HEALTH WATCH: Winners and Losers in the Fight for Better Contraception

Few areas of medical care are as heavy on controversy as female contraception. This single idea seems to enclose an impressive number of non-medical layers (social, religious, ethical etc.) always striving to take precedence over the medical one.

One thing is for sure though: contraception is a relevant part of the public discourse of our times – and it took us a lot to get here.

Moving Forward – Contraception 2.0 

Ever heard of ouabain? It’s a plant-derived toxic substance used by African warriors as a heart-stopping arrow poison, as far back as the 3^rd century BC. Now fast forward to today and modern medicine is set to give it a new use as a safe, non-hormonal male contraceptive.

For the last 10 years, a team of researchers at the University of Minnesota has been working to create a non-toxic derivative of ouabain that can interfere with the sperm’s ability to swim. The new compound showed promise, in rat studies, allowing the team to move to the next phase: animal trials – with a clear goal to prove that a reduction in sperm movement triggers a drop in egg fertilization. If things stay on track, the team hopes to get to human clinical trials within the next five years.

While using a 2,000-year-old poison to slow-mo mission-bent swimmers is seriously cool, there’s still a lot to do before this reversible contraceptive is available at the pharmacy.

But this is not the only such research out there. In recent years, a number of other studies have appeared, all built around both hormonal and non-hormonal alternatives, ranging from pills to injections to gels.

A contraceptive gel study has received a lot of attention in 2017, following tests on a group of 16 rhesus monkeys. The monkeys were given gel injections and placed within a group which included breeding females. The group was monitored for at least one breeding season; some of the monkeys lived alongside females for up to two years. There were no conceptions during this period and side-effects (i.e. localized inflammation) were minimal.

So how does it work? The gel (named Vasalgel) is injected into the small duct between the testicles and the urethra – called vas deferens – so as to fill the interior of the passage. Seminal fluid can still be produced and released during ejaculation, the procedure only blocks sperm (which are reabsorbed by the body) – similar to a vasectomy.

But, unlike a vasectomy, which sections the vas deferens, Vasalgel can be eliminated through the use of a baking soda solution. In a nutshell: the procedure does not interfere with sperm production or hormone levels and is reversible.

For the time being male birth control – beyond the 2 options currently available: condoms and vasectomies – remains a work in progress as researchers still need to counter side-effects that have held back the development of alternatives (this is especially the case with hormonal contraceptives).

Such side-effects include irreversible effects on fertility, birth defects in future offspring, depression, increased or decreased libido etc., all caused by interfering with male hormones. As it turns out, ‘switching-off’ the male reproductive system is no child’s play.

Things Can Go Wrong

And the same goes for female hormonal contraceptives known to cause an array of health problems such as blood clots, high blood pressure, heart attacks and liver disease, just to name a few.

Enter IUD – the intrauterine contraceptive device – a novel approach to birth control that takes hormone imbalance out of the contraceptive equation. Plus, it promises potentially decades-long wear.

But what if reasons other than health care motivate actions? What if key decisions are taken irresponsibly and damaging consequences dealt with the hush-hush way? The answer becomes clear when we consider the problems with Essure that have recently resurfaced.

On paper it looked great: flexible coils are inserted, through the vagina and into the fallopian tubes prompting tissue to grow through & around them thus blocking the tubes. Sperm is therefore unable to reach the eggs and pregnancy is prevented. But in real life, this translated into perforations of the fallopian tubes, persistent pain, bleeding and unwanted pregnancies.

The product was discontinued by September 2017 and detailed investigations revealed that the manufacturer (Conceptus, a subsidiary of Bayer AG) knowingly hid information about all the risks associated with its product.

Conclusion

Like many other things in life, contraception is a matter of choice (and education) – an essential one as bad (or no) contraception can end up feeling like a life-long sentence, the sort that will keep circling around every day. So it’s important for each party responsible to pay attention and make the right decision for themselves.

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