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One step closer to a Pill for men? Add to ...

Bad news for Maury Povich: The nerve-wracking paternity tests that make up the bulk of his trashy TV show may soon be a thing of the past, as scientists inched closer to a male contraceptive this week.

New research suggests therapeutic ultrasound could one day be used to shut down sperm production, handy for men who want something more fool-proof than withdrawal or condoms, but less permanent than a vasectomy.

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The treatment – which has been performed on rats and is a long way from being tested on humans – involved warming the testes briefly over two sessions. It “pretty much wiped out” sperm, said James Tsuruta, lead author of the report published in the journal Reproductive Biology and Endocrinology.

“Just two weeks after we did these treatments, the rats’ sperm counts were down far below levels that we would normally see in fertile men,” said Dr. Tsuruta, assistant professor of pediatrics at the University of North Carolina at Chapel Hill.

In the distant future, he envisions men rendered infertile for six months after one quick treatment: “Basically they would sit and a mini-hot tub would come up. Their testes would be submerged in this cup of saline solution or water. From underneath, you would turn on the ultrasound, which travels through the liquid and gets to the testes.”

Men poaching their boys? “People don’t think twice about taking a soak in a hot tub. We’re not talking about much difference in terms of temperature or feeling,” assured Dr. Tsuruta, adding that a latex barrier would further separate a man's gonads from the apparatus.

As with scores of other male contraceptives currently under study, questions abound: What are the side effects, how long does the contraceptive effect last and is it safely reversible?

Even as parental responsibility equalizes between the genders, options for men who want to wield control over their fertility remain scant. With attempts to create a “male Pill” now spanning three decades, scientists are still experimenting with a wide range of options, including hormones in the form of gels, implants and shots; plant-based pills being tested in Indonesia as well as “accidental discovery” oral drugs that block sperm production or even hinder ejaculation during orgasm.

“Male contraception has always sort of been the little brother to female contraception,” Dr. Tsuruta said. “The success of the Pill – that’s just stupendous. But there are women who have bad side effects from hormonal contraception. Men need to be aware that sometimes they have to step up.”

He cited a 2005 United Nations survey that found that 75 per cent of Canadian men don’t use any form of contraception – not condoms (often shirked by committed partners), or permanent vasectomies, or the dubious withdrawal method.

Advocates of the treatments currently under study suggest more options would bring those numbers up. A 2005 report found that more than 60 per cent of men in Germany, Spain, Brazil and Mexico were willing to use a new method of male contraception. Although not highly scientific, last July’s AskMen.com large-scale survey of 100,000 men found that 64 per cent of Canadian men would take a male birth-control pill if it were available.

So why has it taken so long for newer male contraceptives to emerge? The problem appears to be the robust male sperm count: Unlike women, who produce one quality egg a month, men blast out 100 million sperm with every ejaculation, with one scientist comparing testes to a “factory.”

“Men are making sperm all the time. It’s harder to turn them off,” said John Amory, a professor of medicine at the University of Washington, who is now working on a drug developed for worm infections that also blocks retinoic acid, which is responsible for sperm production.

Dr. Amory had experimented with hormonal options but isn’t optimistic about them today. Pharmaceutical companies backed away a decade ago amid concerns over side effects such as mood swings, delivery (testosterone is given via shot, gel or implants – not ideal) and efficacy: None has been able to suppress sperm count to zero in 100 per cent of the men in each efficacy study, meaning it can’t be used as a sole method of contraception.

Beyond these drawbacks, a more profound double standard remains: Culturally, there’s still the question of whether men can be trusted to take reproductive control in a relationship.

“The stereotype is that men say, ‘Don’t touch my junk’ – that men are not willing to have their private parts messed with and that men aren’t willing to take responsibility,” said Elaine Lissner, director of the Male Contraception Information Project in San Francisco.

“The stereotype is still there, but men actually shoulder quite a lot of the responsibility at this point without having a lot of control. While they have condoms, which are important but not perfect, men now also have liability: There are DNA tests, child support.”

Ms. Lissner said that while some men will always fear having their “boys zapped,” there are others who are “tired of seeing their girlfriend suffer on the Pill or have cramps from the IUD, and have a lot of motivation to contribute.”

According to MaleContraceptives.org, an organization devoted to cataloguing treatments coming down the pipe, “Stereotypes about men are the most common source of skepticism about the feasibility of new male contraceptives.”

Some of the bias is historical, Ms. Lissner contends.

“For a long time policy makers thought men didn’t want it. There’s been a generational shift and there are a lot of men who want it now. … Boomers are now the people in power and coming to it with a fairly open mind. It’s their children who need contraception.”

As for concerns the advent of a male contraceptive would contribute to sexually transmitted diseases, with some foregoing finicky condoms for a Pill, “If it’s a guy at the bar, you should be using condoms, end of story,” said Ms. Lissner. “This is for your husband, this is about you and your fiancé. This does not protect from STDs.”

In a distant, seemingly sci-fi world, men could take their Pill, apply a gel or undergo ultrasound therapy without necessarily discussing the details with a girlfriend, just as many women do with their contraceptive choices and boyfriends now.

“I think mostly it will be more collaborative [between partners] but in some cases women will get a dose of their own medicine,” said Ms. Lissner.

“A woman decides to go on the Pill in the context of a monogamous relationship, but she also has every right to go on the Pill of her own volition if she’s a sexually active human being. Why would that be any different for a man?” said Tom Matlack, the founder of the Boston-based Good Men Project.

Asked if he would have taken a male Pill were it available during his college years, Mr. Matlack is unequivocal: “Absolutely.” Now married happily with three kids, he said choice is always a good thing.

“I can’t imagine why it would be a bad thing for men to have a choice to shoot blanks. I can’t imagine why it would be viewed as somehow feminizing to men. It’s men taking control of their own destiny.”

As Dr. Amory put it: “Men are very interested in this. Men like to have sex. Your choices if you’re a man: You can put on a sheath or have surgery. There’s room for options.”

What’s in the pipe

Myriad options are being explored in the hunt for the male “Pill.” Here are some of them:

Therapeutic ultrasound: Rats’ testes were exposed to high-frequency ultrasound for 15 minutes in two sessions, which lowered sperm concentrations to 3 million per millilitre of semen (experts define low sperm count in men as anything below 15 million sperm per mL).

Testosterone and progestin: Tested for 30 years, hormonal treatments have included patches, injections and gels. Efficacy issues and side effects have hindered their entry into the market.

“Dry orgasm” drugs: Phenoxybenzamine, a high-blood-pressure medication, and thioridazine, a discontinued schizophrenia medication, prevent sperm from mixing with semen. Researchers are seeking alternatives with fewer side effects. They envision a drug taken only as needed before sex, and wears off within 24 hours.

The steroid DMAU: A synthetic androgen that has both testosterone and progesterone-like qualities is showing promise in tests on rabbits.

Gamendazole: an oral anti-cancer drug that interrupts the maturation cycle of sperm.

RISUG: a polymer gel injected into the vas deferens, the tubes that carry the sperm, in the same procedure as a no-scalpel vasectomy. The gel’s mesh-like structure filters out sperm. Men in clinical trials in India have been using it for up to 20 years with success. Bonus: It’s reversible with another injection.

Gandarusa: Derived from a plant know to treat stress, this pill weakens sperm so it can’t penetrate the egg wall. Men regain fertility two months after stopping the pill, which is currently undergoing clinical trials in Indonesia.

Follow on Twitter: @ZosiaBielski

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