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A new male contraceptive could help men bear the family planning burden
A new method of male contraception that is as effective as a vasectomy but entirely reversible with little to no side-effects is being tested and is showing promising results in animal trials.
If it is successful, it could drastically change the field of contraception. It would give men the power to prevent a pregnancy without any input from women using a method that is not permanent, such as the vasectomy.
The vasectomy is currently the only reliable contraceptive option available to men. It is a minor surgical procedure where the the duct that conveys sperm from the testicle to the urethra is tied or cut. The challenge is that it is not reversible.
The new contraceptive – Vasalgel – is a type of no-scalpel vasectomy. It has no hormonal effects or other side-effects, and can be reversed when the man wants to start a family.
In the same way that a vasectomy would, Vasalgel blocks the flow of sperm from the testicles to the penis. But it does not require any surgery. Instead of severing the tube that carries sperm – called the vas deferens – a gel is injected into the tube, forming a barrier that blocks sperm but allows other fluids to pass through.
Low uptake of vasectomies
Vasectomies are usually quick and straightforward procedures that carry minor risks like bleeding or infection. There is also a small chance that a man might experience post-vasectomy pain due to pressure build-up in the testicles.
Although very few vasectomies fail or go wrong, globally there has been a low uptake of this procedure.
In 2013 only 2.2% of men globally had vasectomies. This compares to 18.9% of women who underwent female sterilisation. Although some countries like Canada have higher rates of men who have undergone a vasectomy (22%), in Africa only 0.1% of men have undergone vasectomies.
On the continent, vasectomies could be one of the most effective male birth control methods because they are inexpensive and could therefore have a major impact on sustainable development and population growth. But the procedure is misunderstood and, as a result, is poorly used.
A second attempt
The new contraceptive is not the first time a male contraceptive has been introduced. Several years ago, the idea of the “male pill” was abandoned and more recent research efforts have been focusing on intra-vas devices, including Vasalgel.
Previous efforts to develop a male contraceptive focused on hormonal manipulation, which is how the contraceptive “pill” for women works. A man would basically be given hormones (like testosterone and progesterone) and these hormones would then interfere with certain processes in the body and cause the testicles to stop producing sperm.
The male hormone testosterone is linked to sperm production and by lowering the testosterone level in a man’s testicles you can prevent the production of sperm. But to lower testosterone in the testicles, you have to increase testosterone levels in the blood. Several studies have shown that there are too many unpleasant side-effects to this. These include aggression, depression, fatigue, low libido, high blood pressure and an increase in cholesterol levels.
Researchers have also tried to tweak the method of hormonal male contraception by adding other hormones, like the female hormone progesterone. But it still had too many side-effects and wasn’t effective enough.
Vasalgel is currently being tested in humans but its reversability has only been shown in animal studies. These studies have shown rapid restoration of sperm flow.
For the reversal to happen, the man gets an injection of a bicarbonate solution into the duct that conveys sperm from the testicle to the urethra. This bicarbonate solution will dissolve the Vasalgel and it is flushed from the duct.
The challenge with Vasalgel is that although it blocks the flow of sperm, it does not offer any protection against the transmission of sexually-transmitted infections such as HIV.
Family planning is still considered a woman’s responsibility in many parts of the world. This has prevented men from being more involved in family decisions about fertility. It has also limited their access to family planning services targeted at them. The new method could be the first step to change this.
Amir Zarrabi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond the academic appointment above.
Amir Zarrabi, Urologist and Lecturer, Stellenbosch University