. Using a hysteroscope, the doctor inserts a tiny titanium coil into each tube via the uterus. The woman's own tissue then grows around the coils, forming a natural but permanent barrier.

It's caught on slowly in the U.S., in part because doctors require additional training. Women must also have a follow-up test in three months to make sure a seal has formed, and to use other birth control in the meantime. But it's over 99% effective, without surgery or hormones.

A competing version, called Adiana that uses a smaller implant and radio-frequency energy, was approved by the FDA last year.

Cost: about $2,000

Downsides: The procedure may cause mild cramping, does not protect against STDs and is not reversible.

Vasectomy Variations

On the male side, there are new variations as well. Traditionally, a doctor makes an incision in the scrotum and cuts the two vas deferens, the tubes that carry sperm out of the testicles, and ties, stitches or seals them closed. The procedure takes about 30 minutes and is done in a doctor's office or clinic.

In one newer version, the doctor pokes a clamp through the skin instead of using a scalpel; there's less bleeding and fewer complications. In another, the vas deferens are locked closed with a clip, though some studies have shown that may not be as effective as other methods.

In general, vasectomies are nearly 100% effective—but since some sperm may remain in the blocked tubes, couples must use another form of birth control for three months. In very rare cases, the tubes may grow back together and permit the passage of sperm again.

Cost: $350 to $1000, covered by insurers and Medicaid.

Downsides: There's some minor pain, swelling and numbness for several days after the procedure, but most men can resume sexual activities within a week. Vasectomies theoretically can be reversed, but they are often not effective. Men should consider them permanent.”

Personal comment: This is a good overview of what is available to the general public but does not cover the barrier needs for professional escorts and women fetishists who routinely need gas guards for upper reproductive tract protection. However, those needs are covered in this blog.

Wet Wednesday and sperm

An AST student relaxing after pointe class

‘Wet Wednesday’: Today was Wet Wednesday, the first in a series of confidence building exercises for the students in my AST, Advanced Sexual Techniques class. The 16, 17 and two 15 y/os are usually a pretty giggly group but Wet Wednesday is the first time everyone including their teacher (me) was supposed to come to pointe class with live sperm in our vaginas and of course if that’s the case draining into the thong bottoms of our leotards and soaking the crotch pads of our ballet tights. Which it’s why the day is called ‘Wet Wednesday’. My students were asked to have their boyfriends fill them no more than four hours before class which with the dorm policy at St Lucy’s isn’t that difficult since 16 y/os have visitor sleep-over privileges. I wrote requests for ‘conjugal’ exceptions for the 15 y/os and got permission for them to sleep with their sperm donors in the guest dorm so that worked well and everyone was on time. I’m very strict about tardiness and won’t let a tardy student participate that day and no one wants to be late on Wet Wednesday!

Show-and-tell: We have a show-and-tell about our sperm donor and what method of contraception we were using. I went first telling about Robin who slept over last night and shot his wad in me again at the casino before I drove over to school for class. What we do in class is each girl will Kegel out a bit of her coitial discharge on to a slide and put it in the microscope and project the image on a screen so that everyone can see the live sperm swimming in the sample. I knew from his health records that Robin’s sperm count was high and that a very high percentage of his sperm were well formed and highly motile, but I’d never seen a sample under a microscope so I was eager to see what they look liked. It was pretty awesome seeing all the wiggly little guys and to know if any one of them buried its head in my egg it might impregnate me. Since I’m CD20 today and ovulated last week there is no chance of that happening this cycle but still it gave me a chill and made my belly tingle seeing all those live sperm knowing that there were millions more swimming inside me. I told the girls I was wearing a Prentif cervical cap, the same kind famous European ballet dancers used to wear 50 years ago and that Prentif was still one of the best cervical barriers ever made with an effectiveness of 96% for women who had never given birth. The girls wanted to see what it looked like when it was sucking on a cervix so I used the fiber-optic lens on the video cam, inserting it into my vagina and after using the washer to clean the lens of semen and adjusting the focus we all got a good look at my Prentif in place sucking tightly on my cervix. I pointed out to the girls how the top of the dome of my 25 mm Prentif dimpled from the strong vacuum in the dome, a sign that it was sucking tightly on the cervix. I had never seen a video of a Prentif on my cervix and so I was fascinated as were all the girls and you could have heard a pin drop they were so quiet. Afterward they wanted to know if it hurt to wear a Prentif and I told them it was a bit different from the much smaller Oves I typically wear. The area under vacuum in the Prentif cavity rim is larger and feels a bit different but a wearer becomes used to the feeling, not unpleasant, just different and forgets she is wearing a Prentif just as we all forget we are wearing diaphragms.

A vasectomy: Many of the AST students have had GyneFix IUDs implanted but they were all wearing diaphragms as gas guards because their next class was dive-sex which I also teach and we were going straight to the pool after show-and-tell in pointe class. The girls all made their slides, showed their lovers sperm and all was going well until we got to a 17 y/o who is not using a GyneFix and as her primary method of contraception is using a Semina diaphragm. She said her guy was a new hunky friend and had had a vasectomy and was shooting blanks so we shouldn’t expect to see much. I found that interesting because I thought I knew at least a little something about every man the students are having sex with because the guys have all been screened for STIs and I would remember because a sterile guy would be a first. So she Kegels some discharge onto a slide and slipped it under the microscope. We all gasp and she screams! From the sample in the microscope, rather than shooting blanks her lover seems to have a high sperm count with well formed highly motile sperm, meaning he is very fertile. She’s screaming “OMG! He’s been riding me bareback and I’m fertile this week!”

A teaching moment: The class discipline evaporated and the girls began to talk among themselves. I got order restored quickly and used the deceived student’s boyfriends deceit as a teaching moment to urge my students to ask to see their BF’s fertility report which accompanies the results of their STI panel. The girl who had been betrayed calmed down and I lead the class in a discussion about her options, which were: Take Plan B immediately, or wait to see if she misses her period. If she does miss her period, then her options are: A menstrual extraction, Mifeprex or carry the pregnancy to term. Once she realized she was still in control she decided that she would wait to see if her period was late and if it is then have a menstrual extraction. I think she opted for the ME because I have talked about my routine MEs at the start of every cycle. Teaching moments that occur after incidents like that leave lessons embedded in student’s minds far better than if taught from a book or lecture.

By then the class was focused again and we finished with the last two show-and-tell presentations took a short break and then did a 20 minute barre and 45 minutes of pointe with lots of splits, dégagé en l’air and développés sur les pointes so the girls could see what it is like to dance en pointe when discharging a lover’s spend. It also gave them another opportunity to see that diaphragms that are properly fitted and correctly inserted don’t dislodge regardless of how strenuous the wearer exercises, another building block in establishing young women’s confidence in the reliability of cervical barriers as effective contraceptive protection. I’ll be talking to Mr. Vasectomy myself about his little joke.