Health: It's all right, love, I'm on the pill
Women get pregnant; men don't. No surprises so far, but is there any future for a male oral contraceptive?
Tuesday 03 November 1998
Wey-hey! - as they say.
But what if that was the bloke speaking? Is he to be trusted to tell the truth? And even if he really is "on the pill", who's to say he hasn't missed one or two during the course of the last week? Men are notoriously slack when it comes to that sort of thing, and taking a pill every day just to render his sperm useless, or absent, is not likely to be at the top of his list, at least not when he's got his six-pack to work on and all those exfoliants, depilatory agents and moisturisers to put on.
Then there's the biggest problem of all: it is still women, not men, who get pregnant. Perhaps this is why those involved in the latest step towards male hormonal contraceptives are aiming it at couples in established relationships, where it will give the new-millennium man the chance of avoiding surgery or condoms, while still assuming the primary role in family planning.
The latest trials are being carried out in Manchester, funded by the Medical Research Council, with some pharmaceutical firms donating their products free. No new drugs are being used; they are just being combined in a novel way.
Through advertisements in local papers, 30 of the 60 men needed have so far been recruited. Nearly half were prompted to reply by wives or girlfriends. Some women find the side-effects of the female pill intolerable; others may be unable to use it for medical reasons. If neither partner can use barrier methods, but, again, neither wishes to be permanently sterilised, their current choices are a bit limited.
The history of male contraception has a long and not altogether savoury past, from snakeskin, sheep's gut and tortoiseshell condoms, to early attempts at hormonal manipulation that often made the men spotty and aggressive (apparently the lowered sperm count - rather than mere physical repulsion - was, it seems, responsible for the contraceptive effect).
In contraception-obsessed China, there's a small electrical devicewhich is worn inside the underpants. Switch it on for three minutes, and you will be infertile for a month. Unfortunately, the words "electrodes" and "genitals" do not sit comfortably together in advertising copy, particularly with Seventies Chile so much in the news.
The device is never likely to catch on over here, is it?
There is always the withdrawal method, but a man who can't be trusted to take a daily tablet can probably be trusted even less to pull out at the last moment, or before the Point of Ejaculatory Inevitability (PEI), as it is properly called. We probably have PEI to thank for many huge and happy Catholic families the world over.
The drug combination currently being tested was originally tried out on rams, which is a definite plus point for any future marketing people. Previous methods were only 70-80 per cent effective, compared with the impressive 99 per cent for the effectiveness of the female contraceptive pill.
The majority of sperm production was suppressed with testosterone injections (extra testosterone fools a man's body into thinking that it is more butch than it really is, so the testicles slow down a little and produce fewer sperm), but around 20 per cent always slipped through. That elusive 20 per cent has turned out to be controlled by a hormone called prolactin, better known for stimulating milk production in women. Block the action of prolactin at the same time, and you have the perfectly infertile man. Hopefully.
In Manchester they are using a testosterone implant that lasts four months, along with daily tablets of Norprolac, the prolactin inhibitor.
The trials, unlike their participant sperm, are going swimmingly.
Side-effects are apparently few and mild. Lower doses of testosterone are used than in previous experiments, so while subjects may experience a little weight gain and slight greasiness of the skin, they avoid the full-blown teenage acne, mood swings and testicular atrophy associated with higher doses.
The prolactin inhibitor may cause slight dizziness and nausea, but one researcher has tried it himself with no problems.
Reversibility is not thought to be a problem, and so far the drugs have done what they are supposed to do and have made the men infertile. Or at least, they have lowered their sperm count, the only parameter being measured at present.
Male fertility is every bit as complicated as the female version.
Quite apart from the obvious problems of achieving an erection followed by a climax, and expelling the result with the right force and in the right direction, the spermatozoa carried in the seminal fluid - which must contain all the necessary nutrients in all the right proportions - need to be healthy and lively. Normal semen contains anything between 20 and 100 million sperm per millilitre, with the average being around 60 million per mil.
A man with a sperm count of 1,000 per millilitre or less stands the same chance of fathering a child as a woman on the pill has of becoming a mother, so a count of less than 1,000 is what the Manchester team has been aiming at. So far, the team has managed to achieve it.
The obvious concern is that anything that reduces the wearing of condoms could lead to an increase of HIV and Aids, and other sexually transmitted disease.
A spokeswoman for the Terrence Higgins Trust was not over-concerned, mainly because she did not think there was any chance of a woman in a new relationship believing a man who claimed to be taking the pill.
There may, however, be a problem if either partner has extra-marital relationships, and if condoms are abandoned.
If the "male pill" ever comes to fruition, as with every other contraceptive its success will depend on two things - reliability and acceptability. It may eventually prove to be reliable, but its acceptability maybe more problematic.
Perhaps the best way to make men really interested will be to work on a combination pill - contraceptive plus a dose of Viagra.
After all, an impressive-looking "weapon" loaded with noisy but harmless blanks must be every little boy's dream.
Would you use a male pill, or let him?
ANDREA, 30, with
a steady boyfriend
"I wouldn't trust a bloke to take it, no matter what. And even with a married couple, if the man decides he wants a child, all he has to do is stop taking it. He could just claim he was one of the `failure rate'."
PETE, 29, getting
married next year
"I'd take a pill. My fiancee takes it every day, so why shouldn't I? She has to put up with side-effects, and I would too. It would have to be a pill only, though. I'm not keen on the idea of an implant every four months."
DAVID, 36, separated
"I've had a vasectomy, and my girlfriend's had a hysterectomy, so we don't use contraception. A pill won't stop you catching anything though, will it?"
LAURA, 39, married
with one child
"I'd have to watch him take the pill every day, and make sure he swallowed it. Then I might rely on it. Possibly."
JOANNE, 42, married
with two children
"Tell a man to get something out of the freezer and he forgets. No way would I rely on him to remember a pill."
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