Once a week Bill, a social researcher for the state of Washington, drops into his doctor’s office in the Seattle area. He receives a 200-milligram shot of testosterone enanthate (TE), a synthetic version of the male sex hormone now being tested as a contraceptive. The procedure is, quite literally, a pain in the behind, but Bill doesn’t mind. A little soreness is a small price to pay, compared with the frustration he’s endured using conventional methods.
Bill’s wife used to take the Pill but gave it up because of concerns about the side effects, and because of the cost. She tried using the contraceptive sponge, which failed and led to a pregnancy. Then Bill started using condoms.
Both in their 20s, Bill and Mary have two children. Although they decided they didn’t want any more, a vasectomy was out of the question. Faced with dwindling options, Bill became a pioneer on the frontier of reproductive biology.
Bill and Mary are volunteers in a program conducted by the researchers at the University of Washington as part of a World Health Organization study involving more than 300 couples worldwide. For the past year he and 10 other men have relied on weekly injections of TE, which lowers sperm production, as their sole means of contraception. None of their spouses has become pregnant.
The program is a promising development in a quest many scientists regard as, at best, quixotic: the search for a male version of the Pill.
Other potential male contraceptive drugs are being studied at several research centers around the world. Because the dosages are potent enough to damage the liver if taken orally, the so-called “male pill” is being developed as a series of shots or implants designed to be long-lasting. Few of the projects have reached the clinical-trial stage, and all of the drugs are years away from practical development.
The need for more acceptable and reliable forms of birth control is critical, according to a report released last winter by a prestigious panel of scientists and policy makers assembled by the National Research Council and the National Academy of Sciences’ Institute of Medicine. Half of the estimated 1.5 million abortions performed in the United States each year are the result of contraceptive failure.
Oral contraceptives remain the most popular form of reversible birth control among fertile, sexually active women, but up to two-thirds of those at risk for unwanted pregnancy can’t or won’t take the Pill. For their part, men have traditionally had three less-than-ideal options: vasectomy, condoms or “whatever she’s using.”
Despite advances in microsurgery and better vasectomy techniques, the chances of restoring fertility remain slim in a male who has had a vasectomy. Condoms, quite apart from their lack of aesthetic appeal, have an actual failure rate of 12 percent or more in the first year of use. The failure rate of diaphragms, sponges and spermicides is even greater.
Unfortunately, a viable male contraceptive won’t be available for at least a decade. Questions remain about the effectiveness of drugs that appear to lower sperm production, as well as their long-term health risks. Yet many researchers insist the most formidable roadblocks aren’t medical but social, economic and political.
No fundamentally new form of contraception has reached the American consumer in almost 30 years. In the past decade the number of private U.S. companies researching new types of contraception has dropped from 17 to one, and the United States now trails in the field behind European countries, where women have several options--including progestin implants or injections, an abortifacient and a new generation of IUD’s. But even in Europe, male contraception is a neglected science.
Scientists have known for decades that it’s possible to manipulate male fertility with drugs in much the same way the Pill prevents women from ovulating. Translating that knowledge into trouble-free contraception is another matter. It’s easier to target one egg a month than to suspend the daily production of millions of spermatozoa--unless, of course, the goal is to shut the factory altogether.