Friday, November 29, 2019

Male Birth Control- a new option in preventing unwanted pregnancy

Important news was recently released in India in regards to male birth control. According to The Hindustan Times, the Indian Council of Medical research finally completed a clinical trial on injectable male contraceptive (Kaul, 2019). This injection prevents pregnancy for 13 years. The birth control requires one single injection of a polymer into the vas deferens of a male. This new method is called reversible inhibition of sperm under guidance or RISUG for short (Jha et al., 2019).  RISUG is made of  styrene maleic anhydride and is reported to a multitude of things. The US patent states that the mechanism by which this contraceptive option works is still ambigous (Lohyia et al., 2014), but research has shown that it causes partial occlusion and lowers pH which affects sperm motility (Carr, 1985). Researchers in India ensure that there are no side effects, despite side effects being seen in previous research studies in the U.K. and the U.S. (Sharma et al., 2019).

For years, birth control has been the responsibility of the females in relationships. Side effects of one female birth control (nexplanon) are outlined here: weight gain,  increased risk for serious blood clot, cyst development, abnormal bleeding, vaginitis, acne, breast pain, dizziness, etc. (“Important Safety Information for NEXPLANON® (etonogestrel implant) 68 mg Radiopaque,” n.d.). This is just one of the many birth controls! With the biomedical principle of non-malfeasance in mind, I as a future medical professional would be very hesitant to prescribe this to a patient, if I knew that there was a safer option out there for the opposing sex.  I am aware that RISUG is not yet legal in the United States, but based on the bioethical principle of justice, I believe the United States has a responsibility to investigate this as a future option because society should not exclusively put the responsibility of preventing unwanted pregnancies on females.  Males who are not intending to have sex result in pregnancy should also carry this burden. 

What are your thoughts on male contraceptives? If it truly is a safe option do medical professionals have obligations to encourage usage, knowing that many women suffer from side effects from their birth control options? 




Carr, D. W. (1985). Effects of pH, Lactate, and Viscoelastic Drag on Sperm Motility: A Species Comparison1 | Biology of Reproduction | Oxford Academic. Retrieved November 29, 2019, from https://academic.oup.com/biolreprod/article/33/3/588/2764005



Kaul, R. (n.d.). India closer to world’s first male contraceptive injection—India news—Hindustan Times. Retrieved November 29, 2019, from https://www.hindustantimes.com/india-news/india-closer-to-world-s-first-male-contraceptive-injection/story-o3lTFLnCkKHpuEDNNqrEnO.html

Jha, P., Jha, R., Gupta, B. L., & Guha, S. (n.d.). Effect of γ-dose rate and total dose interrelation on the polymeric hydrogel: A novel injectable male contraceptive—ScienceDirect. Retrieved November 29, 2019, from https://www.sciencedirect.com/science/article/abs/pii/S0969806X09005544

Lohiya, N. K., Alam, I., Hussain, M., Khan, S. R., & Ansari, A. S. (2014). RISUG: An intravasal injectable male contraceptive. Retrieved November 29, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345756/
Sharma, R., Mathur, A. K., Singh, R., Das, H. C., Singh, G. J., Singh Toor, D. P., & Guha, S. K. (2019). Safety & efficacy of an intravasal, one-time injectable & non-hormonal male contraceptive (RISUG): A clinical experience Sharma RS, Mathur AK, Singh R, Das HC, Singh GJ, Toor DP, Guha SK - Indian J Med Res. Retrieved November 29, 2019, from http://www.ijmr.org.in/article.asp?issn=0971-5916;year=2019;volume=150;issue=1;spage=81;epage=86;aulast=Sharma
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6 comments:

  1. SahandF436December 1, 2019 at 1:26 PM

    Creating male hormonal contraceptives would be very beneficial considering how complicated and hazardous female hormonal contraceptives can be. In addition, male reproductive physiology is much more simple than the female physiology so it would be much easier to provide contraceptives to the male. However, considering the logistics of the male physiology it is a much harder task to provide contraceptives. A healthy adult can release between 40 million to 1.2 billion sperm cells in a single ejaculation (Live Science), and only a tenth of these sperm cells are needed for fertilization. As such, purely on a numbers basis it would be easier to provide contraceptive to the female who only produces one to two eggs each month. Furthermore, contraceptives have historically been given to females because childbirth and pregnancy can be dangerous and life-threatening - so there is also a safety measure for female contraceptives. Despite this, male hormonal contraceptives should still be created and sold to the public as it provides variety and choices for consumers. In addition, a market does exist for the product as a recent survey reported that up to 83% of males would use a male contraceptive pill (Martin, et al., 2000).

    References:
    Live Science. Why Are 250 Million Sperm Cells Released During Sex? (n.d.). Retrieved from https://www.livescience.com/32437-why-are-250-million-sperm-cells-released-during-sex.html.
    Martin, C., Anderson, R., Cheng, L., Ho, P., Derspuy, Z. V., Smith, K., … Baird, D. (2000). Potential impact of hormonal male contraception: cross-cultural implications for development of novel preparations. Human Reproduction, 15(3), 637–645.

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  2. RobertD436December 1, 2019 at 8:32 PM

    I agree with both your assessment as well as Sahand's to an extent. I think creating more male contraceptives would be highly beneficial as well as practical. Like Sahand said males have a simpler reproductive physiology which in theory should allow for a simple contraceptive. in order to prevent a pregnancy at least from the male side there are 3 ways to do it. The first is to prevent sperm from reaching the egg by forming a barrier of sorts ie vasectomy or condoms. The second method is to prevent the production of sperm. This could be done using hormones or other methods. The third way that a male contraceptive could work is to destroy the motility of the sperm in order to prevent it from reaching the egg. The third method is what the researchers in India seem to be studying.
    While the third method seems to be making progress, there is also research being done in order to create a hormonal contraceptive analogous to the estrogen-progesterone pill of women (Amory). Ultimately, as Sahand said, another contraceptive would be beneficial in giving consumers a choice.
    Amory J. K. (2016). Male contraception. Fertility and sterility, 106(6), 1303–1309. doi:10.1016/j.fertnstert.2016.08.036

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  3. ErinR618December 2, 2019 at 10:28 PM

    I agree that there should be further studies for male contraceptives. Thirteen-years does seems long especially for those who may be considering having children in the relative future. I am curious to see if this injected male contraceptive can be reversed if desired earlier then thirteen-years. I completely agree contraceptives should not solely rely on females. However, males do have the autonomy of using condoms to prevent unwanted pregnancies or a vasectomy for a more permanent approach.

    Although men have the option of using condoms, a study in Germany found that condoms were the most dissatisfying form of contraceptive to women. Even though there are many side effects to women contraceptives results showed that intrauterine contraceptive devices, oral contraceptives, and sterilization processes enhanced a women’s sex life and condoms showed a negative impact on sexual activity (Oddens, 1999).

    Female birth control as been vastly studied since the 1960’s, and there are still many ways we can improve female contraceptives. However, given that male contraceptives are so new I do not recommend that we start to prescribe them based on the medical principle non-maleficence. We should conduct more research to truly understand the long-term side effects of these immerging contraceptives before we open them to the public. That being said I agree with you that based on justice that men should have more contraceptive options as well as help lighten the burden of pregnancy prevention.

    Reference
    B.J. Oddens, Women’s satisfaction with birth control: a population survey of physical and psychological effects of oral contraceptives, intrauterine devices, condoms, natural family planning, and sterilization among 1466 women Contraception, 59 (1999), pp. 277-286

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  4. TumiI618December 4, 2019 at 2:38 AM

    I believe there should be more research on the topic at hand with more insight on the side effects of the 13 years prevention. Even though this form of birth control will help relieve contraceptive responsibilities from the female counterpart, the length of the study does provide valuable solid statistical standings. Especially in terms of male gamete integrity and future conception.

    To expand on stated standing, a study showed that the duration of a copper IUD or hormonal IUD did not affect the return to fertility state in women, but that prolong usage of either IUDs in women that have never conceived or have complications in conceiving were associated with impaired fertility (Makram, n.d.). Also, another study showed that prolong usage in IUD devices correlated with an increase in ectopic pregnancies and spontaneous abortions (Dawood & Elsharawy, 2017.). Therefore in regards to the inhibiting length period in the male contraception (13 years) and no real information on the reversal mechanism needs to be further studied.

    Another insight can be on the integrity of the male gamete in regards to fertilization after ejaculation while on such contraception. For all contraceptions, there is a small percentage of inefficacy (CDC, 2019.). And with the ambiguous knowledge of how RISUG works, what is the percentage of inefficacy and if fertilization should occur, how are the effects of RISUG injections on the DNA and structural integrity of the male gamete thus the effect of this drug on future conceptus? Just some points for the researchers to take into consideration before pushing for the approval of the contraception.

    Reference
    Doll H, Vessey M, Painter R. Return of fertility in nulliparous women after discontinuation of the intrauterine device: comparison with women discontinuing other methods of contraception. BJOG. 2001;108(3):304-314.

    Makram, S. (n.d.). Fertility After IUD, Risks & Side-Effects. Retrieved December 4, 2019, from http://susannahmakram.com/fertility-after-iuds-risks-side-effects/.

    Dawood, A. S., & Elsharawy, M. A. (2017, May 2). Outcome of Pregnancies on Top of Intrauterine Missed IUDs at a Tertiary Care Hospital in Egypt: A Three-Year Retrospective StudyOutcome of Pregnancies on Top of Intrauterine Missed ... Retrieved December 4, 2019, from https://www.researchgate.net/publication/321836190_Outcome_of_Pregnancies_on_Top_of_Intrauterine_Missed_IUDs_at_a_Tertiary_Care_Hospital_in_Egypt_A_Three-Year_Retrospective_Study.

    CDC. Contraception. (2019, November 1). Retrieved December 4, 2019, from https://www.cdc.gov/reproductivehealth/contraception/index.htm.

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    Replies
    1. TumiI618December 9, 2019 at 6:04 PM

      * Does Not 1.2.11 (paragraph 1, line 2, word 11).

      Delete
  5. AnonymousDecember 5, 2019 at 7:51 PM

    I think it's important to consider the fact that women already have a lot of side effects from using their birth controls. This includes nausea, headaches, cramping, tenderness, vaginal bleeding, and decreased libido. Since there are side effects for women, it's likely that men could also have side effects and therefore, it's important to think about possible long-term side effects for men.

    In addition, given the fact that the birth control lasts for 12-13 years further research needs to be done to discuss possible reverse methods, as Whitney already stated. Especially given the period of time, I think it's important to decide if this should be offered if there are not any ways to reverse the contraceptive. I think there should be more research that could be similar to female oral contraceptive which would likely allow it to be reversible. In the news, there has been ongoing research about oral contraceptives use for mice. The research is promising because sperm production mice is similar to that of humans. The research showed that they had a decreased sperm count as well as decrease sperm mobility and some were completely infertile. Again, in this scenario, it would be important to look at long-term effects because of the changes in hormones.

    Cooper DB, Mahdy H. Oral Contraceptive Pills. [Updated 2019 Nov 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430882/

    Gallagher, J. (2012, August 17). Male contraceptive pill 'step closer' after mice studies. Retrieved from https://www.bbc.com/news/health-19281690.

    Vollenhoven, B., & Talmor, A. (2012). Faculty of 1000 evaluation for Small-Molecule Inhibition of BRDT for Male Contraception. F1000 - Post-Publication Peer Review of the Biomedical Literature. doi: 10.3410/f.717953522.793460578

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